| ClCr (ml/min) |
VKA |
Dabigatran |
Rivaroxaban |
Apixaban |
Edoxaban |
| > 50 |
para INR 2-3 |
150 mg BID(1) |
20 mg HS |
2.5*-5 mg BID |
60 mg-30 QD |
| 30-50 |
para INR 2-3 |
150 o 75 mg BID |
15 mg HS |
2.5*-5 mg BID |
30 mg-15 QD |
| 15-30 |
para INR 2-3 |
75 mg BID |
15 mg HS |
NO/¿‡ |
NO |
|
< 15 |
para INR 2-3 | NO |
NO |
NO/¿‡ |
NO |
| Dialisis |
para INR 2-3 |
NO |
NO |
NO/¿‡ |
NO |
BID: dos veces al día; QD: una vez al día; HS: por la tarde con comida; Clcr: aclaramiento de creatinina utilizando el método de
Crockoft-Gault.
1Dosis de 110 mg No se aceptan en EE.UU.
*En≥80 años o ≤60 kg.
¿‡Retrospective studies suggest similar efficacy and no increased bleeding risk with use of apixaban when compared to warfarin in patients with advanced CKD (CrCl <25 mL/min) (Herndon 2019; Schafer 2018; Stanton 2017) and dialysis patients (Chokesuwattanaskul 2018; Reed 2018; Siontis 2018). However, until more robust data become available, some experts avoid use of apixaban for all indications in patients with a severe reduction in kidney function since safety and efficacy remain untested and cannot be assured (Hull 2018b; Manning 2018; Pai 2018).
VKA: Vitamina K antagonistas (dicumarínicos);
ACO (NoVKA): Dabigatran (antitrombina), Rivaroxaban (Inhibidor Fc-Xa), Apixaban (Inhibidor Fc-Xa)