A nurse is reviewing the medication list of a client who is prescribed dabigatran and has a history of peptic ulcer disease. The nurse should recognize that which of the following medications can increase the risk of bleeding in this client?

Apixaban (Eliquis) is a blood thinner that prevents blood clots from forming or growing larger.

It is used to treat or prevent deep vein thrombosis (DVT), a condition in which a blood clot forms in a vein deep in the body, usually in the legs.

It can also prevent pulmonary embolism (PE), a condition in which a blood clot breaks off and travels to the lungs, blocking blood flow and causing breathing problems.

Patients taking apixaban should follow these instructions:

• Avoid activities that may cause injury.

Apixaban can increase the risk of bleeding, so patients should be careful not to cut or bruise themselves.

They should use a soft toothbrush, an electric razor, and avoid contact sports or other activities that may cause bleeding.They should also wear a medical alert bracelet or carry an identification card that states they are taking apixaban.

• Report signs and symptoms of bleeding immediately.Patients should notify their doctor or seek emergency care if they have any signs of bleeding, such as unusual bruising, red or black stools, blood in the urine, coughing up blood, vomiting blood, nosebleeds, heavy menstrual bleeding, headaches, dizziness, weakness, or swelling.

• Do not take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs).

These drugs can also increase the risk of bleeding and interfere with the effects of apixaban.

Patients should avoid taking aspirin, ibuprofen, naproxen, or other NSAIDs unless prescribed by their doctor.They should also check the labels of any over-the-counter medications or supplements they use and avoid those that contain aspirin or NSAIDs.

Choice B and D are wrong because:

• Take medication with food.Apixaban can be taken with or without food.Taking it with food does not affect its absorption or efficacy.

Therefore, this instruction is not necessary for patients taking apixaban.

• Monitor vital signs regularly.Apixaban does not affect blood pressure, heart rate, or oxygen saturation.

Therefore, monitoring vital signs regularly is not required for patients taking apixaban.However, patients should still follow their doctor’s advice on how often to check their blood tests, such as hemoglobin, hematocrit, and platelets.

This is because swelling in one leg could indicate a new or worsening deep vein thrombosis (DVT), which is a serious condition that can lead to pulmonary embolism or other complications. The client should report this finding to the provider immediately and seek medical attention.

Choice A) Bruising at injection site is wrong because bruising is a common and expected side effect of enoxaparin therapy, especially if the client is using the same injection site repeatedly.

The client should be instructed to rotate the injection sites and apply gentle pressure after each injection to minimize bruising.

Choice B) Redness at injection site is wrong because redness is also a common and expected side effect of enoxaparin therapy, as it indicates a local inflammatory response to the medication.

The client should be advised to avoid rubbing or scratching the injection site and to apply a cold compress if needed.

Choice D) Mild pain at injection site is wrong because mild pain is also a common and expected side effect of enoxaparin therapy, as it reflects the needle insertion and the medication delivery.

The client should be reassured that the pain will subside shortly and to use a different injection site for the next dose.

Normal ranges for enoxaparin therapy are based on the client’s weight, indication, and renal function.

The usual dose for DVT prophylaxis is 40 mg subcutaneously once daily, and the usual dose for DVT treatment is 1 mg/kg subcutaneously every 12 hours.

The client should have regular blood tests to monitor the anti-factor Xa level, which should be between 0.5 and 1.0 IU/mL for DVT prophylaxis and between 0.6 and 1.0 IU/mL for DVT treatment.

The client should also have regular platelet counts to check for heparin-induced thrombocytopenia (HIT), which is a rare but serious complication of enoxaparin therapy that causes a drop in platelets and an increased risk of thrombosis.

The normal platelet count range is 150,000 to 450,000/mm3.