Case presentation

A 76-year-old woman is admitted with a left hemiparesis. CT head excludes haemorrhage. She is found to be in AF (newly diagnosed). The on-call medical team has prescribed: 1) Apixaban 5 mg BD (started today for AF stroke prevention); 2) Enoxaparin 40 mg SC OD (continued from admission for VTE prophylaxis). Renal function is normal. She has no bleeding history. CHA2DS2-VASc 6.

Observations / investigations

Task

Tick the prescription(s) representing inappropriate duplicate anticoagulation.

AQuestion A

This patient is receiving therapeutic anticoagulation for AF stroke prevention. Select the ONE prescription that represents inappropriate duplicate (prophylactic) anticoagulation and should be stopped (mark it in column A).

BQuestion B

Given this is an ACUTE ischaemic stroke (CT today, started this admission), select the ONE prescription that should be withheld/deferred because starting it now risks haemorrhagic transformation and its timing should follow the 1-3-6-12 rule (mark it in column B).