Drug	Indications	Usual dosage (assess renal function before beginning direct oral anticoagulant and as clinically indicated)*	Hepatic dosing	Impact of weight†	Half-life	Cost‡	Comments
Apixaban (Eliquis)	Reduce risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation; treat DVT and PE Not recommended as an acute alternative to unfractionated heparin in patients with PE who present with hemodynamic instability or may receive thrombolysis or pulmonary embolectomy Reduce risk of recurrent DVT and PE and DVT prophylaxis (hip and knee replacement)	Prophylaxis for stroke and systemic embolism in nonvalvular atrial fibrillation: 5 mg twice per day Decrease dose by 50% if on 5 mg or 10 mg twice per day and taking combined strong P-glycoprotein inhibitor and strong CYP3A4 inhibitor Avoid in patients taking combined P-glycoprotein and strong CYP3A4 inducers if on 2.5 mg twice per day Decrease dose to 2.5 mg twice per day if two of the following: age 80 years or older, body weight ≤ 60 kg (132 lb); serum creatinine ≥ 1.5 mg per dL (114 μmol per L) Prophylaxis for DVT or PE: Avoid in patients taking combined P-glycoprotein and strong CYP3A4 inducers Reduce recurrence: 2.5 mg twice per day after six months or more of DVT or PE treatment Total hip or knee replacement surgery: 2.5 mg twice per day for 12 days after knee replacement surgery and 35 days after hip replacement surgery DVT or PE treatment: 10 mg twice per day for 7 days, then 5 mg twice per day Decrease dose by 50% if on 5 mg or 10 mg twice per day and taking combined strong P-glycoprotein inhibitor and strong CYP3A4 inhibitor Avoid in patients taking combined P-glycoprotein and strong CYP3A4 inducers if on 2.5 mg twice per day	Child-Pugh Class A: do not need dose adjustment Child-Pugh Class B and C: not recommended	Refer to usual dosage section for impact of lower weight Appropriate standard direct oral anticoagulant dosing in patients with a BMI ≤ 40 kg per m² or weight ≤ 120 kg (265 lb) Suggest direct oral anticoagulants not be used in patients with a BMI > 40 kg per m² or weight > 120 kg; if used in these patients, check drug-specific peak and trough levels	12 hours	$460 for 60 5-mg tablets	Starter pack for initial dosing for treatment of DVT and PE Coupons available for starter pack and maintenance dosing
Betrixaban (Bevyxxa)	VTE prophylaxis in adults hospitalized for an acute medical illness	VTE prophylaxis in at-risk, acutely ill, hospitalized patients: 160 mg with food for first dose, then 80 mg per day with food for 35 to 42 days CrCl 15 to 29 mL per minute per 1.73 m² (0.25 to 0.48 mL per second per m²): 80 mg with food for first dose, then 40 mg per day with food for 35 to 42 days With P-glycoprotein inhibitors: 80 mg with food for first dose, then 40 mg per day with food for 35 to 42 days Avoid use with P-glycoprotein inhibitors and CrCl < 30 mL per minute per 1.73 m² (0.50 mL per second per m²)	Not recommended in patients with hepatic impairment	Appropriate standard direct oral anticoagulant dosing in patients with a BMI ≥ 40 kg per m² or weight ≥ 120 kg Suggest direct oral anticoagulants not be used in patients with a BMI > 40 kg per m² or weight > 120 kg; if used in these patients, check drug-specific peak and trough levels	19 to 27 hours	$470 for 30 80-mg capsules	Take with food when used for VTE prophylaxis
Dabigatran (Pradaxa)	Reduce risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation; treat DVT and PE Not recommended as an acute alternative to unfractionated heparin in patients with PE who present with hemodynamic instability or may receive thrombolysis or pulmonary embolectomy Reduce risk of recurrent DVT and PE, and DVT prophylaxis (hip replacement)	Prophylaxis for stroke and systemic embolism in nonvalvular atrial fibrillation: 150 mg twice per day With P-glycoprotein inhibitors dronedarone (Multaq) or ketoconazole§ and CrCl 30 to 50 mL per minute per 1.73 m² (0.50 to 0.83 mL per second per m²): 75 mg twice per day CrCl 15 to 30 mL per minute per 1.73 m²: 75 mg twice per day Avoid use with P-glycoprotein inhibitors and CrCl < 30 mL per minute per 1.73 m² Avoid use with CrCl < 15 mL per minute per 1.73 m² with or without drug interaction Avoid with rifampin Prophylaxis for DVT or PE: Total hip replacement surgery: 110 mg on first day, then 220 mg per day for 28 to 35 days Avoid with P-glycoprotein inhibitor and CrCl < 50 mL per minute per 1.73 m² Avoid with CrCl < 30 mL per minute per 1.73 m² with or without drug interaction Avoid with rifampin Reduce recurrence: 150 mg twice per day Avoid with P-glycoprotein inhibitor and CrCl < 50 mL per minute per 1.73 m² Avoid with CrCl ≤ 30 mL per minute per 1.73 m² with or without drug interaction Avoid with rifampin DVT or PE treatment: 150 mg twice per day Avoid with