A patient has been prescribed dabigatran (Pradaxa) for atrial fibrillation (AF). Which laboratory test should be monitored while on this medication?

The correct answer is choice D) Use a soft-bristled toothbrush.

This is because enoxaparin (Lovenox) is an anticoagulant that prevents blood clots by thinning the blood.Therefore, patients who take enoxaparin should avoid activities that can cause bleeding, such as using a hard-bristled toothbrush, flossing, shaving, or cutting their nails.

Choice A) Avoid foods that are high in vitamin K is wrong because vitamin K interacts with warfarin, another anticoagulant, but not with enoxaparin.Vitamin K helps the blood clot, so patients who take warfarin should avoid foods that are high in vitamin K, such as leafy green vegetables, broccoli, or liver.

Choice B) Administer injections into areas with decreased subcutaneous tissue is wrong because enoxaparin should be injected into areas with adequate subcutaneous tissue, such as the abdomen or the thighs.Injecting into areas with decreased subcutaneous tissue can cause bruising, pain, or hematoma formation.

Choice C) Massage injection sites after administration is wrong because massaging the injection sites can cause bleeding, bruising, or irritation.Patients who take enoxaparin should not rub or press on the injection sites after administration.

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.