Direct-Acting Oral Anticoagulants: Practical Considerations for Emergency Medicine Physicians

Table 4

DOAC dosing for treatment and secondary prevention of VTE in the US [13–16].

Patient population	Dabigatran	Rivaroxaban	Apixaban	Edoxaban
General population	150 mg twice daily after 5–10 days of initial parenteral therapy if CrCl >30 mL/min	15 mg twice daily for 21 days and then 20 mg once daily	10 mg twice daily for 7 days and then 5 mg twice daily	60 mg once daily following 5–10 days of initial parenteral anticoagulant therapy
Renal impairment	No recommendations if CrCl ≤30 mL/min or on dialysis	Avoid if CrCl <30 mL/min	No dose change	Reduce dose to 30 mg once daily if CrCl is 15–50 mL/min
Elderly	No dose change	No dose change	No dose change	No dose change
Low body weight	NR	No dose change	NR	Reduce dose to 30 mg once daily if weight ≤60 kg
Concomitant P-gp inhibitor	Avoid if CrCl <50 mL/min	Avoid if P-gp inhibitor is also a strong CYP3A4 inhibitor	Reduce to 5.0 or 2.5 mg (for 10.0 and 5.0 mg doses, resp.) if P-gp inhibitor is also a strong CYP3A4 inhibitor; avoid if already taking 2.5-mg dose	Reduce dose to 30 mg once daily
Concomitant P-gp inducer	Avoid (e.g., rifampin)	Avoid if P-gp inducer is also a strong CYP3A4 inducer	Avoid if P-gp inducer is also a strong CYP3A4 inducer	Avoid concomitant use with rifampin

Should be taken with food.
Risk of stroke and bleeding increases with age but risk/benefit is favorable.
CrCl, creatinine clearance; CYP3A4, cytochrome P450 3A4 enzyme; DOAC, direct-acting oral anticoagulant; NR, not reported; P-gp, P-glycoprotein; VTE, venous thromboembolism.