1. M.R. is a 66-year-old black woman with well controlled hypertension, osteoarthritis (for which she takes ibuprofen 400 mg 3 times a day), and newly diagnosed nonvalvular atrial fibrillation. What is her CHA2DS2-VASc score and, based on this score, is she a candidate for oral anticoagulation?

2. A 58-year-old white man with pleuritic chest pain and dyspnea that has progressively worsened over the past 2 weeks is diagnosed with massive bilateral pulmonary embolism. Significant findings include right ventricular enlargement on echocardiogram and elevated cardiac troponin I levels (0.09 ng/ml). Based on pivotal trial data, which of the following TSOAs would you recommend?

3. The package insert for which TSOA clearly states that: “Hemodialysis can remove______________; however the clinical experience supporting the use of hemodialysis as a treatment for bleeding is limited."

4. L.H., a 67-year-old white female (creatinine clearance 82 mL/min) receiving a TSOA for stroke prevention in atrial fibrillation is coming in for a surgical procedure with a standard risk for bleeding. Based on prescribing information, how long before the procedure should dabigatran, rivaroxaban, apixaban, and edoxaban be discontinued?

5. Which of the following organizations provides resources for implementing clinical pharmacy-led anticoagulation management services?

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