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SSRI and DOAC bleeding risk — GPhC CRA MCQ

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HardDrug InteractionsSSRI and DOAC bleeding riskGPhC CRA

A GP asks about a 74-year-old man taking sertraline 100mg daily who has been newly prescribed apixaban 5mg twice daily for AF. He has a past upper GI bleed and takes lansoprazole. What is the most important interaction to flag?

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Correct answer: C — Increased bleeding risk from SSRI and apixaban combination

SSRIs can increase bleeding risk by impairing platelet serotonin uptake, and this is clinically relevant when combined with anticoagulants. His previous GI bleed makes risk assessment and counselling particularly important. Sertraline is not a meaningful enzyme inducer of apixaban in routine practice. The other proposed interactions do not explain the main safety concern in this scenario.

Reference: BNF