Dosing in non-valvular atrial fibrillation: renal function, age and body weight
| Dabigatran | Rivaroxaban | Apixaban | Edoxaban | |
|---|---|---|---|---|
| Standard dose | 150 mg bd | 20 mg od | 5 mg bd | 60 mg od |
| Renal function | ||||
| CrCl 30–49 mL/min | Consider 110 mg bd | 15 mg od | 5 mg bd | 30 mg od |
| CrCl 15–29 mL/min | Not recommended | Use with caution | 2.5 mg bd | 30 mg od |
| CrCl <15 mL/min | Not recommended | Not recommended | Not recommended | Not recommended |
| CrCl >95 mL/min | – | – | – | Not recommended |
| Age | ≥80 years: 110 mg bd | – | 2.5 mg bd where two of: | – |
| ≥75 years: consider 110 mg bd | > serum creatinine ≥1.5 mg/dL > age ≥80 years > weight ≤60 kg | |||
| Body weight | – | – | 2.5 mg bd where two of: | 30 mg od: |
| > serum creatinine ≥1.5 mg/dL > age ≥80 years > weight ≤60 kg | > weight ≤60 kg | |||
| Others | 110 mg bd: | 30 mg od: | ||
| > concomitant verapamil > consider where increased risk of bleeding | > concomitant use of cyclosporine, dronedarone, erythromycin or ketoconazole |
bd = twice per day; CrCl = creatinine clearance; NVAF = non-valvular atrial fibrillation; od = once daily