Key result
Off-label dosing of DOACs occurred in 25% to 50% of patients, with overdosing linked to higher mortality and bleeding, and underdosing of apixaban linked to a nearly five times higher risk of stroke.
Why the study?
Observational studies reveal a lack of agreement between clinical recommendations and actual practice regarding DOAC dosages in real-world settings.
Does inappropriate dosing of DOACs affect clinical outcomes in patients with atrial fibrillation?
Does inappropriate dosing of DOACs affect clinical outcomes in patients with atrial fibrillation?
Inappropriate dosing of DOACs in real-world atrial fibrillation patients is common (25-50%) and is associated with increased risks of mortality, bleeding, and stroke, reinforcing the importance of adhering to guideline-recommended dosages.
Off-label DOAC dosing in AF may heighten risks; leaves open optimal adherence strategies for prospective trials.
Background: Global observational studies are revealing a lack of agreement between recommendations and actual clinical practice when it comes to the dosages of direct oral anticoagulant drugs (DOACs). Aim of Work: This review provides a concise and critical assessment of the use of Direct Oral Anticoagulants (DOACs) in real-world clinical setting. Methods: This study was conducted using the PubMed (MEDLINE) and Medscape databases for the search. Results: Analysis of data from 75 trials revealed that the majority of patients who were administered DOACs for stroke prevention in atrial fibrillation were given dosages that aligned with the recommended recommendations. Nevertheless, a considerable proportion of patients were given dosages that were not approved for their specific condition (ranging from 25% to 50% in the majority of the assessed trials). Overdosing on DOACs was linked to higher rates of death from any cause and more severe bleeding episodes. Underdosing, on the other hand, was connected with higher rates of hospitalization for cardiovascular issues. Specifically, with apixaban, underdosing was linked to a nearly five times higher risk of stroke.
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Shammari et al. (2020) conducted a review in Atrial Fibrillation. Off-label dosing of Direct Oral Anticoagulants (DOACs) vs. Recommended dosages was evaluated on Clinical outcomes including stroke, bleeding, mortality, and hospitalization. Off-label dosing of DOACs occurred in 25% to 50% of patients, with overdosing linked to higher mortality and bleeding, and underdosing of apixaban linked to a nearly five times higher risk of stroke.
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