Table 1.

Recommended doses of DOACs in NVAF and VTE patients according to phase-3 randomized controlled trials (RCTs)

	NVAF		VTE
	Standard dose	Dose reduction	Standard dose	Dose reduction
Apixaban	5 mg bid	2.5 mg bid if: age ≥ 80 yrs, weight ≤ 60 kg, creatinine ≥ 1.5 mg/dl (at least two); eGFR 15–29 ml/min (single criterion)	10 mg bid for 7 days followed by 5 mg bid	No in acute VTEa Extended treatment: possible 2.5 mg bid after 3–6 months
Edoxaban	60 mg od	30 mg od if eGFR 15–49 ml/min, weight ≤ 60 kg, concomitant potent P-Gp inhibitor	60 mg od preceded by LMWH for 5 days	30 mg od if dose reduction criteria as for AF satisfied
Rivaroxaban	20 mg od	15 mg od if eGFR 15–49 ml/min	15 mg bid for 21 days followed by 20 mg od	No in acute VTEb Extended treatment: possible 10 mg od after 3–6 months
Dabigatran	150 mg bid/110 mg bid	110 mg bid if age ≥ 80 yrs, concomitant verapamil, increased bleeding riskc	150 mg bid preceded by LMWH for 5 days	Nod

Adapted from [3]

bid twice a day, od once daily, eGFR estimated glomerular filtration rate, LMWH low molecular weight heparin, P-Gp P-glycoprotein, RCT randomized controlled trial, SmPc summary of product characteristics (from European Medicines Agency), yrs years

^aPer SmPc: it should be used with caution in patients eGFR 15–29 ml/min

^bPer SmPc: in patients with eGFR 15–49 ml/min reduced dose 15 mg od should be considered only if risk of bleeding outweighs risk for recurrent DVT/PE (based on pharmacokinetics/ pharmacodynamic analyses; not studied in this setting)

^cPer SmPc: no prespecified dose reduction criteria in phase-3 RCT

^dPer SmPc: possible dose-reduction criteria as for AF (based on pharmacokinetics/pharmacodynamic analyses; not studied in this setting)