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Chronic Heart Failure Management — UKMLA MCQ

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MediumCardiologyChronic Heart Failure ManagementUKMLAMRCGP AKTPARAMRCP Part 1PSA

A 78-year-old woman with non-valvular atrial fibrillation is starting rivaroxaban. Renal function has been stable, and Cockcroft–Gault creatinine clearance is exactly 50 mL/min. The laboratory-reported eGFR is 66 mL/min/1.73 m². Which regimen is appropriate?

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Correct answer: A — Rivaroxaban 20 mg once daily with food

A is correct. For prevention of stroke and systemic embolism in non-valvular atrial fibrillation, the UK SmPC specifies rivaroxaban 20 mg once daily when renal function is above the reduced-dose range. The 15 mg once-daily regimen applies when Cockcroft–Gault creatinine clearance is 15–49 mL/min; a value exactly equal to 50 therefore remains on 20 mg. Both the 15 mg and 20 mg tablets must be taken with food. B incorrectly treats 50 as part of the 15–49 range. C has the correct strength but omits the food requirement. D is the initial acute venous-thromboembolism frequency rather than the atrial-fibrillation regimen. E is not the licensed atrial-fibrillation dose at this renal function.

Reference: MHRA, renal-function estimation for prescribing: https://www.gov.uk/drug-safety-update/prescribing-medicines-in-renal-impairment-using-the-appropriate-estimate-of-renal-function-to-avoid-the-risk-of-adverse-drug-reactions ; UK SmPC, Xarelto: https://www.medicines.org.uk/emc/product/2793/smpc