68
Management
Table 19. Recommended Doses of Currently Approved
DOACs According to Renal Function
CrCl (mL/min)
DOAC >95 mL/min 51–95 31–50 15–30
<15 or on
dialysis
Apixaban 5 or 2.5 mg twice
daily*
5 or 2.5
mg twice
daily*
5 or 2.5
mg twice
daily*
5 or 2.5
mg twice
daily*
5 or 2.5 mg twice
daily*
Dabigatran 150 mg twice
daily
150 mg
twice
daily
150 mg
twice
daily
75 mg
twice
daily
Contraindicated
Edoxaban Contraindicated 60 mg
once
daily
30 mg
once
daily
30 mg
once
daily
Contraindicated
Rivaroxaban 20 mg once daily 20 mg
once
daily
15 mg
once
daily
15 mg
once
daily
15 mg once
daily
†
Note that other, nonrenal considerations such as drug interactions may also apply.
e gray area indicates doses not studied in the pivotal clinical trials of these agents.
* If at least 2 of the following are present: serum creatinine ≥1.5 mg/dL, age ≥80 years, or
body weight ≤60 kg, the recommended dose is 2.5 mg twice daily. e ARISTOTLE trial
excluded patients with either a creatinine of >2.5 mg/dl or a calculated CrCl <25 mL/min.
†
Rivaroxaban is not recommended for other indications in patients with a CrCl <15 mL/min,
but such a recommendation is not made for the AF indication. However, pharmacokinetic
data are limited.
6.8.5. AF in Valvular Heart Disease
COR LOE
Recommendations
1 B-R 1. In patients with rheumatic mitral stenosis or mitral stenosis
of moderate or greater severity and history of AF, long-term
anticoagulation with warfarin is recommended over DOACs,
independent of the CHA
2
DS
2
-VASc score to prevent
cardiovascular events, including stroke or death.
1 B-NR 2. In patients with AF and valve disease other than moderate or
greater mitral stenosis or a mechanical heart valve, DOACs
are recommended over VKAs.
