Direct oral anticoagulants lack robust clinical trial evidence to guide dosing in patients with atrial fibrillation and kidney-, age-, or weight-related alterations in pharmacokinetics.
How should direct oral anticoagulants be used for stroke prevention in patients with atrial fibrillation and renal impairment, extremes in weight, or advanced age?
This review summarizes the pharmacokinetics and available clinical evidence to guide the dosing of direct oral anticoagulants in patients with atrial fibrillation and renal impairment, extreme weight, or advanced age.
A growing number of patients with an indication for stroke prevention in atrial fibrillation have kidney-, age-, or weight-related alterations in pharmacokinetics that affect dosing of direct oral anticoagulants. Because these patients were excluded from or comprised a small number of patients in clinical trials, there is a lack of evidence to guide clinicians. As a consequence, many patients do not receive oral anticoagulation despite a high risk for atrial fibrillation-related stroke. Here, we present a review of direct oral anticoagulant pharmacokinetics and a review of the available clinical evidence in patients with weight-, kidney-, and age-related disease.
Buckley et al. (Fri,) conducted a review in Atrial fibrillation. Direct oral anticoagulants was evaluated. Direct oral anticoagulants lack robust clinical trial evidence to guide dosing in patients with atrial fibrillation and kidney-, age-, or weight-related alterations in pharmacokinetics.