Novel Anticoagulants in Atrial Fibrillation: Monitoring, Reversal and Perioperative Management

Table 3

Dosage recommendations for NOACs and contraindications [17, 34, 48].

NOACs	Dosage for stroke prevention	Indications for a reduced dosage	Contraindications
Dabigatran	150 mg twice daily	(i) 75 mg twice daily for those with CrCl 15–30 mL/min; (ii) 75 mg twice daily for those on P-gp inhibitors in with CrCl 30–50 mL/min	(i) Patients with CrCl < 15 mL/min; (ii) Active pathological bleeding; (iii) Mechanical prosthetic heart valve; (iv) Patients on P-gp inducer rifampin; (v) Patients on P-gp inhibitors with CrCl <30 mL/min
Rivaroxaban	20 mg once a day	15 mg once daily for those with CrCl 15–50 mL/min	(i) Severe renal impairment (CrCL <15 mL/min); (ii) Moderate or severe hepatic impairment (Child-Pugh B or Child-Pugh C) or with any degree of hepatic disease associated with coagulopathy; (iii) Nursing women; (iv) Active pathological bleeding; (v) Coadministration of combined P-gp and strong CYP3A4 inhibitors and inducers
Apixaban	5 mg twice daily	(i) 2.5 mg twice daily if patients meet 2 of 3 criteria: age 80 years, body weight 60 kg, or serum creatinine level 1.5 mg/dL; (ii) 2.5 mg twice daily if coadministration of strong dual inhibitors of CYP3A4 and P-gp	(i) Active pathological bleeding; (ii) Pregnant and nursing women; (iii) Coadministration of strong dual inducers of CYP3A4 and P-gp