Anticoagulant prescribing in CKD — ESENeph MCQ

Correct answer: E — Use Cockcroft–Gault creatinine clearance

Direct oral anticoagulant licensing studies and product dosing use creatinine clearance calculated by Cockcroft–Gault, not laboratory eGFR. In older or low-weight adults the two estimates can diverge enough to cause overdosing. The final drug and dose must also incorporate the indication, age, weight, interacting medicines and product-specific criteria. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: BNF: Prescribing in renal impairment. https://bnf.nice.org.uk/medicines-guidance/prescribing-in-renal-impairment/