Fast Five Quiz: Direct Oral Anticoagulant Therapy for Atrial Fibrillation

Sandeep K. Goyal, MD


April 02, 2020

The AHA/ACC/HRS focused update notes that dabigatran, edoxaban, and rivaroxaban are not recommended for use in patients with AF and ESRD. The guidelines further state that for patients with a creatinine clearance rate < 15 mL/min or who are receiving dialysis, it is reasonable to use apixaban or warfarin for oral anticoagulation therapy.

The 2016 ESC guidelines do not make specific recommendations for patients with AF and ESRD; however, they do note that "anticoagulation can be safely used in AF patients with moderate or moderate-to-severe CKD [glomerular filtration rate (GFR) ≥ 15 mL/min]." The ESC guidelines also note the lack of controlled trials of DOACs in patients with severe chronic kidney disease (creatinine clearance rate, 25-30 mL/min) to make a recommendation for their use in this patient population.

Learn more about renal function considerations for DOAC agent use.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.