In patients with atrial fibrillation, which anticoagulant is least likely to require renal adjustment?

Warfarin is the anticoagulant that is least likely to require renal adjustment in patients with atrial fibrillation. Unlike direct oral anticoagulants (DOACs) such as dabigatran, edoxaban, and apixaban, which have varying degrees of renal clearance and thus may need dose adjustments based on kidney function, warfarin is primarily metabolized by liver enzymes and does not rely on renal function for its anticoagulant effect.

Patients on warfarin require monitoring of their international normalized ratio (INR) to ensure therapeutic levels are maintained, but the adjustment of warfarin dosages is based primarily on INR results rather than renal function. This characteristic makes warfarin a more versatile option in patients who may have renal impairment.