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Case Narrative

A 53 year old Malay lady was seen in the cardiac clinic for atrial fibrillation. To reduce her risk of developing an embolic stroke, she was prescribed a 75mg oral dose of an anti-coagulant to be taken every 12 hours. The patient is relatively well although clinical lab tests show mild renal impairment.

Relevant Drug Information

The anti-coagulant is a direct thrombin inhibitor with a low bioavailability. It is cleared primarily by renal mechanisms with an average elimination half-life of about 14.3 hours. Large scale clinical studies suggest that the optimal plasma concentrations of the anticoagulant should be between 0.06-0.12 mg/L. Concentrations above 0.12 mg/L are associated with increased risks of life-threatening bleeds.

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