Home CPD Balancing the scale: the role of oral anticoagulants in atrial fibrillation

Balancing the scale: the role of oral anticoagulants in atrial fibrillation

CPD

Adam Livori, Jarrah Anderson and Rawa Osman

June 20, 2025

CPD credits

Accreditation Number : C2506CDMJA

Group 1 : 0.75 CPD credits

Group 2 : 1.5 CPD credits

This activity has been accredited for 0.75 hours of Group 1 CPD (or 0.75 CPD credits) suitable for inclusion in an individual pharmacist's CPD plan, which can be converted to 0.75 hours of Group 2 CPD (or 1.5 CPD credits) upon successful completion of relevant assessment activities.

Case scenario

Mrs Alvarez, an 82-year-old woman, presents to your pharmacy with a new prescription for apixaban 5 mg twice daily and some discharge paperwork, following a recent hospital admission after a fall at home. You notice that she was diagnosed with AF during her stay. Her medical history includes a myocardial infarction (MI) 2 years ago, for which she has been taking metoprolol, atorvastatin and aspirin.

Sponsorship statement

Funded by the Australian Government through the Quality Use of Diagnostics, Therapeutics and Pathology Program

Learning objectives

After reading this article, pharmacists should be able to:

Describe the clinical features of atrial fibrillation
Explain the role of anticoagulant therapy in atrial fibrillation
Outline the role of pharmacists in patient education on medication adherence, bleeding risk reduction and symptom monitoring
Identify opportunities for opportunistic AF screening to facilitate early detection and referral, particularly in high-risk populations.

Competency standards (2016) addressed: 1.1, 1.4, 1.5, 2.2, 3.1, 3.5

Accreditation number: C2506CDMJA

Accreditation expiry: 31/5/2028

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Introduction

Atrial fibrillation (AF) is the most common recurrent arrhythmia worldwide,¹ characterised by uncoordinated atrial activity and irregular ventricular contractions. While its causes and contributors are many, all share a common sequela – an increased risk of ischaemic stroke that can be mitigated by anticoagulation.¹ While the use of anticoagulan

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ACT³	No comparable criteria
NSW⁴	· pharmacist gives the person an opportunity to seek advice as to the use of the substance · quantity, or for a purpose must accord with the recognised therapeutic standard of what is appropriate in the circumstances
NT⁵	· pharmacist must not intentionally supply to a person in a manner reckless to their circumstance
QLD⁶	· pharmacist reasonably believes the patient has a therapeutic need
SA	No comparable criteria
TAS⁷	· pharmacist forms the opinion use in the treatment of the patient is justified on consideration of the condition, disease or symptoms of the person
VIC⁸	· for treatment of a patient under pharmacist’s care · pharmacist has taken all reasonable steps to ensure a therapeutic need exists
WA⁹	No comparable criteria

ACT³	No comparable criteria
NSW⁴	· pharmacist gives the person an opportunity to seek advice as to the use of the substance · quantity, or for a purpose must accord with the recognised therapeutic standard of what is appropriate in the circumstances
NT⁵	· pharmacist must not intentionally supply to a person in a manner reckless to their circumstance
QLD⁶	· pharmacist reasonably believes the patient has a therapeutic need
SA	No comparable criteria
TAS⁷	· pharmacist forms the opinion use in the treatment of the patient is justified on consideration of the condition, disease or symptoms of the person
VIC⁸	· for treatment of a patient under pharmacist’s care · pharmacist has taken all reasonable steps to ensure a therapeutic need exists
WA⁹	No comparable criteria

