Why the study?
Reduced-dose DOACs are commonly used in clinical practice for atrial fibrillation despite limited comparative evidence on their outcomes compared with standard doses.
Does reduced-dose DOAC therapy compared to standard-dose DOAC therapy alter the risk of stroke/systemic embolism and major bleeding in patients with atrial fibrillation?
Population
369,480 AF patients initiating apixaban or rivaroxaban in Veterans Affairs EHR
Comparison
Reduced-dose vs standard-dose DOACs
Design
Observational analysis
Key result
Reduced-dose DOACs were associated with a higher risk of stroke or systemic embolism (HR 1.06; 95% CI 1.03-1.09; P<0.001) but a lower risk of major bleeding compared to standard-dose DOACs.
Authors
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Should not yet change dosing practice in AF; leaves open optimal strategies pending randomized confirmation.
Observational (n=369,480)
Yes
Does reduced-dose DOAC therapy compared to standard-dose DOAC therapy alter the risk of stroke/systemic embolism and major bleeding in patients with atrial fibrillation?
Hazard Ratio: 1.06 (95% CI 1.03–1.09)
p-value: p=<0.001
In a large observational cohort of Veterans Affairs patients with atrial fibrillation, reduced-dose DOACs were associated with a higher risk of stroke/systemic embolism but a lower risk of major bleeding compared to standard-dose DOACs, with important variations by age and race.
LEE et al. (2026) conducted an observational in Atrial Fibrillation (n=369,480). Reduced-dose direct oral anticoagulants vs. Standard-dose direct oral anticoagulants was evaluated on any stroke/systemic embolism [SE] (HR 1.06, 95% CI 1.03-1.09, p=<0.001). Reduced-dose DOACs were associated with a higher risk of stroke or systemic embolism (HR 1.06; 95% CI 1.03-1.09; P<0.001) but a lower risk of major bleeding compared to standard-dose DOACs.