Direct oral anticoagulant dosages and precautions in liver disease
| Condition and direct oral anticoagulant | Child-Pugh class | ||
|---|---|---|---|
| A | B | C | |
| Nonvalvular atrial fibrillation | |||
| Apixaban | 5 mg twice daily or 2.5 mg twice dailya | Limited clinical experience; recommendations cannot be provided | Avoid |
| Edoxaban | 60 mg once daily | Avoid | Avoid |
| Rivaroxaban | 20 mg once daily | Avoidb | No clinical data available; avoid |
| Dabigatran | 150 mg twice daily | Large intersubject variability, but no evidence of a consistent change in drug exposure; use with caution or avoid | No clinical data available; avoid |
| Venous thromboembolism | |||
| Apixaban | 10 mg twice daily; transition to 5 mg twice daily after 7 days | Limited clinical experience; recommendations cannot be provided | Avoid |
| Edoxaban | 60 mg once daily | Avoid | Avoid |
| Rivaroxaban | 15 mg twice daily; transition to 20 mg once daily after 21 days | Avoidb | No clinical data available; avoidb |
| Dabigatran | 150 mg twice daily | Large intersubject variability, but no evidence of a consistent change in drug exposure; use with caution or avoid | No clinical data available; avoid |
Note: Class A is mild hepatic impairment, B is moderate impairment, and C is severe liver disease. Additional adjustments needed for concomitant use of P-glycoprotein or cytochrome P450 3A4 inhibitors, or both, are not included.
↵aReduce dose in patients with at least 2 of the following: age ≥ 80, body weight ≤ 60 kg, serum creatinine ≥ 1.5 mg/dL.17
↵bDrug exposure and bleeding risk may be increased.17,37
Based on information from reference 36.