Pharmacological targets and UK licensed indications of oral anticoagulants
| Oral anticoagulant | Target | UK indications | Dosing based on CrCl (mL/min) | |||
|---|---|---|---|---|---|---|
| ≥50 | 30–49 | 15–29 | <15 or ESKD | |||
| Warfarin | Inhibitor of vitamin K-dependent clotting factors | AF, prosthetic heart valve, VTE, TIA | Monitor INR | |||
| Dabigatran | Direct thrombin inhibitor | VTE, AF | 150 mg twice daily (110 mg twice daily if ≥80 years, or on verapamil, or increased bleeding risk) | Not recommended | ||
| Rivaroxaban | Direct inhibitor of activated factor X | VTE, AF, or atheroembolic prophylaxis after ACS, or in CAD, or PAD | 20 mg once daily | 15 mg once daily | Not recommended | |
| Apixaban | Direct inhibitor of activated factor X | VTE, AF | 5 mg twice daily (2.5 mg twice daily if two out of age ≥80 years, Wt <60 kg and sCr ≥133 μmol/L) | 2.5 mg twice daily | Not recommended | |
| Edoxaban | Direct inhibitor of activated factor X | VTE, AF | 60 mg once daily (30 mg once daily if Wt <60 kg and treatment with verapamil, dronedarone or quinidine) | 30 mg once daily | Not recommended | |
The dose adjustments suggested are for guidance only and the reader is directed to local protocols and formularies for definitive dosing. ACS = acute coronary syndrome; AF = atrial fibrillation; CAD = coronary artery disease; CrCL = creatinine clearance rate; INR = international normalised ratio; PAD = peripheral arterial disease; sCr = serum creatinine; TIA = transient ischaemic attack; VTE = venous thromboembolism; Wt = body weight.