title: Direct oral anticoagulants in patients with atrial fibrillation and renal impairment, extremes in weight, or advanced age.
abstract: A growing number of patients with an indication for stroke prevention in atrial fibrillation have kidney-, age-, or weight-related alterations in pharmacokinetics that affect dosing of direct oral anticoagulants. Because these patients were excluded from or comprised a small number of patients in clinical trials, there is a lack of evidence to guide clinicians. As a consequence, many patients do not receive oral anticoagulation despite a high risk for atrial fibrillation-related stroke. Here, we present a review of direct oral anticoagulant pharmacokinetics and a review of the available clinical evidence in patients with weight-, kidney-, and age-related disease.
authors.affiliation: Department of Pharmacotherapy and Outcomes Science and VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Leo F
authors.initials: LF
authors.lastname: Buckley
authors.affiliation: Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Eva
authors.initials: E
authors.lastname: Rybak
authors.affiliation: Eshelman School of Pharmacy, University of North Carolina at Chapel Hill.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Aldemerdash
authors.affiliation: Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts.
authors.forename: Judy W M
authors.initials: JW
authors.lastname: Cheng
authors.affiliation: Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: John
authors.initials: J
authors.lastname: Fanikos
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D001835:Body Weight; D006801:Humans; D051437:Renal Insufficiency / Q000150:complications*; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: advanced age; atrial fibrillation; chronic kidney disease; direct oral anticoagulants; obesity; stroke prevention