Objectives: The primary objective of this study was to assess an optimal dose of direct oral anticoagulants (DOACs), complied with prescribing information using the Cockcroft and Gault (C-G) equation in patients with renal impairment. The secondary objective was to evaluate the consistency between the prescribed dose and the prescribing information. Clinical outcomes, including recurrence of stroke, venous thromboembolism (VTE), and bleeding, were also evaluated.
Materials and methods: This retrospective study included patients with renal impairment who received their first DOACs between 1 January 2019, and 31 December 2020, at Siriraj Hospital. The included patients were monitored for 1 year.
Results: There were 148 patients in the study with 899 prescriptions for DOACs. Edoxaban was the most frequently prescribed appropriate dose (87.70%), followed by rivaroxaban (84.51%), apixaban (53.72%) and dabigatran (40.00%). When dabigatran and apixaban dosages were adjusted using the CKD-EPI equation, the appropriate dosing frequency increased. Bleeding was reported in one patient receiving dabigatran, one patient receiving apixaban, and two patients receiving rivaroxaban. Recurrent stroke was identified twice in one patient who received rivaroxaban.
Conclusion: This study shows the consistency of dosage adjustment of DOACs according to the prescribing information in patients with renal impairment. Clinical impacts of DOACs dosing in practice are further needed to support appropriate dose adjustment in the Thai population.