Atrial fibrillation
DOAC choice & dose — CKD and liver disease
Checks DOAC contraindications (mechanical valve, moderate–severe mitral stenosis, antiphospholipid syndrome, pregnancy), calculates Cockcroft-Gault creatinine clearance and Child-Pugh class, and gives the licensed AF dose or the reason to avoid each DOAC, with guidance for dialysis, GI bleeding risk and older patients.
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DOAC contraindications
Any of these: use a VKA
Patient and renal function
Cockcroft-Gault with actual body weight, as in the DOAC trials
Chronic kidney disease
Liver disease
Child-Pugh class
Other factors
DOAC choice and dose · AF
Enter renal function (or dialysis status).
References
- Van Gelder IC, et al. 2024 ESC Guidelines for the management of atrial fibrillation. Eur Heart J 2024;45:3314-3414.
- Steffel J, et al. 2021 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Europace 2021;23:1612-1676.
- Granger CB, et al. Apixaban versus warfarin in patients with atrial fibrillation (ARISTOTLE). N Engl J Med 2011;365:981-992.
- Connolly SJ, et al. Dabigatran versus warfarin in patients with atrial fibrillation (RE-LY). N Engl J Med 2009;361:1139-1151.
- Giugliano RP, et al. Edoxaban versus warfarin in patients with atrial fibrillation (ENGAGE AF-TIMI 48). N Engl J Med 2013;369:2093-2104.
- Patel MR, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation (ROCKET AF). N Engl J Med 2011;365:883-891.
- Pugh RN, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60:646-649.
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