Anticoagulation Specialist CACP Practice
Exam
**Question 1.** Which vitamin K‑dependent clotting factor is the first to be inhibited by
warfarin?
A) Factor II
B) Factor VII
C) Factor IX
D) Factor X
Answer: B
Explanation: Warfarin most rapidly reduces factor VII because it has the shortest half‑life,
leading to early INR changes.
**Question 2.** A patient on dabigatran develops a major bleed. Which reversal agent should
be administered?
A) Vitamin K
B) Idarucizumab
C) Andexanet alfa
D) Prothrombin complex concentrate (PCC)
Answer: B
Explanation: Idarucizumab is a monoclonal antibody fragment that specifically binds and
neutralizes dabigatran.
**Question 3.** Which DOAC is primarily eliminated unchanged by the kidneys?
A) Apixaban
B) Rivaroxaban
C) Edoxaban
D) Dabigatran
Answer: D
, Anticoagulation Specialist CACP Practice
Exam
Explanation: Approximately 80 % of dabigatran is excreted renally, making renal function critical
for dosing.
**Question 4.** The target INR range for a patient with a mechanical mitral valve is:
A) 1.5–2.0
B) 2.0–3.0
C) 2.5–3.5
D) 3.0–4.0
Answer: C
Explanation: Mechanical mitral valves require higher anticoagulation intensity; the usual target
is 2.5–3.5.
**Question 5.** Which enzyme predominantly metabolizes rivaroxaban?
A) CYP2C9
B) CYP3A4
C) CYP1A2
D) CYP2D6
Answer: B
Explanation: Rivaroxaban is mainly metabolized by CYP3A4 and also undergoes P‑gp transport.
**Question 6.** A patient on warfarin reports consuming large amounts of leafy greens. This
dietary change most likely will:
A) Increase INR
B) Decrease INR
C) Have no effect on INR
D) Cause warfarin toxicity
, Anticoagulation Specialist CACP Practice
Exam
Answer: B
Explanation: Leafy greens are high in vitamin K, which antagonizes warfarin’s effect and lowers
INR.
**Question 7.** Which of the following is a contraindication to the use of DOACs in atrial
fibrillation?
A) CHA₂DS₂‑VASc score ≥ 2
B) CrCl < 15 mL/min
C) Age > 75 years
D) Prior stroke
Answer: B
Explanation: Severe renal impairment (CrCl < 15 mL/min) is a contraindication because DOACs
accumulate.
**Question 8.** Low molecular weight heparin (LMWH) primarily prolongs which laboratory
test?
A) aPTT
B) PT/INR
C) Anti‑Xa activity
D) Thrombin time
Answer: C
Explanation: LMWH activity is best monitored by measuring anti‑Xa levels, not aPTT.
**Question 9.** Which scoring system is used to assess bleeding risk in patients on
anticoagulation?
A) CHA₂DS₂‑VASc
, Anticoagulation Specialist CACP Practice
Exam
B) HAS‑BLED
C) Wells score
D) Padua prediction score
Answer: B
Explanation: HAS‑BLED evaluates hypertension, abnormal renal/liver function, stroke, bleeding
history, etc., to predict bleeding.
**Question 10.** In a patient with cancer‑associated thrombosis, the preferred initial
anticoagulant is:
A) Warfarin
B) Apixaban
C) Low molecular weight heparin
D) Fondaparinux
Answer: C
Explanation: LMWH is the standard of care for cancer‑associated VTE due to superior efficacy
and safety.
**Question 11.** Which of the following agents is a direct factor Xa inhibitor that can be given
once daily?
A) Dabigatran
B) Apixaban
C) Rivaroxaban
D) Argatroban
Answer: C
Explanation: Rivaroxaban has a once‑daily dosing regimen for most indications.
Exam
**Question 1.** Which vitamin K‑dependent clotting factor is the first to be inhibited by
warfarin?
A) Factor II
B) Factor VII
C) Factor IX
D) Factor X
Answer: B
Explanation: Warfarin most rapidly reduces factor VII because it has the shortest half‑life,
leading to early INR changes.
**Question 2.** A patient on dabigatran develops a major bleed. Which reversal agent should
be administered?
A) Vitamin K
B) Idarucizumab
C) Andexanet alfa
D) Prothrombin complex concentrate (PCC)
Answer: B
Explanation: Idarucizumab is a monoclonal antibody fragment that specifically binds and
neutralizes dabigatran.
**Question 3.** Which DOAC is primarily eliminated unchanged by the kidneys?
A) Apixaban
B) Rivaroxaban
C) Edoxaban
D) Dabigatran
Answer: D
, Anticoagulation Specialist CACP Practice
Exam
Explanation: Approximately 80 % of dabigatran is excreted renally, making renal function critical
for dosing.
**Question 4.** The target INR range for a patient with a mechanical mitral valve is:
A) 1.5–2.0
B) 2.0–3.0
C) 2.5–3.5
D) 3.0–4.0
Answer: C
Explanation: Mechanical mitral valves require higher anticoagulation intensity; the usual target
is 2.5–3.5.
**Question 5.** Which enzyme predominantly metabolizes rivaroxaban?
A) CYP2C9
B) CYP3A4
C) CYP1A2
D) CYP2D6
Answer: B
Explanation: Rivaroxaban is mainly metabolized by CYP3A4 and also undergoes P‑gp transport.
**Question 6.** A patient on warfarin reports consuming large amounts of leafy greens. This
dietary change most likely will:
A) Increase INR
B) Decrease INR
C) Have no effect on INR
D) Cause warfarin toxicity
, Anticoagulation Specialist CACP Practice
Exam
Answer: B
Explanation: Leafy greens are high in vitamin K, which antagonizes warfarin’s effect and lowers
INR.
**Question 7.** Which of the following is a contraindication to the use of DOACs in atrial
fibrillation?
A) CHA₂DS₂‑VASc score ≥ 2
B) CrCl < 15 mL/min
C) Age > 75 years
D) Prior stroke
Answer: B
Explanation: Severe renal impairment (CrCl < 15 mL/min) is a contraindication because DOACs
accumulate.
**Question 8.** Low molecular weight heparin (LMWH) primarily prolongs which laboratory
test?
A) aPTT
B) PT/INR
C) Anti‑Xa activity
D) Thrombin time
Answer: C
Explanation: LMWH activity is best monitored by measuring anti‑Xa levels, not aPTT.
**Question 9.** Which scoring system is used to assess bleeding risk in patients on
anticoagulation?
A) CHA₂DS₂‑VASc
, Anticoagulation Specialist CACP Practice
Exam
B) HAS‑BLED
C) Wells score
D) Padua prediction score
Answer: B
Explanation: HAS‑BLED evaluates hypertension, abnormal renal/liver function, stroke, bleeding
history, etc., to predict bleeding.
**Question 10.** In a patient with cancer‑associated thrombosis, the preferred initial
anticoagulant is:
A) Warfarin
B) Apixaban
C) Low molecular weight heparin
D) Fondaparinux
Answer: C
Explanation: LMWH is the standard of care for cancer‑associated VTE due to superior efficacy
and safety.
**Question 11.** Which of the following agents is a direct factor Xa inhibitor that can be given
once daily?
A) Dabigatran
B) Apixaban
C) Rivaroxaban
D) Argatroban
Answer: C
Explanation: Rivaroxaban has a once‑daily dosing regimen for most indications.
