Abstract
The Cockcroft-Gault (CG) formula is recommended to guide clinicians in the choice of the appropriate dosage for direct oral anticoagulants (DOACs). However, the performance of the CG formula varies depending on the patient’s age, weight, and degree of renal function. We aimed to compare the validity of the CG formula with that of Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) formulae for dosing DOACs. A total of 6268 consecutive patients on anticoagulants for atrial fibrillation (AF) were retrospectively investigated. Among underweight and elderly patients, the CG formula underestimated renal function compared with the non-CG formulae. However, the concordant rate of drug indications between the CG and the non-CG formulae was approximately 94%. On-label uses under the three formulae were associated with a lower risk of major bleeding (but not thromboembolism) compared to warfarin. Although we found differences in estimating renal function and the proportions of drug indications between the CG and non-CG formulae, the risks of thromboembolism and major bleeding were similar to those with warfarin regardless of which formula was used.
Highlights
Direct oral anticoagulants (DOACs) have been approved for the prevention of stroke or systemic embolism in patients with non-valvular atrial fibrillation (AF)
There are concerns about the accuracy of creatinine clearance (CrCl) estimated using the CG formula, which depends on the patient’s age, body weight, and degree of renal function, even though it is generally used in practice and its clinical utility is supported by evidence from phase III DOAC trials [2,3,4]
Dabigatran, rivaroxaban, apixaban, and edoxaban were prescribed for 7.6 ± 7.5, 7.7 ± 6.6, 7.3 ± 5.6, and 9.1 ± 6.4 months, respectively
Summary
Direct oral anticoagulants (DOACs) have been approved for the prevention of stroke or systemic embolism in patients with non-valvular atrial fibrillation (AF). Phase III trials have demonstrated that DOACs are as effective as dose-adjusted warfarin and have a more favorable safety profile [1,2,3,4]. In recent guidelines for using DOACs to treat AF, patients with chronic kidney disease require assessment of their renal function to choose the appropriate dosage, measured as the estimated creatinine clearance (CrCl), using the Cockcroft-Gault (CG) formula [7]. There are concerns about the accuracy of CrCl estimated using the CG formula, which depends on the patient’s age, body weight, and degree of renal function, even though it is generally used in practice and its clinical utility is supported by evidence from phase III DOAC trials [2,3,4]. The National Kidney Foundation recommended the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula for estimating GFR because it offers improved estimation accuracy compared with earlier formulae [10,11]
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