Table 1.

Evidence from randomized trial data regarding therapeutic anticoagulation on the basis of kidney function^4,63,64

eCrCl (mL/min)a	Warfarin	Apixabanb	Dabigatran	Edoxabanc	Rivaroxaban
>95	Adjusted dose (INR 2–3)	5 mg b.i.d.	150 mg b.i.d.	60 mg QDd	20 mg QD
51–95	Adjusted dose (INR 2–3)	5 mg b.i.d.	150 mg b.i.d.	60 mg QD	20 mg QD
31–50	Adjusted dose (INR 2–3)	5 mg b.i.d.(eCrCl cut-off 25 mL/min)	150 mg b.i.d. or 110 mg b.i.d.e	30 mg QD	15 mg QD

INR, international normalized ratio.

^aCockcroft-Gault estimated creatinine clearance (eCrCl).

^bApixaban dose modification from 5mg b.i.d. to 2.5mg b.i.d. if patient has any two of the following: serum creatinine ≥1.5mg/dL, age ≥80years, or body weight ≤60kg.

^cIn the ENGAGE-AF TIMI 48 study, the dose was halved if any of the following: eCrCl of 30–50mL/min, body weight ≤60kg, or concomitant use of verapamil or quinidine (potent P-glycoprotein inhibitors).

^dThis dose has not been approved for use by the US Food and Drug Administration in this category of kidney function.

^eIn countries where 110 mg b.i.d. is approved, clinicians may prefer this dose after clinical assessment of thromboembolic vs bleeding risk. This dose has not been approved for use by the US Food and Drug Administration.