P-glycoprotein inhibitor and CrCl < 50 mL per minute per 1.73 m² Avoid with CrCl ≤ 30 mL per minute per 1.73 m² with or without drug interaction Avoid with rifampin	Limited data in patients with hepatic impairment; no specific dosing adjustment recommended	Appropriate standard direct oral anticoagulant dosing in patients with a BMI ≤ 40 kg per m² or weight ≤ 120 kg Suggest direct oral anticoagulants not be used in patients with a BMI > 40 kg per m² or weight > 120 kg; if used in these patients, check drug-specific peak and trough levels	12 to 17 hours	$420 for 60 150-mg capsules	Do not chew, break, or open capsules Capsules must be dispensed in original container and cannot be repackaged because of the sensitivity to moisture May cause dyspepsia
Edoxaban (Savaysa)	Reduce risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation; treat DVT and PE Not recommended as an acute alternative to unfractionated heparin in patients with PE who present with hemodynamic instability or may receive thrombolysis or pulmonary embolectomy	Prophylaxis for stroke and systemic embolism in nonvalvular atrial fibrillation: 60 mg daily Avoid use in patients with CrCl > 95 mL per minute per 1.73 m² (1.59 mL per second per m²) CrCl 15 to 50 mL per minute per 1.73 m²: 30 mg per day Avoid use with rifampin DVT or PE treatment: 60 mg per day after 5 to 10 days of initial parenteral anticoagulant therapy (patients > 60 kg); 30 mg daily after 5 to 10 days of initial parenteral anticoagulant therapy (patients ≤ 60 kg) If taking certain P-glycoprotein inhibitors or CrCl 15 to 50 mL per minute per 1.73 m²: 30 mg per day Avoid use with rifampin	Child-Pugh Class A: do not need dose adjustment Child-Pugh Class B and C: not recommended	Refer to usual dosage section for impact of lower weight Appropriate standard direct oral anticoagulant dosing in patients with a BMI ≤ 40 kg per m² or weight ≤ 120 kg Suggest direct oral anticoagulants not be used in patients with a BMI > 40 kg per m² or weight > 120 kg; if used in these patients, check drug-specific peak and trough levels	10 to 14 hours	$380 for 30 60-mg tablets	—
Rivaroxaban (Xarelto)	Reduce risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation; treat DVT and PE Not recommended as an acute alternative to unfractionated heparin in patients with PE who present with hemodynamic instability or may receive thrombolysis or pulmonary embolectomy Reduce risk of recurrent DVT and PE, and for DVT prophylaxis (hip and knee replacement)	Discontinue in patients who develop acute renal failure on rivaroxaban Prophylaxis for stroke and systemic embolism in nonvalvular atrial fibrillation: 20 mg per day with evening meal Avoid with combined P-glycoprotein and moderate CYP3A4 inhibitors and CrCl 15 to 80 mL per minute per 1.73 m² (0.25 to 1.34 mL per second per m²) CrCl 15 to 50 mL per minute per 1.73 m²: 15 mg per day (patients with a CrCl < 30 mL per minute per 1.73 m² were not studied in trials) Avoid with combined P-glycoprotein and strong CYP3A4 inhibitors or inducers Prophylaxis for DVT or PE: Total hip or knee replacement surgery: 10 mg daily for 12 days after knee replacement surgery or 35 days after hip replacement surgery Observe for blood loss in CrCl 30 to 50 mL per minute per 1.73 m² Avoid use in CrCl < 30 mL per minute per 1.73 m² Avoid with combined P-glycoprotein inhibitors and moderate CYP3A4 inhibitors and CrCl 15 to 80 mL per minute per 1.73 m² Avoid with combined P-glycoprotein and strong CYP3A4 inhibitors or inducers Reduce recurrence: 10 mg per day after six months or longer of standard anticoagulant therapy Avoid with combined P-glycoprotein inhibitors and moderate CYP3A4 inhibitors and CrCl 15 to 80 mL per minute per 1.73 m² Avoid use in CrCl < 30 mL per minute per 1.73 m² Avoid with combined P-glycoprotein and strong CYP3A4 inhibitors or inducers DVT or PE treatment: 15 mg twice per day with food for the first 21 days, then 20 mg per day with food for six months Avoid with combined P-glycoprotein inhibitors and moderate CYP3A4 inhibitors and CrCl 15 to 80 mL per minute per 1.73 m² Avoid use in CrCl < 30 mL per minute per 1.73 m² Avoid with combined P-glycoprotein and strong CYP3A4 inhibitors or inducers	Child-Pugh Class A: do not need dose adjustment Child-Pugh Class B and C: not recommended	Appropriate standard direct oral anticoagulant dosing in patients with a BMI ≤ 40 kg per m² or weight ≤ 120 kg Suggest direct oral anticoagulants not be used In patients with a BMI > 40 kg per m² or weight > 120 kg; if used in these patients, check drug-specific peak and trough levels	5 to 9 hours	$470 for 30 20-mg tablets	Take with food Starter pack for initial dosing for treatment of DVT and PE Coupons available for starter pack and maintenance dosing Information