A 51-year-old patient asks for ibuprofen while on Edoxaban 60 mg daily and reports chest pain on inspiration. What is the most appropriate action?

A 51-year-old patient asks for ibuprofen while on Edoxaban 60 mg daily and reports chest pain on inspiration. What is the most appropriate action?

• A. Take with food for GI protection
• B. Refer to Accident and Emergency
• C. Take one dose and monitor for symptoms
• D. Stop Edoxaban for 24 hours

Answer: (B)

The situation combines two safety concerns: a direct oral anticoagulant (edoxaban) and an NSAID (ibuprofen) together raise the risk of major bleeding, especially in someone who also has a new chest pain that is pleuritic (pain with inspiration). Chest pain on inspiration suggests a potentially serious condition such as pulmonary embolism, pneumothorax, or other acute cardiopulmonary issues, which require urgent assessment. Therefore, the most appropriate action is to refer the patient to Accident & Emergency for immediate evaluation. In the meantime, avoid NSAIDs like ibuprofen and manage pain with non-NSAID alternatives if advised by a clinician, and do not stop the anticoagulant without medical supervision.

The situation combines two safety concerns: a direct oral anticoagulant (edoxaban) and an NSAID (ibuprofen) together raise the risk of major bleeding, especially in someone who also has a new chest pain that is pleuritic (pain with inspiration). Chest pain on inspiration suggests a potentially serious condition such as pulmonary embolism, pneumothorax, or other acute cardiopulmonary issues, which require urgent assessment.

Therefore, the most appropriate action is to refer the patient to Accident & Emergency for immediate evaluation. In the meantime, avoid NSAIDs like ibuprofen and manage pain with non-NSAID alternatives if advised by a clinician, and do not stop the anticoagulant without medical supervision.