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Apixaban and NSAID bleeding risk — GPhC CRA MCQ

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HardCardiovascular TherapeuticsApixaban and NSAID bleeding riskGPhC CRA

A 76-year-old woman with AF takes apixaban 5mg twice daily. She presents with new extensive bruising and has started naproxen bought OTC for knee pain. Her eGFR is 58mL/min/1.73m2 and haemoglobin was normal last month. What is the most important interaction to flag?

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Correct answer: B — Advise her to stop naproxen and contact the prescriber urgently about bleeding risk.

An NSAID with a DOAC increases bleeding risk, and new extensive bruising suggests clinically relevant bleeding risk rather than routine counselling alone. The pharmacist should advise stopping the OTC NSAID and escalate to the prescriber for assessment. Dose reduction of apixaban without prescriber review is unsafe, and aspirin would add further antiplatelet bleeding risk.

Reference: BNF