Table 1 Characteristics of DOACs for patients with VTE, and considerations relating to patient risk factors/comorbidities
DOAC | Â | Dosing schedule | Requirement of LMWH pre-treatment | Considerations for patients with renal impairment | Considerations for patients in relation to body weight | Considerations for patients who are elderly |
|---|---|---|---|---|---|---|
Apixaban (Eliquis) | Initial treatment of DVT or PE | First 7 days: 10 mg twice daily | Not required | CrCl – 15 to 29mL/min – use with caution CrCl < 15mL/min – not recommended for use | None | None |
Followed by: 5 mg twice daily (for 3–6 months) | ||||||
Continuation of treatment if prevention of recurrence is required | 2. 5Â mg twice daily | |||||
Rivaroxaban (Xarelto) | Initial treatment of DVT or PE | Day 1 to day 21: 15 mg twice daily | Not required | CrCl – 30–49mL/min – patients should be treated with 15 mg twice daily for the first 3 weeks, when recommended dose is 20 mg, a reduction to 15 mg should be considered CrCl – 15 to 29mL/min – to be used with caution in these patients. Patients should be treated with 15 mg twice daily for the first 3 weeks, when recommended dose is 20 mg, a reduction to 15 mg should be considered. Use according to individual assessment of thromboembolic risk and risk of bleeding CrCl < 15mL/min – not recommended for use | None | None |
Day 22 onwards: 20Â mg once daily | ||||||
Continuation of treatment if prevention of recurrence is required | 10Â mg once daily or 20Â mg once daily (in case of patients at high risk) | |||||
Edoxaban (Lixiana) | Initial treatment and continuation of treatment for DVT and PE | 60 mg once daily following at least 5 days of parental anticoagulation | Required | CrCl – 15 to 30mL/min – use 30 mg once daily | For those with body weight ≤ 60 kg use 30 mg once daily | None |
Dabigatran (Pradaxa) | Treatment and continuation of treatment for DVT and PE | 150 mg twice daily following at least 5 days of treatment with a parenteral anticoagulant | Required | CrCl < 30 mL/min dabigatran is contraindicated CrCl 30 mL/min to 50 mL/min use daily dose of 300 mg or 220 mg according to individual assessment of thromboembolic risk and risk of bleeding | None | For those aged ≥ 80 years twice daily dose of 110 mg For those aged 75–80 years use daily dose of 300 mg or 220 mg according to individual assessment of thromboembolic risk and risk of bleeding |