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Apixaban dose review — GPhC CRA MCQ

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HardCardiovascular TherapeuticsApixaban dose reviewGPhC CRA

A 71-year-old woman with non-valvular AF takes apixaban 5mg twice daily. She weighs 54kg, her serum creatinine is 148 micromol/L, and she is aged over 80 next month; the GP asks whether the dose is appropriate. What is the most appropriate action?

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Correct answer: B — Ask the prescriber to review whether apixaban 2.5mg twice daily is indicated

For apixaban in AF, dose reduction is considered when the patient meets relevant criteria including age, body weight and serum creatinine. This patient is close to or meets multiple criteria, so prescriber review is needed before continuing the standard dose. Aspirin or added antiplatelet therapy is not an appropriate substitute for anticoagulation in AF. The pharmacist should flag the dosing issue rather than unilaterally changing the prescription.

Reference: BNF; NICE CKS Anticoagulation oral