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DOAC dosing and NSAID bleeding risk — SCE Geriatric Medicine MCQ

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HardCardiovascular medicineDOAC dosing and NSAID bleeding riskSCE Geriatric Medicine

An 84-year-old woman with chronic AF, CKD3 and osteoporosis is reviewed for recurrent epistaxis. She takes apixaban 5 mg twice daily, diltiazem, naproxen, alendronate and sertraline. Weight is 48 kg, creatinine is 142 micromol/L and age is 84 years. Which medication issue is most important?

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Correct answer: C — Review apixaban dose criteria and stop naproxen if possible

She meets apixaban dose-reduction criteria by age, weight and creatinine, and NSAID co-prescribing increases bleeding risk. The safest approach is dose review plus removal of avoidable bleeding contributors such as naproxen. Aspirin would increase bleeding without improving AF anticoagulation. The pearl is that anticoagulant safety in geriatrics often depends on dose criteria, renal function and interacting medicines.

Reference: BNF; NICE NG196; STOPP/START v3