Criteria for dose reduction of non-VKA oral anticoagulants in the treatment of acute VTE
| Criteria . | Dabigatran 110 mg twice per day* . | Rivaroxaban 15 mg once per day . | Apixaban 2.5 mg twice per day . | Edoxaban 30 mg once per day . |
|---|---|---|---|---|
| Age | >80 or >75 years plus history of bleeding | No | No† | No |
| Weight ≤60 kg | No | No | No† | Yes |
| Moderate renal impairment‡ | No | Only for SPAF | No† | Yes |
| Concomitant P-gp inhibitors§ | No | No | No | Yes |
| Increased risk of bleeding|| | No | In Europe | No | No |
| After 6 months of treatment | No | No | Yes | No |
| Criteria . | Dabigatran 110 mg twice per day* . | Rivaroxaban 15 mg once per day . | Apixaban 2.5 mg twice per day . | Edoxaban 30 mg once per day . |
|---|---|---|---|---|
| Age | >80 or >75 years plus history of bleeding | No | No† | No |
| Weight ≤60 kg | No | No | No† | Yes |
| Moderate renal impairment‡ | No | Only for SPAF | No† | Yes |
| Concomitant P-gp inhibitors§ | No | No | No | Yes |
| Increased risk of bleeding|| | No | In Europe | No | No |
| After 6 months of treatment | No | No | Yes | No |
SPAF, stroke prophylaxis in atrial fibrillation.
Approved only in countries outside the United States.
Apixaban is dose-reduced only for stroke prophylaxis and only if 2 of the 3 criteria are fulfilled.
Calculated creatinine clearance of 30-50 mL/min.
Strong P-gp inhibitors with recommended dose reduction of edoxaban are cyclosporine, dronedarone, erythromycin, ketokonazole, and quinidine.
In the European product monograph for rivaroxaban “increased risk of bleeding” is defined as patients with uncontrolled severe arterial hypertension and/or receiving concomitant treatment affecting hemostasis.