Direct Acting Oral Anticoagulants (DOACs) in Renal Impairment: Practice Guide to Dosing Issues

Choosing the correct dose of an anticoagulant is important to ensure that the patient receives the benefits of reduction of thrombo-embolic events whilst minimising the risk of adverse bleeding events. For many patients the direct acting oral anticoagulants (DOACs) are now an alternative to treatment with a vitamin K antagonist (usually warfarin).

The purpose of this paper is to explain the background to dosing decisions for DOACs in patients with impaired renal function. The paper focuses on the use of DOACs in patients with atrial fibrillation and provides case study examples from current clinical practice.  It is intended as a practice aid, not national guidance, and is particularly suitable for new or less experienced practitioners working in primary care.

NB Since the publication of this paper the MHRA has issued the following advice for healthcare professionals: creatinine clearance (CrCl) should be calculated using the Cockcroft-Gault formula to determine dosage adjustments for DOACs. The MHRA advice includes this SPS guide in the supporting resources.

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