ACT³	No comparable criteria
NSW⁴	· pharmacist gives the person an opportunity to seek advice as to the use of the substance · quantity, or for a purpose must accord with the recognised therapeutic standard of what is appropriate in the circumstances
NT⁵	· pharmacist must not intentionally supply to a person in a manner reckless to their circumstance
QLD⁶	· pharmacist reasonably believes the patient has a therapeutic need
SA	No comparable criteria
TAS⁷	· pharmacist forms the opinion use in the treatment of the patient is justified on consideration of the condition, disease or symptoms of the person
VIC⁸	· for treatment of a patient under pharmacist’s care · pharmacist has taken all reasonable steps to ensure a therapeutic need exists
WA⁹	No comparable criteria

ACT³	No comparable criteria
NSW⁴	· pharmacist gives the person an opportunity to seek advice as to the use of the substance · quantity, or for a purpose must accord with the recognised therapeutic standard of what is appropriate in the circumstances
NT⁵	· pharmacist must not intentionally supply to a person in a manner reckless to their circumstance
QLD⁶	· pharmacist reasonably believes the patient has a therapeutic need
SA	No comparable criteria
TAS⁷	· pharmacist forms the opinion use in the treatment of the patient is justified on consideration of the condition, disease or symptoms of the person
VIC⁸	· for treatment of a patient under pharmacist’s care · pharmacist has taken all reasonable steps to ensure a therapeutic need exists
WA⁹	No comparable criteria

1. PBS co‑payment will drop

2. Transition to the new MMR credential must be completed

3. Continued freeze on PBS concessional co‑payment

4. Optional allowable discount phase out continues

5. New PSA standards for CPD accreditation launch

Is advance provision of S3s legal?

But don’t we need to assess a patient’s therapeutic need?

So when is advanced supply of S3 OK?

What other things do I need to consider?

So what about the Rikodeine?

Table 1 – Legal requirements for pharmacists when prescribing Schedule 3 medicines

References

What motivated you to seek election as the next PSA National President?

What do you hope to achieve as PSA President?

Why do you feel this is such a pivotal moment for PSA and the profession?

What are the major challenges pharmacists are facing right now?

How do you see the profession evolving in 5 years?

How have your background and previous experiences shaped your views of the profession?

Case scenario

Learning objectives

Introduction

Aetiology and pathophysiology

Clinical features

Diagnosis, differential diagnosis and prognosis

Management and treatment

Knowledge to practice

Conclusion

Case scenario continued

Key points

References

Our authors

Our reviewer

Conflict of interest declaration

1. PBS co‑payment will drop

2. Transition to the new MMR credential must be completed

3. Continued freeze on PBS concessional co‑payment

4. Optional allowable discount phase out continues

5. New PSA standards for CPD accreditation launch

Is advance provision of S3s legal?

But don’t we need to assess a patient’s therapeutic need?

So when is advanced supply of S3 OK?

What other things do I need to consider?

So what about the Rikodeine?

Table 1 – Legal requirements for pharmacists when prescribing Schedule 3 medicines

References

What motivated you to seek election as the next PSA National President?

What do you hope to achieve as PSA President?

Why do you feel this is such a pivotal moment for PSA and the profession?

What are the major challenges pharmacists are facing right now?

How do you see the profession evolving in 5 years?

How have your background and previous experiences shaped your views of the profession?

Case scenario

Learning objectives

Introduction

Aetiology and pathophysiology

Clinical features

Diagnosis, differential diagnosis and prognosis

Management and treatment

Knowledge to practice

Conclusion

Case scenario continued

Key points

References

Our authors

Our reviewer

Conflict of interest declaration

1. PBS co‑payment will drop

2. Transition to the new MMR credential must be completed

3. Continued freeze on PBS concessional co‑payment

4. Optional allowable discount phase out continues

5. New PSA standards for CPD accreditation launch

Is advance provision of S3s legal?

But don’t we need to assess a patient’s therapeutic need?

So when is advanced supply of S3 OK?

What other things do I need to consider?

So what about the Rikodeine?

Table 1 – Legal requirements for pharmacists when prescribing Schedule 3 medicines

References

What motivated you to seek election as the next PSA National President?

What do you hope to achieve as PSA President?