Pharmacy — Discharge Advice for a Patient Starting a DOAC after a DVT
A hospital pharmacist writes a discharge advice letter to a 38-year-old man starting rivaroxaban for a provoked deep vein thrombosis. The proficient challenge is selecting the highest-priority safety instructions from a dense clinical note — the dosing schedule, bleeding warning signs, drug interactions, and the must-not-take OTC caveat — while keeping the letter in clear patient language.
Letter type
Discharge
Write to
Patient
Target length
200–230 words
The case notes
Patient: Mr Oluwaseun Adeyemi, 38 years old, fit and well prior to this admission
Diagnosis: Provoked DVT (left calf extending to popliteal vein) following a 14-hour flight 5 days ago
Rivaroxaban regimen: Rivaroxaban 15 mg TWICE daily with food for the first 21 days; then 20 mg ONCE daily with food for 3 months total; prescribed by haematologist
Taking with food — critical: Rivaroxaban must be taken with food (especially 20 mg dose) for adequate absorption; taking on an empty stomach significantly reduces bioavailability
Bleeding warnings — stop and seek help immediately: Unusual or unexpected bleeding: blood in urine, blood in stool (black or dark red), coughing or vomiting blood, severe unexplained headache or dizziness, excessive bruising — call 999 or go to A&E
OTC interactions — do not take: No NSAIDs (ibuprofen, naproxen — buy-without-prescription) as they significantly increase bleeding risk; no aspirin unless prescribed by a doctor; do not take St John's Wort
Dental and procedural alert: Must inform dentist, surgeon or any healthcare professional before any procedure — rivaroxaban may need to be stopped beforehand
No INR monitoring required: Unlike warfarin, rivaroxaban does not require blood test monitoring; no diet restrictions required (no vitamin K concern)
Duration and review: 3 months total; haematology review at week 8 to assess whether to extend beyond 3 months; do not stop without medical advice
MHRA alert card: Patient given an NPSA anticoagulant alert card — must carry it at all times
Task: Write a discharge advice letter to Mr Adeyemi explaining how to take rivaroxaban safely, what bleeding symptoms to watch for, and what medications to avoid.
Writing task
Write a discharge advice letter to Mr Adeyemi explaining how to take rivaroxaban safely, what bleeding symptoms to watch for, and what medications to avoid.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
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The two-phase dose schedule (15 mg BD for 21 days, then 20 mg OD) and that both must be taken with food
A patient who stays on the higher dose beyond day 21 receives an incorrect dose; one who takes the 20 mg on an empty stomach gets subtherapeutic anticoagulation. Both are safety risks and both must be prevented by the letter.
-
The specific bleeding warning signs that require immediate emergency care
Anticoagulation bleeding is the most serious risk — patients must recognise the signs and know the action (call 999 or go to A&E) without delay.
-
No ibuprofen, naproxen (even OTC), or St John's Wort
NSAIDs are the most commonly self-purchased analgesics. A patient with a calf DVT who takes ibuprofen for leg pain dramatically increases bleeding risk.
Leave out
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A comparison of rivaroxaban vs warfarin
One sentence covers the key patient-facing difference: 'unlike warfarin, this tablet does not require regular blood tests.' A comparison is not part of the discharge counselling task.
-
The pathophysiology of the DVT
One brief orientation sentence is enough: 'Rivaroxaban prevents your blood from clotting further while the existing clot dissolves.' The mechanism of factor Xa inhibition does not belong in a patient advice letter.
Criterion in focus · Content
DOACs are high-alert medications. The Content grade falls if any of these are missing: (1) the two-phase dosing schedule with the food requirement, (2) emergency bleeding signs and the emergency action, (3) the NSAID/aspirin avoidance instruction, (4) the must-inform-healthcare-professionals instruction before any procedure. All four are clinically non-negotiable.
Now write the letter — and find out what is blocking your Grade B
Write a 200–230 words discharge letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.