Which finding would be MOST significant in assessing possible internal bleeding?

• A. The patient had a stroke 5 years prior.
• B. The patient has a history of hypertension.
• C. The patient has not eaten in 24 hours.
• D. The patient takes rivaroxaban (Xarelto).

Answer: (D)

Anticoagulation directly drives the risk of internal bleeding. Being on rivaroxaban (Xarelto) means the blood’s ability to clot is inhibited, so bleeding can occur more easily and be more difficult to stop, even with minor injuries or spontaneously. This makes it the strongest clue for potential internal bleeding among the options. The other factors—history of a stroke, hypertension, or not eating for 24 hours—don’t directly elevate the current bleeding risk to the same degree. A past stroke and hypertension relate to vascular health, not an active impairment of clot formation, and fasting mainly affects metabolic status rather than bleeding propensity. So the presence of rivaroxaban is the most significant finding when assessing possible internal bleeding.