# A 72-year-old patient with atrial fibrillation is being discharged on apixaban. Which patient safety teaching should the nurse include? Select all that apply.

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> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A 72-year-old patient with atrial fibrillation is being discharged on apixaban. Which patient safety teaching should the nurse include? Select all that apply.

1

Notify the provider before any dental procedure, surgery, or invasive procedure so the apixaban can be paused per protocol.

2

Avoid over-the-counter NSAIDs (ibuprofen, naproxen) and aspirin-containing products unless prescribed, because they increase bleeding risk.

3

Use a soft-bristled toothbrush, an electric razor, and avoid contact sports to reduce bleeding from minor injury.

4

Implement fall-prevention measures at home — clear walkways, adequate lighting, grab bars in the bathroom — and use assistive devices as needed.

5

Keep oral vitamin K at home and take it after any fall or head injury to reverse apixaban's anticoagulant effect.

## Explanation

Apixaban is a Factor Xa inhibitor (DOAC). Patient safety teaching for any anticoagulant: (1) reduce bleeding from minor injury — soft toothbrush, electric razor, avoid contact sports; (2) avoid OTC NSAIDs and aspirin unless prescribed — NSAIDs add platelet inhibition and gastric bleed risk; (3) hold before invasive procedures per provider — typically 24–48 hours preprocedure; (4) prevent falls — older adults on anticoagulants are at high risk for intracranial hemorrhage from minor head trauma. Choice 5 is incorrect — vitamin K reverses warfarin, not apixaban. The reversal agent for apixaban is andexanet alfa (administered in hospital), not a take-home medication.

## In-depth explanation

Bleeding precautions for any anticoagulant include using a soft-bristled toothbrush, an electric razor, avoiding contact sports, no aspirin or NSAIDs unless prescribed, and holding the drug before procedures per provider order. Patients should report unusual bruising, dark or tarry stools, hematuria, severe headache, dizziness, or any prolonged bleeding. The NSAID-anticoagulant interaction matters because NSAIDs add platelet inhibition and gastric mucosal damage to the anticoagulant effect, multiplying bleed risk; acetaminophen is the preferred over-the-counter analgesic for patients on anticoagulants. Topical NSAIDs (diclofenac gel) carry less systemic effect but still need provider approval. Reversal of apixaban or rivaroxaban for life-threatening bleeding uses andexanet alfa, a Factor Xa inhibitor antidote given intravenously in hospital. Vitamin K reverses warfarin only, and idarucizumab reverses dabigatran. Reversal agents are hospital-administered, not patient-carried.

## Clinical scenario

A **72-year-old patient with atrial fibrillation** is being discharged on **apixaban**. The nurse provides safety teaching for the new anticoagulant.

## Key concepts

- **Bleeding Precautions** — Soft-bristled toothbrush, electric razor, avoid contact sports, no ASA/NSAIDs unless prescribed, hold before procedures per provider. Report unusual bruising, dark or tarry stools, hematuria, severe headache, dizziness, or any prolonged bleeding.
- **NSAID-Anticoagulant Interaction** — NSAIDs add platelet inhibition and gastric mucosal damage to the anticoagulant effect, multiplying bleed risk. Acetaminophen is the preferred OTC analgesic for patients on anticoagulants. Topical NSAIDs (diclofenac gel) carry less systemic effect but should still be approved by provider.
- **Apixaban Reversal** — Andexanet alfa (Factor Xa inhibitor antidote) for life-threatening bleeding from apixaban or rivaroxaban. Vitamin K reverses warfarin only. Idarucizumab is the reversal for dabigatran. Reversal agents are hospital-administered, not patient-carried.

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