AF anticoagulation adherence — GPhC CRA MCQ
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Correct answer: E — Explain missed-dose stroke risk and arrange a regimen adherence review
Explain missed-dose stroke risk and arrange a regimen adherence review: Repeated omissions materially reduce protection because apixaban has a short anticoagulant effect; the cause should be explored and a workable regimen or support agreed with the prescriber. Take both daily apixaban tablets together immediately before each shift: Combining the twice-daily regimen changes exposure and is not an authorised adherence solution. Take twice the next morning dose after every missed evening dose: Double dosing can increase bleeding and is not the standard missed-dose instruction. Use daily aspirin in place of apixaban throughout the shift-work period: Aspirin is not an equivalent stroke-prevention strategy for this high-risk patient. Stop anticoagulation until a consistent evening routine can be maintained: Stopping leaves the patient unprotected and avoids rather than solves the adherence problem.
Reference: BNF: apixaban: https://bnf.nice.org.uk/drugs/apixaban/; NICE NG196: atrial fibrillation: https://www.nice.org.uk/guidance/ng196/chapter/Recommendations