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Direct oral anticoagulant renal monitoring — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentDirect oral anticoagulant renal monitoringGPhC CRA

A 77-year-old man weighs 68 kg and has serum creatinine 150 micromol/L. Using Cockcroft–Gault, what creatinine clearance should guide his DOAC review? Use 1.23 for men.

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Correct answer: C — About 35 mL/min because (140−77)×68×1.23÷150

Cockcroft–Gault gives (140 − 77) × 68 × 1.23 ÷ 150 = 35.1 mL/min. MHRA advises using calculated creatinine clearance rather than laboratory eGFR for DOAC dose adjustment, with actual or appropriate body weight selected according to clinical context.

Reference: MHRA: using creatinine clearance for medicines requiring renal dose adjustment: 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