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While the decision may be shaped by local protocols and formularies, selecting between available NOACs should be a joint decision made with the patient, and based on clinical features and preference.1 As AF is a chronic condition, consideration needs to be given to how your patient’s general health may change over time, for example, a decline in renal function.

Please refer to the relative Summary of Product Characteristics for full indications.2–5 Each of these have variations in interactions, contraindications, efficacy and safety profiles, and other characteristics including dosing schedules.2–5

NOAC dosage recommendations in patients with NVAF across renal function levels2–6
Pharmacology-of-NOACs

Adapted from Steffel et al. 2018.6
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.5
*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.2–5

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

Abbreviations

AF = Atrial Fibrillation CI = Confidence Intervals NOAC = Non-VKA Oral Anticoagulant NVAF Non-Valvular Atrial Fibrillation
RR = Relative Risk SE = Systemic Embolism

References
  1. NICE. CG180. 2014. Available at: https://www.nice.org.uk/guidance/cg180. Accessed August 2019.
  2. Apixaban Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/2878/smpc. Accessed August 2019.
  3. Rivaroxaban Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/2793/smpc. Accessed August 2019.
  4. Dabigatran Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/4703/smpc. Accessed August 2019.
  5. Edoxaban Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/6906/smpc. Accessed August 2019.
  6. 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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