KISS: DOACs and Reduced Renal Function
NO
PHARMACEUTICAL INFLUENCE
| CrCl > 50 ml/min | CrCl 30-49 ml/min | CrCl 15-29 ml/min | CrCl <15 ml/min | |
|
Apixaban:
AF |
5mg BD.
|
5mg BD.
|
Reduce dose 2.5mg BD. | Do not use. |
|
Apixaban:
Treatment of VTE* |
Initially 10mg BD for first 7 days, then 5mg BD. | Initially 10mg BD for first 7 days, then 5mg BD. | Use with caution. | Do not use. |
|
Rivaroxaban:
AF |
20mg OD. | Reduce dose 15mg OD. |
Reduce dose 15mg OD.
|
Do not use. |
|
Rivaroxaban:
Treatment of VTE* |
15mg BD for 3 weeks then 20mg OD. | 15mg BD for 3 weeks, then consider reduced dose 15mg OD. | 15mg BD for 3 weeks, then consider reduced dose 15mg OD. | Do not use. |
|
Edoxaban:
AF |
60mg OD.
|
Reduce dose 30mg OD. | Reduce dose 30mg OD. | Do not use. |
|
Edoxaban:
Treatment of VTE* |
Dose as above for AF (after 5 days of LMWH). | Reduce dose 30mg OD. (after 5 days of LMWH). | Reduce dose 30mg OD. (after 5 days of LMWH). | Do not use. |
|
Dabigatran:
AF |
150mg BD. ↓ dose 110mg BD if:
|
Consider Reduced dose 110mg BD depending on thrombosis-embolic/bleeding risk | Do not use. | Do not use. |
|
Dabiagatran:
Treatment of VTE* |
Dose as above for AF (after 5 days of LMWH). | Reduce dose 110mg BD (after 5 days of LMWH). | Do not use. | Do not use. |
-
Renal function monitoring:
- Minimum yearly and every 6 months if aged >75 years or frail.
- If CrCl < 60 mL/min, frequency of monitoring = the CrCl divided by 10; e.g. every 3 months if CrCl is 30 mL/minute.
*These refer to standard treatment doses for DVT and PE, usually for a minimum of 3 months, but the length of treatment should be specialist-led depending on VTE recurrence risk. *For prophylaxis of recurrent DVT/PE, lower doses may be recommended after a minimum 6 months of full treatment dose, but should be specialist-led and will be determined by the individual risk of VTE recurrence and bleeding risk (e.g. apixaban 2.5mg BD; rivaroxaban 10-20mg OD;) **P-gp inhibitors = ciclosporin, dronedarone, erythromycin, ketoconazole
Published on 25th September 2024
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