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Apixaban dose adjustment — GPhC CRA MCQ

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HardCardiovascular TherapeuticsApixaban dose adjustmentGPhC CRA

A 84-year-old woman with non-valvular AF is prescribed apixaban 5mg twice daily. She weighs 58kg and her serum creatinine is 145micromol/L. She also takes amlodipine and atorvastatin, and there is no history of valvular heart disease. What is the most appropriate alternative?

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Correct answer: D — Apixaban 2.5mg twice daily

For stroke prevention in non-valvular AF, apixaban dose reduction is required when at least two dose-reduction criteria are met. This patient meets age, body weight and serum creatinine criteria. Aspirin is not an anticoagulant substitute for AF stroke prevention. Rivaroxaban 20mg daily would also need renal consideration and is not the best correction to this prescription.

Reference: BNF; NICE CKS Atrial fibrillation