Atrial fibrillation with chronic kidney disease: anticoagulation
Write a prescription for atrial fibrillation with chronic kidney disease stage 3b and have every line marked: drug choice, dose, route, frequency and duration, checked against the patient's allergies, current medicines, renal function and the interaction database, with each error explained.
medium8 scoring rulesrenal impairment
- Patient
- 78 years, female, 70 kg
- Diagnosis
- Atrial fibrillation with chronic kidney disease stage 3b
- Renal function
- eGFR 35 mL/min/1.73m²
- Allergies
- None known
- Current medicines
- amlodipine 5mg once daily; metformin 500mg twice daily
The scenario
Patient C-104, a 78-year-old woman, presents with a 2-day history of palpitations and worsening breathlessness on exertion. She has a history of hypertension and type 2 diabetes. On examination, she is alert and comfortable at rest, with an irregularly irregular pulse at 110 beats per minute, blood pressure 142/78 mmHg, respiratory rate 18/min, oxygen saturation 96% on room air. Cardiovascular and respiratory examinations are otherwise unremarkable. An ECG confirms atrial fibrillation. Laboratory investigations: serum creatinine 145 µmol/L (1.64 mg/dL), estimated glomerular filtration rate (eGFR) 35 mL/min/1.73m², consistent with chronic kidney disease stage 3b. Liver function tests are within normal limits. She is not pregnant. Body weight 70 kg.
Your task
No prior anticoagulation.
What gets marked
- Whether you chose an indicated drug, and whether you avoided the contraindicated ones.
- Dose, route, frequency and duration against the range for this patient.
- Renal and hepatic dose adjustment where this patient's numbers demand it.
- Allergy cross-reactivity and interactions with the medicines already on the chart.
- The instructions and monitoring you write, not only the drug you pick.
8 scoring rules apply to this scenario. A single critical error fails the attempt whatever the score.
Log in to prescribe for "Atrial fibrillation with chronic kidney disease: anticoagulation"
A free account opens the prescription pad: search the formulary, write the chart, and have it marked line by line by the safety engine.
Taught in
More like this
- Clinical case: Acute Stroke Thrombolysis and Thrombectomy Decision
- Clinical case: A 70-Year-Old Woman with Atrial Fibrillation and a Cold, Pale, Painful Leg
- Clinical case: A Warfarinised Elderly Man with a Fall: A Case of Fractured Neck of Femur
- Community-acquired pneumonia in a penicillin-allergic patient taking warfarin
- Cellulitis in a penicillin-allergic patient with renal impairment
- Community-Acquired Pneumonia: Initial Prescribing
Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.