All 4 NOACs with FDA approval for use in patients with AF have dosing defined by renal function (creatinine or CrCl using the Cockcroft-Gault equation). Apixaban adds additional dosing considerations of age 80 years or weight 60 Edoxaban is not approved for use in patients with poor renal function (CrCl <30 mL/ min) or upper-range renal function (CrCl >95 mL/ Renal function should be regularly monitored and CrCl calculated at an interval that depends on the individual degree of renal dys- function and likelihood of fluctuation, and dose adjustments should be made according to FDA In addition, for the factor Xa inhibitors, hepatic function should occasionally be monitored. NOACs are not recommended for use in patients with severe hepatic dysfunction. 11. Edoxaban (30 mg or 60 mg once daily) was stud- ied in a large randomized prospective AF trial (ENGAGE AF-TIMI 48); it was noninferior to war- farin with regard to the prevention of stroke or systemic embolization and was associated with significantly lower rates of bleeding and death from cardiovascular causes.S4.1.1-11 12. Many risk factors contribute to the increased risk of stroke in patients with AF as expressed in the -VASc score. The evidence for female sex as a risk factor has been assessed in many stud- ies. Most studies support the finding that females CLINICAL STATEMENTS AND GUIDELINES with AF are at increased risk of stroke. One meta- elevated risk of stroke in females with AF, with the risk appearing greatest for females 75 years Recent studies have suggested that female sex, in the absence of other AF risk fac- -VASc score of 0 in males and 1 in females), carries a low stroke risk that is similar to males. 