renal effects

Rivaroxaban - Dosing and Renal Function Effects

The presence of chronic kidney disease is an independent risk factor for increased bleeding events, including hemorrhagic stroke. Please carefully consider the risks and benefits of any oral anticoagulant prior to initiating therapy.

 

CrCl FDA Recommended Dose for Atrial Fibrillation FDA Recommended Dose for VTE Prevention in Ortho Surgery FDA Recommended Dose for VTE Treatment AUC T 1/2
> 80 ml/min 20mg daily 10mg daily 15mg bid for 21 days, then 20mg daily for remainder of treatment course - 8.3 hrs
50-80 ml/min 1.4 x increase 8.7 hrs
30-49 ml/min

CrCl 15-49 ml/min:     15mg daily

CrCl < 15ml/min:         avoid use

UWMedicine: RESTRICTED IF CrCl < 30 ml/min, consider alternative therapy

1.5 x increase 9 hrs
<30 ml/min

CrCl < 30ml/min: avoid use

UWMedicine: RESTRICTED IF CrCl < 30 ml/min, consider alternative therapy

CrCl< 30ml/min: avoid use

UWMedicine: RESTRICTED IF  CrCl < 30 ml/min, consider alternative therapy

1.6 x increase 9.5 hrs

 

 

 

 

 

 

 

 

 

 

 

Kubitza D et al. Effects of renal impairment on the pharmacokinetics, pharmacodynamics and safety of rivaroxaban, an oral, direct Factor Xa inhibitor. B J Clin Pharmacol 2010; 70:703-12.

Dabigatran - Dosing and Renal Function Effects

The presence of chronic kidney disease is an independent risk factor for increased bleeding events, including hemorrhagic stroke. Please carefully consider the risks and benefits of any oral anticoagulant prior to initiating therapy.

 

Stangier J et al. Influence of renal impairment on the pharmacokinetics and pharmacodynamics of oral dabigatran etexilate: an open-label, parallel-group, single-centre study.Clin Pharmacokinetics 2010; 49:259-68

CrCl FDA Recommended Dose  Treatment of DVT/PE

FDA Recommended Dose Stroke Prevention in AF

UW Medicine Restrictions AUC Cmax T 1/2
> 80 ml/min 150mg BID after 5-10 days of parenteral anticoagulant therapy 150 mg BID UWMedicine: RESTRICTED IF CrCl < 50 ml/min - - 14 hrs
50 – 80 ml/min 1.5 x increase 1.1 x increase 17 hrs
30 – 50 ml/min 3.2 x increase 1.7 x increase 19 hrs
<  30 ml/min Not recommended CrCl 15-30 ml/min: 75mg BID*
*based on computer modeling; not studied in patients

Consider alternative therapy

RESTRICTED

6.3 x increase 2.1 x increase 28 hrs
CrCl < 15 ml/min: not recommended

Consider alternative therapy

RESTRICTED

10-20 ml/min
on HD
Not recommended Not recommended

Consider alternative therapy

RESTRICTED

    34 hrs
(~65% removed by HD)