Prescription: Apixaban: Non-Valvular AF

Casebank Prescription
1

Where you are
You are FY2 in Medicine.

Who the patient is
Mr. John Smith, aged 81, was diagnosed with Non-Valvular Atrial Fibrillation.

Other Information
Patient had CABG 10 Years ago.
His serum creatinine is 140 micromole/litter
Patient was prescribed apixaban and atenolol.

Special Note
None

Shortcut:

  1. Regular: Apixaban 2.5 mg PO BD
  2. Regular: Atenolol 50mg PO OD

Explanation:

  1. For prophylaxis of stroke in Non-valvular AF
    – Apixaban Normally 5 mg BD
    – Reduce dose to 2.5 mg BD in pt with at least two of the following criteria:

    1. Age- more or equal to 80
    2. Weight- equal or less to 60
    3. S. Creatinine- equal or more to 133 micromole/liter.

  2. For arrhythmia
    – Atenolol: Starting dose is 50 mg OD, If eGFR greater than 15.
    – If eGFR is less than 15, we reduce dose to 25 mg OD.
    – If we dont know the GFR , we can prescribe 50 mg OD as this is the usually starting dose.

Note: Hold Aspirin and Dalteparin, while on Apixaban due to drug interactions.

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