A 62-year-old woman, Mrs. Brown, comes to you as a new patient. She has a history of gastrointestinal reflux disease (GERD) and atrial fibrillation for the last 7 years and had a stroke about a year ago. Because she previously had a CHADS2 score of 0, her primary care physician had not initiated therapeutic anticoagulation. After examining her you calculate her CHADS2 score which is now 2. You decide that she has sufficient risk to warrant anticoagulation and choose one of the novel anticoagulants (NOACs) to begin therapy.
As you are writing the prescription, she asks you whether she should take her anticoagulant pills with meals or whether she can take them at any time of day. What do you advise her?
A. There is no relationship between any of the NOACs with food intake so she can take them whenever they are convenient for her.
B. NOACs should always be taken with food because they can cause GI upset.
C. NOACs should always be taken with food because their bioavailability can vary depending on food intake.
D. It depends; certain NOACs should be taken with food but not all.
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