TABLE 19.

Recommended Doses of Currently Approved DOACs According to Renal Function

DOAC	CrCl (mL/min)
	>95	51-95	31-50	15-30	<15 or on dialysis
Apixaban	5 or 2.5 mg twice daily*	5 or 2.5 mg twice daily*	5 or 2.5 mg twice daily*	5 or 2.5 mgtwice daily*	5 or 2.5 mg twice daily
Dabigatran	150 mg twice daily	150 mg twice daily	150 mg twice daily	75 mg twice daily	Contraindicated
Edoxaban	Contraindicated	60 mg once daily	30 mg once daily	30 mg once daily	Contraindicated
Rivaroxaban	20 mg once daily	20 mg once daily	15 mg once daily	15 mg once daily	15 mg once daily

Note that other, nonrenal considerations such as drug interactions may also apply. The gray area indicates doses not studied in the pivotal clinical trials of these agents.

^*If at least 2 of the following are present: serum creatinine ≥1.5 mg/dL, age ≥80 y, or body weight ≤60 kg, the recommended dose is 2.5 mg twice daily. The ARISTOTLE trial excluded patients with either a creatinine of >2.5 mg/dL or a calculated CrCl <25 mL/min.

^†Rivaroxaban is not recommended for other indications in patients with a CrCl <15 mL/min, but such a recommendation is not made for the AF indication. However, pharmacokinetic data are limited.

AF indicates atrial fibrillation; ARISTOTLE, Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation; CrCl, creatinine clearance; and DOAC, direct oral anticoagulant.