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DOAC missed dose — GPhC CRA MCQ

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HardCardiovascular TherapeuticsDOAC missed doseGPhC CRA

During the first 21 days of rivaroxaban treatment for acute DVT, a patient prescribed 15 mg twice daily forgets the morning tablet and remembers at the evening dose time. What should they do?

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

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Correct answer: C — Take two 15 mg tablets now, then resume twice-daily dosing tomorrow

Take two 15 mg tablets now, then resume twice-daily dosing tomorrow: During the 15 mg twice-daily initiation phase, a missed dose should be taken immediately and two 15 mg tablets may be taken together to ensure 30 mg that day. Take one 15 mg tablet now and abandon the missed morning dose for today: That provides only half the intended 30 mg daily exposure during the acute phase. Take one tablet now and two 15 mg tablets tomorrow morning: Shifting the replacement to the next day creates an excessive single dose and fails to correct today’s exposure. Omit today’s doses and restart 15 mg twice daily tomorrow: A full untreated day early in acute DVT therapy increases recurrence risk. Take 20 mg now and begin once-daily treatment tomorrow: The regimen should not transition to maintenance before completion of 21 days.

Reference: BNF: rivaroxaban: https://bnf.nice.org.uk/drugs/rivaroxaban/