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Heart failure with reduced ejection fraction — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareHeart failure with reduced ejection fractionUSMLE Step 3

An 82-year-old woman with nonvalvular atrial fibrillation weighs 57 kg and has serum creatinine 1.3 mg/dL. She has no interacting medication and has been taking apixaban 5 mg twice daily. Which apixaban dose is indicated for stroke prevention?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Use apixaban 2.5 mg twice daily for stroke prevention

The best answer is “Use apixaban 2.5 mg twice daily for stroke prevention”. The atrial-fibrillation label reduces apixaban to 2.5 mg twice daily when at least two criteria are present: age at least 80 years, weight at most 60 kg, and serum creatinine at least 1.5 mg/dL. She meets the age and weight criteria; all three are not required.

Reference: FDA Prescribing Information: Eliquis (apixaban): https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/202155s039s040lbl.pdf