Table 3.

Dose adjustment for DOACs according to chronic kidney disease severity in patients with atrial fibrillation/venous thromboembolism (adapted from Potpara ‐ 9, Harel ‐ 22, Bhatia ‐ 13, Ghadban ‐ 23)

Recommended oral anticoagulant	CrCl (mL/min) estimated using the Cockroft‐Gault equation
	≥50	30–49	15–29	<15	End‐stage renal disease on dialysis
	DOACs	DOACs	Warfarin/DOACs	Warfarin/DOACs (with caution)
Warfarin	Preferable to adjust the dose function of time in therapeutic range, optimal ≥70%
Dabigatran	150 mg twice daily 110 mg twice daily ≥80 years, or associated with P‐glycoprotein inhibitors, or high risk of hemorrhage	Idem	The United States (based only on FDA approval) ‐ 75 mg twice daily Europe ‐ NO	No
Rivaroxaban	20 mg once daily	15 mg once daily (dose used by landmark trials recommended by small pharmacokinetic studies)		No
Apixaban	5 mg twice daily 2.5 mg twice daily if any ≥2 of the following: age ≥ 80 years, body weight ≤ 60 kg and creatinine ≥1.5 mg/dL	Idem	2.5 mg twice daily	The United States – 2.5 mg twice daily Europe ‐ NO	The United States (FDA) ‐ 5 mg twice daily Europe ‐ NO
Edoxaban	60 mg once daily 30 mg once daily when ≥2 of the following criteria are met: body weight ≤ 60 kg, CrCl 30‐50 mL/min and therapy with Verapamil, Dronedarone or Quinidine is associated FDA black box warning for CrCl >95 mL/min	30 mg once daily		No

Abbreviations: DOAC, direct oral anticoagulant; FDA, Food and Drug Administration.