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Asthma acute deterioration — GPhC CRA MCQ

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HardRespiratory TherapeuticsAsthma acute deteriorationGPhC CRA

A 79-year-old with non-valvular atrial fibrillation weighs 59 kg and has serum creatinine 140 micromol/L. There is no active bleeding, interacting strong dual inhibitor or severe hepatic disease. Which maintenance apixaban dose is authorised for stroke prevention?

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Correct answer: A — Apixaban 2.5 mg twice daily

For NVAF, apixaban is reduced to 2.5 mg twice daily when at least two of three criteria apply: age at least 80, weight at most 60 kg and serum creatinine at least 133 micromol/L. Although this patient is 79, both low weight and raised creatinine apply, so two criteria are met. Five mg twice daily is therefore inappropriate. Once-daily apixaban regimens are not authorised for NVAF, and low weight is a dose-reduction criterion rather than a reason to withhold anticoagulation altogether.

Reference: Apixaban 2.5 mg tablets SmPC. https://www.medicines.org.uk/emc/product/100386/smpc