title: Comparison of estimated glomerular filtration rate equations for dosing new oral anticoagulants in patients with atrial fibrillation.
abstract: OBJECTIVE
  New oral anticoagulants require dosing adjustment according to renal function. We aimed to determine discordance in hypothetical recommended dosing of these drugs using different estimated glomerular filtration rate equations in patients with atrial fibrillation.
  
  
  METHODS
  Cross-sectional analysis of 910 patients with atrial fibrillation and an indication for oral anticoagulation. The glomerular filtration rate was estimated using the Cockcroft-Gault, Modification of Diet in Renal Disease and Chronic Kidney Disease Epidemiology Collaboration equations. For dabigatran, rivaroxaban, and apixaban we identified dose discordance when there was disagreement in the recommended dose based on different equations.
  
  
  RESULTS
  Among the overall population, relative to Cockcroft-Gault, discordance in dabigatran dosage was 11.4% for Modification of Diet in Renal Disease and 10% for Chronic Kidney Disease Epidemiology Collaboration, discordance in rivaroxaban dosage was 10% for Modification of Diet in Renal Disease and 8.5% for the Chronic Kidney Disease Epidemiology Collaboration. The lowest discordance was observed for apixaban: 1.4% for Modification of Diet in Renal Disease and 1.5% for the Chronic Kidney Disease Epidemiology Collaboration. In patients with Cockcroft-Gault<60mL/min or elderly patients, discordances in dabigatran and rivaroxaban dosages were higher, ranging from 13.2% to 30.4%. Discordance in apixaban dosage remained<5% in these patients.
  
  
  CONCLUSIONS
  Discordance in new oral anticoagulation dosages using different equations is frequent, especially among elderly patients with renal impairment. This discordance was higher in dabigatran and rivaroxaban dosages than in apixaban dosages. Further studies are needed to clarify the clinical importance of these discordances and the optimal anticoagulant dosages depending on the use of different equations to estimate renal function.
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Facultad de Medicina, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Manzano-Fernández
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Facultad de Medicina, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Andreu-Cayuelas
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Facultad de Medicina, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Marín
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Facultad de Medicina, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain.
authors.forename: Esteban
authors.initials: E
authors.lastname: Orenes-Piñero
authors.affiliation: Servicio de Hematología, Hospital Rafael Méndez, Lorca, Murcia, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Gallego
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Facultad de Medicina, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés
authors.affiliation: Unidad de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Vicente
authors.affiliation: Haemostasis, Thrombosis and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom. Electronic address: g.y.h.lip@bham.ac.uk.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: Unidad de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Roldán
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D000069604:Dabigatran / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005247:Feeding Behavior; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D011720:Pyrazoles / Q000008:administration & dosage; D011728:Pyridones / Q000008:administration & dosage; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology; D000069552:Rivaroxaban / Q000008:administration & dosage; D020521:Stroke / Q000150:complications / Q000503:physiopathology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Anticoagulant; Anticoagulante; Atrial fibrillation; Dosing; Fibrilación auricular; Función renal; Posología; Renal function