Introduction
Compliance with Ethics Guidelines
Patients with Chronic Kidney Disease
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NOACs are all partly eliminated by the kidneys, causing a pharmacokinetic interaction in the case of chronic kidney disease.
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It is recommended to estimate renal function for AF patients using the Cockcroft–Gault formula used in clinical trials evaluating NOACs.
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Current knowledge indicates that NOACs should not be used in patients with dialysis or creatinine clearance less than 30 mL/min.
Creatinine clearance (mL/min) | Dabigatran | Apixaban | Edoxaban | Rivaroxaban |
---|---|---|---|---|
≥50 | No adjustment | No adjustment | No adjustment | No adjustment |
≥30 and <50 | 110 mg BID | 2.5 mg BIDa
| 30 mg OD | 15 mg OD |
<30 | Not recommended | Not recommended | Not recommended | Not recommended |
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The superiority of NOACs over VKAs demonstrated in clinical trials is also observed in this population at higher risk of thromboembolic and hemorrhagic complications.
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The use of lower doses is recommended for patients with creatinine clearance 30–50 mL/min, also taking into account the patient’s age and weight for apixaban.
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The use of anti-Xa NOACs could be considered with great caution in patients with creatinine clearance 15–30 mL/min.
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In the absence of evidence, all NOACs are contraindicated in patients requiring dialysis or with creatinine clearance less than 15 mL/min.
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Initial and subsequent monitoring of renal function using the Cockroft–Gault formula is recommended.