Table 6.

Dosing of DOACs for VTE treatment [3–12, 15, 16]

	Dabigatran	Rivaroxaban	Apixaban	Edoxaban
Acute VTE	150 mg BID after ≥5 days of parenteral anticoagulation	15 mg BID with food × 3 weeks then 20 mg once daily with food	10 mg BID for 7 days, then 5 mg BID	60 mg once daily after ≥5 days of parenteral anticoagulation
Prevention of VTE recurrence	No dose adjustment	No dose adjustment	Decrease to 2.5 mg BID after at least 6 months of therapeutic anticoagulation	Not studied
Dosage adjustments and/or thresholds for avoidance	Any P-gp inducer: avoid concurrent use Any P-gp inhibitor with CrCl <50 mL/min: avoid concurrent use CrCl <30 mL/min: avoid use	CrCl < 30 mL/min: avoid use Dual strong CYP3A4 and P-gp inhibitors or inducers: avoid use	Dual strong CYP3A4 and P-gp inducers: avoid use Dual strong CYP3A4 and P-gp inhibitors: If dose >2.5 mg BID, decrease dose by 50 % If already taking 2.5 mg BID and dual strong CYP3A4 and P-gp inhibitor: avoid use No dose adjustment for renal impairment provided	30 mg once daily if any of the following:    CrCl 15–50 mL/min    Weight < 60 kg    Concomitant P-gp inhibitor CrCl < 15 mL/min: avoid use

DOAC direct-acting oral anticoagulant, VTE venous thromboembolism, BID twice daily, P-gp P-glycoprotein, CrCl creatinine clearance, CYP3A4 cytochrome P-450 3A4