Both atrial fibrillation (AF) and renal insufficiency are diseases of the elderly patient, and their prevalence increases with advancing age.

Direct oral anticoagulants (DOACs) (including apixaban, dabigatran, edoxaban and rivaroxaban) are preferred over vitamin K antagonists in patients with AF who are eligible for anticoagulation.

Guidelines for DOAC dose reduction are based on calculation of creatinine clearance (CrCl) using the Cockcroft-Gault (CG) equation.

Since DOACs are eliminated by the kidneys to varying degrees, their dosages must be adapted in accordance with renal function.

Therefore, CrCl-CG monitoring is recommended in patients with AF receiving DOAC therapy, particularly elderly patients with comorbidities and receiving multiple medications (and therefore at a special risk of over- or under-dosing).