Mock oral exams › Hip fracture repair in an older patient with dementia taking apixaban
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Hip fracture repair in an older patient with dementia taking apixaban
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The stem
An 86-year-old woman, 64 kg, fell in her memory-care residence at 11 PM last night and has a displaced right femoral neck fracture. She is scheduled for a cemented hemiarthroplasty. She has moderate Alzheimer's dementia, permanent atrial fibrillation, hypertension and overactive bladder. Her daughter holds health-care power of attorney.
Medications: apixaban 5 mg twice daily (last dose 9 PM yesterday), metoprolol succinate 50 mg daily, furosemide 20 mg daily, donepezil 10 mg nightly and oxybutynin 5 mg twice daily. Allergies: none known.
- Blood pressure 142/78 mmHg, heart rate 96 and irregular, SpO2 93% on room air, temperature 36.4 °C
- Hemoglobin 10.9 g/dL, platelets 210,000/µL, INR 1.2
- Creatinine 0.9 mg/dL, eGFR 61 mL/min/1.73 m², potassium 3.6 mEq/L
- ECG: atrial fibrillation at 96, no acute ST changes
- Echocardiogram last year: normal biventricular function, mild mitral regurgitation
- It is now 8 AM, and she is in pain and intermittently confused