Can I use DOAC in a patient with renal disease?

Case A 76-year-old man is diagnosed with non-valvular atrial fibrillation. His comorbid conditions are hypertension, diabetes complicated by neuropathy, and chronic kidney disease stage 3. His current medications include metformin, lisinopril, gabapentin, and aspirin. His most recent laboratories showed a creatinine 1.8, creatinine clearance (CrCl) 35 mL/min, hemoglobin 11g/dL, and international normalized ratio 1.0. His congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, and sex (CHADSVASc) score is 4. Which medication should we use to prevent stroke in this patient?  Brief overview of the issue Chronic kidney disease (CKD) affects approximately 15% of adults worldwide. This disease co-exists with other major cardiovascular diseases such as atrial fibrillation (AF). The prevalence of AF in CKD ranges between 12% and 18% in different studies and increases further with decreasing CrCl.1  Current guidelines recommend anticoagulation to reduce thromboembolic events in patients with AF if the CHADSVASc score is >2 for men and >3 for women. Warfarin is therapeutically satisfactory, but it is the narrow therapeutic window, complex drug-interaction profile, and need for frequent laboratory monitoring which makes it cumbersome for many patients.  Direct oral anticoagulants (DOACs) have emerged as a promising option because of more reliable anticoagulation activity at fixed dose and fewer drug-drug interactions (DDIs).2 Several well conducted, ran...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: Renal & Genitourinary Source Type: research