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DOAC accumulation in CKD — RACP Written MCQ

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HardClinical PharmacologyDOAC accumulation in CKDRACP Written

A 82-year-old woman with atrial fibrillation and eGFR 24 mL/min/1.73 m2 is taking a direct oral anticoagulant at a standard dose. She presents with melaena and anaemia. What is the most likely cause?

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Correct answer: A — Renal impairment increasing anticoagulant exposure

Many direct oral anticoagulants have renal clearance; advanced CKD can increase drug exposure and bleeding risk if dosing is not adjusted.

Reference: AMH; Therapeutic Guidelines: Toxicology and drug-interaction principles