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DOAC and NSAID bleeding risk — GPhC CRA MCQ

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HardDrug InteractionsDOAC and NSAID bleeding riskGPhC CRA

A 73-year-old woman taking rivaroxaban 20mg once daily for AF asks to buy diclofenac tablets for knee pain. She also takes sertraline and has a previous duodenal ulcer. Her eGFR is 52mL/min/1.73m2. What is the most important interaction to flag?

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Correct answer: C — diclofenac increases bleeding risk when combined with rivaroxaban

NSAIDs increase bleeding risk with oral anticoagulants through gastrointestinal mucosal injury and platelet effects. This patient has additional bleeding risks from age, SSRI use and previous ulcer disease. OTC diclofenac supply would be inappropriate and safer analgesic options or clinical review should be discussed. The interaction is not reduced rivaroxaban absorption.

Reference: BNF