رجل عمره ٧٩ سنة على أبيكسابان للرجفان الأذيني، أخرج كمية كبيرة من الدم الأحمر الداكن من المستقيم ٣ مرات خلال ساعة. صار شاحباً ومشوشاً. الضغط ٨٨/٥٠، النبض ١٢٤، الهيموغلوبين ٧٫٦. ما الإجراء الأول؟

A 79-year-old man on apixaban for atrial fibrillation has passed large amounts of dark red rectal blood three times in an hour. He is pale and confused. BP 88/50, HR 124, Hb 7.6 g/dL. What is the first action?

1. Give a laxative to clean out the colon before any test is done
2. Give the next apixaban dose on time
3. Keep him on the ward and recheck Hb tomorrow
4. Two IVs, fluids, blood ready and notify the provider

Answer: D) Two IVs, fluids, blood ready and notify the provider. Major bleeding with shock on an anticoagulant: circulation first (two IVs, fluids, blood), hold the anticoagulant and notify the provider about reversal and locating the source.