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Patients who require anticoagulation often have pre-existing comorbidities or other special considerations that can make treatment decisions more challenging. In older patients (>65 years), key considerations are a heightened risk of stroke and bleeding, as well as comorbidities, concomitant medications, and physical and cognitive health.1,2 Additional NOAC prescribing considerations exist for hepatically and renally impaired patients.3–6 An overview of NOAC dosage recommendations in patients with NVAF across renal function levels is shown below.

NOAC dosage recommendations in patients with NVAF across renal function levels3–7

Adapted from Steffel et al. 2018.7 Please refer to the SmPCs of individual drugs for more detailed information on dosing. A trend towards decreasing efficacy with increasing CrCl was observed for edoxaban compared to well-managed warfarin. Therefore, edoxaban should only be used in patients with NVAF and high CrCl after a careful evaluation of the individual thromboembolic and bleeding risk.6
*Mild renal impairment is defined as CrCl 51–80 ml/min for ELIQUIS, and 50–80 ml/min for rivaroxaban, dabigatran, and edoxaban; moderate renal impairment is defined as 30—50 ml/min for ELIQUIS, dabigatran, and edoxaban, and 30–49 ml/min for rivaroxaban; severe renal impairment is defined as 15–29 ml/min for ELIQUIS, rivaroxaban, and edoxaban and <30 ml/min for dabigatran.3–6


NOAC dosage recommendations in patients with NVAF across hepatic function levels 3–6

For more information on prescribing considerations with NOACs refer to the Summaries of Product Characteristics.3–6

Case studies – assessment of anticoagulation

These case studies highlight typical scenarios that may arise during assessment of anticoagulation.

Click here to view ELIQUIS (apixaban) prescribing and adverse event reporting information.

Abbreviations

AF = Atrial Fibrillation NICE = National Institute for Health and Care Excellence NOAC = Non-VKA Oral Anticoagulant
NVAF = Non-Valvular Atrial Fibrillation VKA = Vitamin K Antagonist

References
  1. Turagam MK et al. Clin Interv Aging 2015; 10: 1431–1444.
  2. Foody JM. Clin Interv Aging 2017; 12: 175–187.
  3. Apixaban Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/2878/smpc.. Accessed August 2019.
  4. Rivaroxaban Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/2793/smpc.. Accessed August 2019.
  5. Dabigatran Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/4703/smpc.. Accessed August 2019.
  6. Edoxaban Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/6906/smpc. Accessed August 2019.
  7. Steffel J, et al. Eur Heart J. 2018; 39: 1330–1393.

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Job code: 432UK1900440-01
Date of preparation: September 2019

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