Renal Function Considerations for Stroke Prevention in Atrial Fibrillation  John Fanikos, RPh, MBA, Allison E. Burnett, PharmD, Charles E. Mahan, PharmD, Paul P. Dobesh, PharmD  The American Journal of Medicine  Volume 130, Issue 9, Pages 1015-1023 (September 2017) DOI: 10.1016/j.amjmed.2017.04.015 Copyright © 2017 The Authors Terms and Conditions

Figure 1 Dosing recommendations in the US based on kidney function measured by creatinine clearance, as per prescribing information.24-27 BID = twice daily; CrCl = creatinine clearance; P-gp = P-glycoproteins; QD = once daily; SCr = serum creatinine. aNot recommended for patients with CrCl <30 mL/min taking concomitant P-gp inhibitors; the dose should be reduced or avoided in patients with CrCl 30-50 mL/min who use concomitant P-gp inhibitors. bShould be taken with the evening meal. cApixaban should be reduced to a dose of 2.5 mg BID in patients for whom 2 of the following apply: serum creatinine >1.5 mg/dL, age ≥80 years old, body weight ≤60 kg; apixaban may be administered to patients on hemodialysis at a dose of 5 mg unless dose administration is warranted based on reduction criteria. dLabeling suggests rivaroxaban may be administered to patients on hemodialysis at a dose of 15 mg unless dose administration is warranted based on reduction criteria; however, as it has not been adequately studied in a large-scale clinical trial, use in this population should be avoided whenever possible. eLabeling suggests apixaban may be administered to patients on hemodialysis at a dose of 5 mg unless dose administration is warranted based on reduction criteria; however, as it has not been adequately studied in a large scale clinical trial, use in this population should be avoided whenever possible. The American Journal of Medicine 2017 130, 1015-1023DOI: (10.1016/j.amjmed.2017.04.015) Copyright © 2017 The Authors Terms and Conditions

Figure 2 Rates of stroke or systemic embolism relative to warfarin for the DOACs stratified by renal function calculated by Cockroft-Gault.24,26,27,32,33 CrCl = creatinine clearance; DOAC = direct oral anticoagulant. aFor CrCl 30-50 mL/min. The American Journal of Medicine 2017 130, 1015-1023DOI: (10.1016/j.amjmed.2017.04.015) Copyright © 2017 The Authors Terms and Conditions

Figure 3 Rates of major bleeding relative to warfarin for the DOACs stratified by renal function calculated by Cockroft-Gault.24,26,27,32-34 CrCl = creatinine clearance; DOAC = direct oral anticoagulant. aFor CrCl 30-50 mL/min. The American Journal of Medicine 2017 130, 1015-1023DOI: (10.1016/j.amjmed.2017.04.015) Copyright © 2017 The Authors Terms and Conditions