. 2016 Dec 31;9(4):1478. doi: 10.4022/jafib.1478

Table 2. Appropriateness criteria for DOACs prescriptions.

Legend: CrCl, creatinine clearance; CHADS2: Congestive Heart Failure, Hypertension, Age ≥ 75 years, Diabetes, Stroke; CHA2DS2-VASc: Congestive Heart Failure, Hypertension, Age ≥ 75 years old, Diabetes, Stroke history, Vascular disease, Age between 65 and 74 years, Sex Category; HAS-BLED: Hypertension, Abnormal renal and/or liver function, Stroke, Bleeding, Labile INR, Elderly, Drugs.

Criteria

1. Type of AF: DOACs are prescribed in patients with non-valvular AF (i.e. mitral or tricuspid valve replacement or repair) [18].

2. Mitral stenosis: In the case of mitral stenosis, DOACS are prescribed in patients with mild to moderate mitral stenosis only (not moderate to severe) [18].

3. CHADS₂ score: When DOACs are prescribed, the CHADS₂ score is > 1. If the CHADS₂ score = 0, the CHA₂DS₂-VASc score must be > 2 or there has been a cardioversion [18].

4. Heart valves:In the case of heart valves, DOACs are used in patients with a bioprosthetic valve (and not a mechanical valve) [19].

5. Concomitant medication:DOACs are prescribed in patients that do not use ketoconazole, itraconazole, voriconazole, posaconazole or ritonavir [5, 20-22].

6. Renal function:Dabigatran and rivaroxaban are prescribed when the estimated CrCl is > 30 mL/min [5, 21, 22].Apixaban is prescribed when CrCl is > 25 mL/min [20].

7. Liver enzyme levels:DOACs are prescribed if blood levels of AST and ALT are < twice the upper limit of normal[5].

8. a. Dose of dabigatran:Dabigatran is prescribed at a reduced dose of 110 mg twice daily if one of the following factors is present:Weight < 50 kg,Age > 80 years old,Haemorrhagic risk factors: HAS-BLED score > 3 and/or CrCl is between 30 and 49 mL/min [5, 21].

8. b. Dose of rivaroxaban:Rivaroxaban is prescribed at a reduced dose of 15 mg once daily if CrCl is between 30 and 49 mL/min [5, 22].

8. c. Dose of apixaban:Apixaban is prescribed at a reduced dose of 2.5 mg twice daily when 2 of the 3 following criteria are present:Serum creatinine > 133 mol/L,Age > 80 years old,Weight <60kg [5, 20].