A PharmD-curated clinical reference for the four FDA-approved DOACs: apixaban, rivaroxaban, dabigatran, and edoxaban. Covers approved indications, dosing, renal/hepatic adjustment, reversal, and key monitoring parameters.
📋 Printable Quick Card →| Drug | DVT/PE Tx | DVT/PE Ppx | AF (stroke prevention) | ACS |
|---|---|---|---|---|
| Apixaban (Eliquis) | ✓ | ✓ | ✓ | — |
| Rivaroxaban (Xarelto) | ✓ | ✓ | ✓ | ✓ |
| Dabigatran (Pradaxa) | ✓ | — | ✓ | — |
| Edoxaban (Savaysa) | ✓ | — | ✓ | — |
| Drug | AF (stroke ppx) | Acute VTE treatment | VTE secondary ppx |
|---|---|---|---|
| Apixaban | 5 mg BID (2.5 mg BID if ≥2 of: age ≥80, weight ≤60 kg, SCr ≥1.5) | 10 mg BID × 7 days, then 5 mg BID | 2.5 mg BID |
| Rivaroxaban | 20 mg QD with evening meal | 15 mg BID × 21 days, then 20 mg QD with meal | 10 mg QD |
| Dabigatran | 150 mg BID (75 mg BID if CrCl 15–30) | After ≥5 days parenteral: 150 mg BID | 150 mg BID |
| Edoxaban | 60 mg QD (30 mg QD if CrCl 15–50, weight ≤60 kg, or P-gp inhibitor) | After ≥5 days parenteral: 60 mg QD | 60 mg QD |
| Drug | CrCl >50 | CrCl 30–50 | CrCl 15–30 | CrCl <15 / HD |
|---|---|---|---|---|
| Apixaban (AF) | Standard | Standard (use SCr-based dose reduction criteria) | Not studied; use caution | FDA-labeled: 5 mg BID (2.5 mg BID if age ≥80 or ≤60 kg), see note |
| Rivaroxaban (AF) | Standard | Standard | 15 mg QD with meal | Avoid |
| Dabigatran (AF) | Standard | Standard | 75 mg BID | Avoid (contraindicated <15) |
| Edoxaban (AF) | Standard | 30 mg QD | 30 mg QD | Avoid |
⚠ Edoxaban showed reduced efficacy in AF patients with CrCl >95 mL/min (a trend toward higher stroke/systemic embolism vs. warfarin in the ENGAGE AF-TIMI 48 trial, attributed to lower drug exposure at high clearance). This is an FDA boxed warning: do not use edoxaban for stroke prevention in AF when CrCl >95 mL/min.
💡 Apixaban is the only DOAC with FDA labeling for ESRD/hemodialysis (5 mg BID, or 2.5 mg BID if age ≥80 or weight ≤60 kg). This dosing is based on pharmacokinetic data rather than outcomes trials; the RENAL-AF RCT was stopped early and did not demonstrate benefit, so use reflects clinical judgment. Apixaban remains the preferred DOAC across the CrCl 15–30 range.
| Agent | Reverses | Dose | Notes |
|---|---|---|---|
| 4-factor PCC (Kcentra) | Apixaban, Rivaroxaban (off-label); also warfarin | 25–50 units/kg IV (often ~50 units/kg for life-threatening factor Xa inhibitor bleeding; institutional protocols vary) | Now the practical default for factor Xa inhibitor–associated major bleeding following the withdrawal of andexanet alfa (see below). Off-label for DOACs but widely used and guideline-supported. |
| Idarucizumab (Praxbind) | Dabigatran | 5 g IV (two 2.5 g vials given consecutively) | Specific reversal agent for dabigatran. Rapid, complete reversal. Rebound possible if dabigatran redistributes from tissue. |
⚠ Andexanet alfa (Andexxa) was voluntarily withdrawn from the US market effective December 22, 2025. The ANNEXA-I trial showed a net increase in thromboembolic events (including MI) versus usual care in intracranial hemorrhage, and the FDA determined its risks outweigh its benefits. 4-factor PCC is now the practical option for factor Xa inhibitor reversal.