138 CHAPTER 8 TABLE 1: INDICATIONS FOR DOSE REDUCTION OF NOACS USED FOR STROKE PREVENTION IN ATRIAL FIBRILLATION PATIENTS. NOAC trials5–8 SPC19–22 FDA23–26 ESC guidelines27 EHRA guidelines28 Dabigatran 150 mg b.d. No dose reduction in trial 110 mg b.d. No dose reduction in trial 150 mg b.d. → 110 mg b.d. - Age ≥80 years - Verapamil use Consider dose reduction in case of: - Age 75-80 years - CrCl 30-50 mL/min/1.73 m2 - Gastritis/esophagitis/GERD - Other increased bleeding risk 150 mg b.d. → 75 mg b.d. - CrCl 15-30 mL/min/1.73 m2 - CrCl 30-50 mL/min/1.73 m2 + dronedarone or systemic ketoconazole 150 mg b.d. → 110 mg b.d. Not reported 150 mg b.d. → 110 mg b.d. - Age ≥80 years - Verapamil use Consider dose reduction in case of ≥2 of the following criteria: - Age ≥75 years - CrCl 30-49 mL/min/1.73 m2 - Body weight ≤60 kg - Quinidine, amiodarone, clarithromycin, or erythromycin use - Other reasons for increased bleeding risk Rivaroxaban 20 mg o.d. → 15 mg o.d.a - CrCl 30-49 mL/min/1.73 m2 15 mg o.d. → 10 mg o.d.b - CrCl 30-49 mL/min/1.73 m2 20 mg o.d. → 15 mg o.d. - CrCl 15-49 mL/min/1.73 m2 20 mg o.d. → 15 mg o.d. - CrCl 15-50 mL/min/1.73 m2 20 mg o.d. → 15 mg o.d. - CrCl 30-49 mL/min/1.73 m2 20 mg o.d. → 15 mg o.d. - CrCl 15-49 mL/min/1.73 m2 Consider dose reduction in case of ≥2 of the following criteria: - Age ≥75 years - Body weight ≤60 kg - Dronedarone, quinidine, clarithromycin, erythromycin, fluconazole, cyclosporin, tacrolimus - Amiodarone when CrCl <50 mL/min/1.73 m2 - Other reasons for increased bleeding risk
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