Non-vitamin K antagonist oral anticoagulant dosing in patients with atrial fibrillation and renal dysfunction

Atrial fibrillation (AF) is the commonest cardiac arrhythmia and is an independent risk factor for stroke and mortality. Oral anticoagulation is the cornerstone of management for primary and secondary stroke prophylaxis in patients with AF and known additional risk factors (1). Whilst oral vitamin K antagonists (VKA) such as warfarin were the mainstay of treatment for decades, they have been superseded by the newer non-vitamin K antagonist oral anticoagulants (NOACs), which offer relative efficacy, safety and convenience compared to VKAs (2,3). The NOACs include direct thrombin inhibitor, dabigatran and direct factor Xa inhibitors such as rivaroxaban, apixaban and edoxaban.