Severe renal impairment: CrCl <30 mL/min with dabigatran CrCl <15 mL/min with apixaban* CrCl <15 mL/min with rivaroxaban* Liver impairment e.g. cirrhosis (Child Pugh C) Current active bleeding or coagulopathy Previous life-threatening haemorrhage while on a direct oral anticoagulant Documented previous anaphylaxis to a direct oral anticoagulant

* International European guidelines approve the use of apixaban and rivaroxaban in patients with CrCl as low as 15 mL/min, however this is not reflected in Australian guidance (see Table 3).

CrCl creatinine clearance

Source: reference 18