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DOAC Renal Clearance Comparison — ESENeph MCQ

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ModerateChronic Kidney DiseaseDOAC Renal Clearance ComparisonESENeph

A 55-year-old woman with CKD G3aA1 (eGFR 55 mL/min/1.73m2) and atrial fibrillation has a CHA2DS2-VASc score of 4. She weighs 82 kg and her creatinine is 98 umol/L. Which anticoagulant requires the LEAST dose adjustment in this patient?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Apixaban

At eGFR 55 mL/min/1.73m2, apixaban requires the least dose adjustment. Apixaban has the lowest renal clearance (~27%) of all DOACs, making it the safest choice across a wide eGFR range. The standard dose (5 mg BD) is appropriate here as she does not meet ≥2 of the 3 criteria for dose reduction (age ≥80, weight ≤60 kg, creatinine ≥133 umol/L). Dabigatran has the highest renal clearance (~80%) and requires dose reduction at lower eGFR thresholds. Rivaroxaban and edoxaban both require dose adjustments at eGFR 15-50 mL/min/1.73m2.

Reference: NICE 2021 – NG196 AF Management; BNF 2024 – DOAC Prescribing