The American College of Cardiology's 2026 scientific statement (published June 2026) reviews direct oral anticoagulant use across atrial fibrillation, acute and extended venous thromboembolism treatment, and special populations, including chronic kidney disease, liver disease, cancer, obesity, frailty, prior bleeding and valvular disease. It also covers periprocedural management, drug selection, dosing, interactions, adherence and cost.
The statement's central concern is implementation: DOACs remain underused and sometimes inappropriately dosed, particularly in higher-risk patients and in groups underrepresented in trials. Patients with CKD are one of those groups, and nephrologists are frequently asked whether and how to anticoagulate them.
The abstract does not list specific recommendations; readers should consult the full statement. The practice points below are ours, not recommendations quoted from the statement. In India, the cost of branded DOACs has been a barrier, but generic apixaban and rivaroxaban have reduced it, which makes correct dosing the more common problem.
- Do not withhold anticoagulation from patients with CKD and atrial fibrillation solely because of reduced kidney function.
- Check every DOAC prescription in CKD against drug-specific creatinine clearance thresholds.
- Avoid inappropriate dose reduction; underdosing is common and reduces protection.
- In dialysis and advanced CKD, evidence is limited; decide jointly with cardiology.
- Review interacting drugs, including some antiepileptics and azoles, that alter DOAC levels.
Why it matters
Kidney patients are among those most often denied or misdosed anticoagulation.
Don't overread it
This is a scientific statement synthesising evidence, not a new trial; areas of uncertainty such as dialysis remain.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for nephrology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free