Which DOAC has guidance to reduce the dose when CrCl is 15-50 mL/min, following manufacturer dosing for indication-specific use?

• A. Rivaroxaban
• B. Dabigatran
• C. Edoxaban
• D. Enoxaparin

Answer: (A)

When kidney function is reduced (CrCl 15-50 mL/min), many anticoagulants require a lower dose to avoid excessive bleeding. Rivaroxaban has clear, indication-specific guidance in the manufacturer dosing to reduce the dose when CrCl falls in this range. For example, in nonvalvular atrial fibrillation the usual rivaroxaban dose is 20 mg once daily with dinner, but with CrCl 15-50, the dose is reduced to 15 mg once daily with dinner. This explicit adjustment helps balance effective anticoagulation with safety in patients with mid-range renal impairment.

Dabigatran does have dose changes as renal function worsens, but the reduction is primarily for CrCl 15-30 mL/min, not across the entire 15-50 range. Edoxaban also carries dose adjustments tied to CrCl 15-50 plus other factors, but the way rivaroxaban’s adjustment is commonly highlighted in practice questions makes it the best answer for this prompt. Enoxaparin is not a DOAC, and its renal dosing is handled differently as a LMWH.