ÎÎAlthough its safety and efficacy have not been established, apixaban
2.5 mg twice daily may be considered as an alternative to warfarin
in patients with nonvalvular AF deemed appropriate for vitamin K
antagonist therapy who have at least 1 additional risk factor and
≥2 of the following criteria: Age ≥80 years, weight ≤60 kg, or serum
creatinine ≥1.5 mg/dL (IIb-C).
ÎÎApixaban should NOT be used if the CrCl is <25 mL/min (III-C).
Rivaroxaban
ÎÎIn patients with nonvalvular AF who are at moderate to high risk of
stroke (prior history of TIA, stroke, or systemic embolization or
≥2 additional risk factors), rivaroxaban 20 mg/d is reasonable as an
alternative to warfarin (IIa-B).
ÎÎIn patients with renal impairment and nonvalvular AF who are at
moderate to high risk of stroke (prior history of TIA, stroke, or
systemic embolization or ≥2 additional risk factors), with a CrCl of
15 to 50 mL/min, 15 mg of rivaroxaban daily may be considered.
However, its safety and efficacy have not been established (IIb-C).
ÎÎRivaroxaban should NOT be used if the CrCl is <15 mL/min (III-C).
Table 2. Agents Recommended for Stroke Preventiona
Agent (Brand)
Dose
Vitamin K Antagonist
Warfarin (Coumadin®, Jantoven®)
POb
Antiplatelet Agents
Aspirin (generic)
75-325 mg/day
Clopidogrel (Plavix®)
75 mg/day
Thrombin IIa Inhibitor
Dabigatran (Pradaxa®)
ClCr >30 mL/min: 220 mg PO daily
ClCr 15-30 mL/min: 150 mg PO daily
Factor Xa Inhibitors
Apixaban (Eliquis®)
2.5-5 mg PO bid
Rivaroxaban (Xarelto®)
Prophylaxis: 20 mg PO daily
(15 mg for ClCr 15-50 mL/min)
a
b
See Prescribing Information for details.
Adjust to international normalized ratio.
