Kidney function estimators for drug dose adjustment of direct oral anticoagulants in older adults with atrial fibrillation

Abstract Background The Cockcroft-Gault equation (CrClC-G) is recommended for dose adjustment of direct oral anticoagulant drugs (DOACs) to kidney function. We aimed assess whether defining DOACs appropriateness according various function estimators changed the associations between and adverse events in older adults with atrial fibrillation (AF). Methods Participants Berlin Initiative Study AF treated were included. investigated CrClC-G estimated glomerular filtration rate (eGFR) using CKD-EPI EKFC equations based on creatinine and/or cystatin C. Marginal structural Cox models yielded confounder-adjusted hazard ratios risk mortality, thromboembolism, bleeding associated status. Results 224 patients included analysis (median age 87 years). Using CrClC-G, 154 (69%) had appropriate DOACs, 52 (23%) underdosed, 18 (8%) overdosed. During a 39-month median follow-up period, 109 (14.9/100 person-years) participants died, 25 (3.6/100 experienced 60 (9.8/100 bleeding. Dose status was not mortality independent equation. Underdose lower all equations, compared group. In discrepancies eGFR occurrence endpoints did differ having or eGFR. Conclusions AF, association when Our results suggest that are inferior within this context.