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Dabigatran contraindication in CKD — GPhC CRA MCQ

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HardRenal Dose AdjustmentDabigatran contraindication in CKDGPhC CRA

An 82-year-old woman weighing 54 kg takes dabigatran 150 mg twice daily for atrial fibrillation. Her serum creatinine is 150 micromol/L. Using Cockcroft–Gault for women, CrCl = (140 − age) × weight × 1.04 / serum creatinine. What is the most appropriate interpretation?

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Correct answer: E — CrCl is about 22 mL/min; withhold and urgently review anticoagulation

Cockcroft–Gault gives (58 × 54 × 1.04) / 150 = 21.7 mL/min, approximately 22 mL/min. Adult dabigatran treatment is contraindicated when CrCl is below 30 mL/min because exposure rises markedly. The dose decision must therefore use CrCl rather than eGFR; the next dose should be withheld and anticoagulation reviewed urgently rather than inventing an unlicensed once-daily regimen.

Reference: Pradaxa SmPC: https://www.medicines.org.uk/emc/product/6229/smpc