Which anticoagulant for atrial fibrillation avoids the need for renal dose adjustment in patients with chronic kidney disease?

The correct answer is warfarin because it is not eliminated by the kidneys, which means it does not require dose adjustments based on renal function. This makes warfarin a viable option for patients with chronic kidney disease (CKD), as its anticoagulant effects are managed through regular monitoring of the INR (International Normalized Ratio) without the concern of renal clearance affecting the drug's efficacy or safety.

In contrast, direct oral anticoagulants like apixaban, dabigatran, and rivaroxaban are primarily eliminated through the kidneys and do require dose adjustments in patients with compromised renal function. As a result, these medications may not be suitable for individuals with significant CKD due to the risk of accumulation and potential bleeding complications. Therefore, for patients with atrial fibrillation who also have chronic kidney disease, warfarin remains a preferred choice since it avoids the complexities associated with renal dose adjustments.