Table 1.
Dosing recommendations for direct oral anticoagulants in chronic kidney disease (stage 3 and 4)
| CKD stage | Guideline-statement | Year- type | Apixaban | Rivaroxaban | Edoxaban | Dabigatran |
|---|---|---|---|---|---|---|
| Stage 3 | AHA/ACC/HRS3 | 2019- guideline | 5 bid* | 15 qd | 30 qd | 150 bid |
| ACCP4 | 2018- guideline | 5 bid* | 15 qd | 30 qd | 150 or 110 bid | |
| EHRA5 | 2018- statement | 5 bid* | 15 qd¶ | 30 qd | 150 or 110 bid | |
| KDIGO6 | 2018- statement | 5 bid* | 15 qd | 30 qd | 150 or 110 bid | |
| ESC7 | 2016- guideline | 5 bid* | 15 qd | 30 (or 15 mg) qd | 150 or 110 bid | |
| Stage 4 | AHA/ACC/HRS3 | 2019- guideline | 5 bid* | 15 qd | Not recommended | 75 bid |
| ACCP4 | 2018- guideline | 2.5 bid | 15 qd | 30 qd | 75 bid (US only) | |
| EHRA5 | 2018- statement | 2.5 bid | 15 qd | 30 qd | Not recommended | |
| KDIGO6 | 2018- statement | Consider 2.5 bid | Consider 15 qd | Consider 30 qd | Consider 75 bid | |
| ESC7 | 2016- guideline | Not recommended | Not recommended | Not recommended | Not recommended |
, 2.5 mg bid if two of the three criteria are met: creatinine ≥1.5 mg/dl, body weight ≤60 kg, age ≥80
, 20 mg qd if creatinine clearance >50 ml/min
CKD, chronic kidney disease; stage 3 defined as CrCl of 30–50 ml/min (AHA/ACC/HRS, EHRA), of 30–59 ml/min (ACCP), of 31–50 ml/min (KDIGO), of 25–50 ml/min (KDIGO for apixaban), of 30–49 ml/min (ESC); stage 4 defined as a CrCl of 15–30 ml/min (AHA/ACC/HRS, ACCP, EHRA, KDIGO), of <30 ml/min (ESC) or of <25 ml/min (ESC for apixaban). AHA, American Heart Association; ACC, American College of Cardiology; HRS, Heart Rhythm Society; ACCP, American College of Chest Physicians; CrCl, creatinine clearance; EHRA, European Heart Rhythm Association; KDIGO, Kidney Disease – Improving Global Outcomes; ESC, European Society of Cardiology; qd, once daily; bid, twice daily
Adapted from Kumar et al. J Am Coll Cardiol 2019; 74:2210.2