Table 3.

Summary of evidence for warfarin and DOACs in AF by CKD stage

CKD stage	Warfarin	DOACs
Mild to moderate Stages 2‐3 (eGFR 30‐90 mL/min/1.73 m2)	Primarily observational data supporting use	High quality data support use, may be superior to warfarin
Severe Stage 4 (eGFR 15‐29 mL/min/1.73 m2)	Limited data supports use	Pharmacologic studies allow for use with dose reductions, lack patient data
End stage renal disease Stage 5 (eGFR <15 mL/min/1.73 m2 or on hemodialysis)	Majority of studies suggest lack of benefit and possible harm	Dabigatran removed by dialysis Rivaroxaban has safe drug levels based on modeling, but lacks patient data Apixaban safe and effective based on modeling and retrospective data, prospective data needed

Abbreviations: AF, atrial fibrillation; CKD, chronic kidney disease; DOAC, direct oral anticoagulant; eGFR, estimated glomerular filtration rate.