ACO
Anticoagulantes orales
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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 2-3NO 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)