Table 2 Dose adjustment of dabigatran, rivaroxaban and apixaban according to age, renal function and body weight

Dabigatran

• <75 years: 150 mg b.i.d.

• CrCl ≥50 mL/min: no dose adjustment is necessary.

• No dose adjustment is necessary according to body weight. However, close clinical follow-up is required for patients with a body weight <50 kg.

• 75-80 years: 150 b.i.d. (110 mg b.i.d. should be considered when the risk of stroke is low and the bleeding risk is high).

• CrCl 30-50 mL/min: the recommended dose is 150 mg b.i.d. (110 mg b.i.d. for patients with high risk of bleeding).

• ≥80 years: 110 mg b.i.d.

• CrCl < 30 ml/min: contraindicated.

Rivaroxaban

• No dose adjustment is required.

• CrCl ≥50 mL/min: 20 mg o.d.

• No dose adjustment is necessary according to body weight.

• CrCl 15-49 mL/min: 15 mg o.d.

• CrCl <15 mL/min: not recommended.

Apixaban

• Recommended dose: 5 mg b.i.d.

• Recommended dose: 5 mg b.i.d.

• Recommended dose: 5 mg b.i.d.

• 2.5 mg b.i.d. in case of at least 2 of the following characteristics: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥ 1.5 mg/dL.

• 2.5 mg b.i.d. in case of at least 2 of the following characteristics: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥ 1.5 mg/dL.

• 2.5 mg b.i.d. in case of at least 2 of the following characteristics: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥ 1.5 mg/dL.

• No dose adjustment is required according to age, unless criteria for dose reduction are met.

• No dose adjustment is necessary in patients with mild or moderate renal impairment, unless criteria for dose reduction are met.

• No dose adjustment is required according to body weight, unless criteria for dose reduction are met

• CrCl 15-29 mL/min: 2.5 mg b.i.d.

• CrCl < 15 ml/min, or dialysis: not recommended.

Edoxaban

• No dose adjustment is required.

• CrCl ≥50 mL/min: 60 mg o.d.

• Body weight >60 kg: 60 mg o.d.

• CrCl 15-49 mL/min: 30 mg o.d.

• Body weight ≤60 kg: 30 mg o.d.

• CrCl <15 mL/min: not recommended.