MHRA advises on anticoagulant dose adjustment in patients with renal impairment

Estimated glomerular filtration rate (eGFR) should not be used to adjust doses of direct-acting oral anticoagulants in patients with renal impairment, the MHRA has advised.

For most drugs and for most adult patients of average build and height, eGFR is an acceptable estimate of renal function.

However, use of eGFR to guide dosing of direct-acting oral anticoagulants is known to increase the risk of bleeding events as a consequence of overestimating renal function. In patients taking these drugs, the MHRA says creatinine clearance should be calculated using the Cockcroft-Gault formula to determine dosage adjustments.

Creatinine clearance should also be used to determine dosage adjustments for:

  • patients taking nephrotoxic drugs (such as vancomycin and amphotericin B)
  • elderly patients (aged 75 years and older)
  • patients at extremes of muscle mass (BMI < 18kg or > 40kg/m²)
  • patients taking medicines that are largely renally excreted and have a narrow therapeutic index (such as digoxin and sotalol)

Prescribers can quickly look up dose adjustments for direct-acting oral anticoagulants in renal impairment using the at-a-glance MIMS guide to NOAC dosages in non-valvular atrial fibrillation.

There are currently four direct-acting oral anticoagulants available in the UK: apixaban, dabigatran, edoxaban, and rivaroxaban.

Want news like this straight to your inbox?
Sign up for our bulletins

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register
Already registered?
Sign in

More from MIMS

New antibiotic guidance for diabetic foot infection

New antibiotic guidance for diabetic foot infection

NICE has updated its guidance on the prevention and...

Drug shortages - live tracker

Drug shortages - live tracker

Added: co-fluampicil.
Use our constantly updated...

Further drug shortages prompt advice to consider unlicensed alternatives

Further drug shortages prompt advice to consider unlicensed alternatives

Prescribers are being advised to prioritise supplies...

Vaping still safer than smoking, say health bosses after report of severe lung injury