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Question preview · FRCA Final

A 63-year-old man with non-valvular atrial fibrillation takes apixaban 5 mg twice daily. His creatinine clearance is 78 mL/min and his CHA2DS2-VASc score is 2. He is scheduled for elective total hip arthroplasty under single-shot spinal anaesthesia. His last dose of apixaban was 60 hours ago. PT and aPTT are normal, but a calibrated apixaban level is unavailable. Which is the most appropriate management?

  1. A. Perform the spinal now because the 48-hour surgical interruption interval has elapsed
  2. B. Delay the spinal until 72 hours after the last dose and use no LMWH bridge
  3. C. Start therapeutic LMWH now and perform the spinal 24 hours after its last dose
  4. D. Convert to warfarin and perform the spinal once the INR is below 1.5
  5. E. Perform the spinal now because normal PT and aPTT exclude residual apixaban effect

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