A. Direct oral anticoagulants are associated with a 50% increase in the risk of intracranial hemorrhage compared to vitamin K antagonists B. The 30-90 day mortality rate for patients who experience anticoagulant associated intracranial hemorrhage is low, estimated to be 2-5% C. Risk factors for bleeding while on a direct oral anticoagulant include reduced renal function and concomitant antiplatelet therapy D. Patients who experience anticoagulant associated bleeding have not been shown to have increased length of hospital stay. E. Unsure

A. Warfarin associated hemorrhage has been decreasing over time in the last 20 years B. The presence of a midline shift is an indicator of good prognosis C. Mortality associated with ICH is similar between patients taking warfarin and patients not on warfarin D. Failure to lower the INR rapidly is associated with a worse prognosis E. Unsure

A. Idarucizimab is capable of binding to both free and thrombin bound dabigatran B. Idarucuzumab also has the ability to reverse the anticoagulant effect of unfractionated heparin C. Idarucizumab has a long half-life (24 hours) allowing for one time bolus dosing D. Idarucizumab has intrinsic anticoagulant activity as well through interactions with thrombin E. Unsure

A. The total dose of idarucizimab should be 10 grams, consisting of two 5 gram doses given 10 minutes apart B. The aPTT would be expected to normalize within minutes of administration of idarucizumab C. If anticoagulation is restarted with dabigatran, it should not take place within the first 5 days after antidote administration D. A repeat dose at 24 hours cannot be used in patients who have re-elevation of coagulation assays. E. Unsure

A. Andexanet can only reverse the anticoagulant activity of apixaban and rivaroxaban B. Andexanet can bind to tissue factor pathway inhibitor (TFPI) C. Andexanet has a long half-life allowing for the agent to be given as a onetime bolus infusion D. Andexanet acts a factor II (thrombin) decoy and binds to agents that inhibit thrombin E. Unsure

A. The patient should receive the high dose of andexanet for anticoagulation reversal B. The anticoagulant effect of apixaban would be expected to return at 6 hours after the andexanet infusion if discontinued C. The risk of thrombotic events in this patient would be expected to be around 10% D. Reduction in anticoagulant activity as assessed by anti-Xa level is directly correlated to improved outcomes. E. Unsure

A. According to the 2020 ACC Expert Consensus Decision Pathway on the Management of Patients on Oral Anticoagulants, this patient would be classified as having a minor bleeding event B. According to the 2020 ACC Expert Consensus Decision Pathway on the Management of Patients on Oral Anticoagulants, andexanet alfa would be preferred reversal strategy if available C. According to the 2020 ACC Expert Consensus Decision Pathway on the Management of Patients on Oral Anticoagulants, Kcentra (prothrombin complex concentrates) would be preferred reversal strategy if available D. According to the 2020 ACC Expert Consensus Decision Pathway on the Management of Patients on Oral Anticoagulants, the patient should not restart anticoagulation at any time point after management of the bleeding episode E. Unsure

A. Published studies have routinely included an assessment of the presence of oral factor Xa activity prior to the delivery of PCCs to manage bleeding B. Published studies have routinely included an assessment of the time since last dose taken prior to the delivery of PCCs to manage bleeding C. PCCs have been shown to return endogenous thrombin potential (ETP) and peak thrombin generation back to baseline in the presence of peak plasma concentrations for DOACs D. More recent studies have often demonstrated a mortality benefit for the use of andexanet compared to PCCs in the management of oral factor Xa related bleeding E. Unsure

A. Patients who are experiencing non-major bleeding should receive immediate anticoagulation reversal with an agent specific antidote B. Four factor PCC is the modality of choice to reverse the anticoagulant effect of oral factor Xa agents in patients with major bleeding C. Patients who have experienced a first time VTE less than 3 months ago should consider discontinuing g anticoagulation D. Four factor PCC is the modality of choice to reverse the anticoagulant effect of oral vitamin K antagonists in patients with major bleeding E. Unsure

A. Participate in multidisciplinary efforts to develop institutional guidelines for the management of anticoagulant associated bleeding B. Assist with preparation of any specific antidote medications for a specific patient C. Advocate for the resumption of anticoagulation as soon as possible in a patient if clinically appropriate D. All of the above E. Unsure