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Updated: Nov 15, 2025

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Direct Oral Anticoagulant Use in Special Populations: Elderly, Obesity, and Renal Failure

Evan M White1, James C Coons2

  • 1Implementation Science and Pharmacoanalytics Fellow, Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA.

Current Cardiology Reports
|March 3, 2021
PubMed

Insights

Direct oral anticoagulants (DOACs) show comparable safety and effectiveness to warfarin for obese, elderly, and CKD patients. DOACs may offer a reduced bleeding risk, particularly apixaban, for atrial fibrillation and venous thromboembolism treatment.

Area of Science:

  • Cardiology
  • Pharmacology
  • Nephrology

Background:

  • Obesity, advanced age, and chronic kidney disease (CKD) present unique challenges in anticoagulation management.
  • Warfarin has been the traditional standard, but direct oral anticoagulants (DOACs) offer alternative therapeutic options.

Purpose of the Study:

  • To review the safety and efficacy of DOACs in specific patient populations.
  • To provide evidence-based recommendations for anticoagulation in obese, elderly, and CKD patients with atrial fibrillation (AF) or venous thromboembolism (VTE).

Main Methods:

  • Systematic review of retrospective cohort studies.
  • Comparative analysis of outcomes between DOACs and warfarin.

Main Results:

  • DOACs demonstrate similar rates of bleeding, stroke, and VTE compared to warfarin in obese, elderly, and CKD/dialysis patients.
  • Some studies suggest a potentially lower bleeding risk with DOACs, especially apixaban, versus warfarin.
  • DOACs appear safe and effective for stroke prevention in AF patients within these cohorts.

Conclusions:

  • DOACs represent a viable and potentially safer alternative to warfarin for stroke prevention in AF patients with obesity, advanced age, or CKD.
  • DOACs are effective for VTE treatment in obese patients; further research is needed for elderly and CKD populations.
Abstract

Keywords:
Chronic kidney diseaseDirect oral anticoagulantsElderlyNon-valvular atrial fibrillationObesityVenous thromboembolism

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