Direct oral anticoagulants, Summaries of Pharmacology

DOACS summary dosing and crcl cut off

Typology: Summaries

2023/2024

Uploaded on 09/14/2024

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DOAC:&VTE&Treatment&Courses&&
Rivaroxaban:15&mg&twice&daily&x&21&days&& 20&mg&daily&&
Apixaban:10&mg&twice&daily&&
&x&7&days&
5&mg&&
twice&daily&
2.5$mg$
twice$
daily*$
Parenteral&
Anticoagulation&5-10&
days&FIRST&&
Dabigatran:150&mg&twice&daily&&
Parenteral&Anticoagulation&
5-10&days&FIRST&& Edoxaban:60&mg&daily&&
* Optional at 6 months
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DOAC: VTE Treatment Courses

Rivaroxaban: 15 mg twice daily x 21 days 20 mg daily

Apixaban: 10 mg twice daily

x 7 days

5 mg

twice daily

2.5 mg twice daily*

Parenteral

Anticoagulation 5-

days FIRST

Dabigatran: 150 mg twice daily

Parenteral Anticoagulation

5-10 days FIRST

Edoxaban: 60 mg daily

  • Optional at 6 months

DOAC: VTE Treatment Dosing

VTE

Treatment

Dabigatran Apixaban Rivaroxaban Edoxaban

Initial

Treatment

Dose

150 mg BID AFTER 5-10 days parenteral anticoagulation (i.e. heparin or LMWH) 10 mg BID for 7 days à 5 mg BID 15 mg BID for 21 days à 20 mg daily with food 60 mg daily AFTER 5-10 days parenteral anticoagulation (i.e. heparin or LMWH)

Risk of

Recurrence

Reduction

150 mg BID (if CrCl >30 ml/min) *After previous treatment 2.5 mg BID *After >6 months 10 mg daily (with/without food) *After >6 months Not in labeling

Renal Dosing

(ml/min)

CrCl <30: AVOID No dose adjustment (CrCl <25 not studied) CrCl <30: AVOID CrCl 15 – 50: 30mg CrCl <15: AVOID

Warfarin Conversion to DOACs

DOAC Conversion FROM Warfarin TO a DOAC

Rivaroxaban STOP warfarin and START rivaroxaban when INR <3.

Edoxaban STOP warfarin and START^ edoxaban^ when INR^ <2.

Apixaban STOP warfarin and START apixaban when INR^ <2.

Dabigatran STOP warfarin and START dabigatran when INR^ <2.