Direct oral anticoagulant recommendations and dosages based on kidney function
| Condition and direct oral anticoagulant | Creatinine clearance, mL/min | |||
|---|---|---|---|---|
| < 15 or on hemodialysis | 15 to < 30 | 30 to < 50 | ≥ 50 | |
| Nonvalvular atrial fibrillation | ||||
| Apixaban | Not studieda | 5 mg twice daily or 2.5 mg twice dailyb | 5 mg twice daily or 2.5 mg twice dailyb | 5 mg twice daily or 2.5 mg twice dailyb |
| Edoxaban | Recommendations cannot be provided | 30 mg once dailyc | 30 mg once dailyc | 60 mg once dailyd |
| Rivaroxaban | Not studiede | Treat as moderate impairment; 15 mg once daily (not studied) | 15 mg once daily | 20 mg once daily |
| Dabigatran | Recommendations cannot be provided | 75 mg twice dailyf | 150 mg twice daily | 150 mg twice daily |
| Venous thromboembolism | ||||
| Apixaban | No prospective clinical data on efficacy and safety | No prospective clinical data on efficacy and safety | 10 mg twice daily; transition to 5 mg twice daily after 7 days | 10 mg twice daily; transition to 5 mg twice daily after 7 days |
| Edoxaban | Recommendations cannot be provided | 30 mg once dailyc | 30 mg once dailyc | 60 mg once dailyd |
| Rivaroxaban | Avoid | No prospective clinical data on efficacy and safety | 15 mg twice daily; transition to 20 mg once daily after 21 days | 15 mg twice daily; transition to 20 mg once daily after 21 days |
| Dabigatran | Recommendations cannot be provided | Recommendations cannot be provided | 150 mg twice daily | 150 mg twice daily |
Note: Additional adjustments needed for concomitant use of P-glycoprotein or cytochrome P450 3A4 inhibitors, or both, are not included.
↵aExpected pharmacokinetic and pharmacodynamic profile as in ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial.27
↵bReduce dose in patients with at least 2 of the following: age ≥ 80, body weight ≤ 60 kg, serum creatinine ≥ 1.5 mg/dL.17
↵cPatients with creatinine clearance < 30 mL/min were not included in randomized clinical trials.31
↵dDo not use in patients with creatinine clearance > 95 mL/min due to increased risk of ischemic strokes.19
↵eExpected pharmacokinetic and pharmacodynamic profile as in ROCKET AF (Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation).28
↵fNot based on prospective clinical data.17
Based on information from references 17, 33, and 34.