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Atrial Fibrillation — UKMLA MCQ

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HardCardiologyAtrial FibrillationUKMLAMRCGP AKTPARAMRCEM SBAMRCP Part 1PSA

A patient taking apixaban for atrial fibrillation is prescribed clarithromycin and develops extensive spontaneous bruising. Renal function has worsened. What is the best next action?

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Correct answer: C — Review bleeding risk and drug interaction

The best answer is “Review bleeding risk and drug interaction”. Apixaban exposure and bleeding risk can rise with interacting CYP3A4 and P-glycoprotein inhibitors, and renal deterioration adds further risk. The patient needs urgent clinical assessment, blood count and renal function review, with the interacting antimicrobial and anticoagulant plan reconsidered. Vitamin K reverses warfarin, not apixaban.

Reference: Eliquis 5 mg tablets Summary of Product Characteristics: https://www.medicines.org.uk/emc/product/2878/smpc