A 67-year-old woman comes to the ER because of intermittent chest pain and palpitation. She states that she felt the same symptoms on multiple occasions before and disappeared without intervention. She has an irregular and fast beat . She has chronic hypertension without any other chronic diseases. Temperature is 37.1 C , pulse is 106/min and irregular, blood pressure is 145/84 mm Hg, and respirations are 17/min. Cardiopulmonary auscultation reveals clear lungs and no heart murmurs. ECG shows an irregularly irregular rhythm with absent P waves. The patient is started on metoprolol and apixaban. Which of the following is likely to be directly affected as the result of this therapy?

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Eductional Objective: Direct factor Xa inhibitors (eg, apixaban) are oral anticoagulants with no requirement of drug level monitoring that block the active site of factor Xa, which leads to reduced conversion of prothrombin to thrombin.

A 67-Year-Old Woman Comes to the ER Because of Intermittent