Key result
Underdosing of direct-acting oral anticoagulants is common in elderly patients with atrial fibrillation, increasing stroke risk despite their superiority to vitamin K antagonists.
Why the study?
Underdosing of DOACs is common in elderly patients with atrial fibrillation due to bleeding concerns and complex dose adjustments, increasing stroke risk.
Does correct dosing of DOACs improve stroke prevention compared to underdosing in elderly patients with nonvalvular atrial fibrillation?
Does correct dosing of DOACs improve stroke prevention compared to underdosing in elderly patients with nonvalvular atrial fibrillation?
Correct dosing of DOACs is crucial in elderly patients with atrial fibrillation to maximize stroke prevention and avoid the high risks associated with underdosing.
Underdosing may raise stroke risk in elderly AF patients; leaves open need for optimized dosing trials before practice change.
Unless contraindicated, anticoagulant therapy should be prescribed to elderly patients with atrial fibrillation. Direct-acting oral anticoagulants (DOACs) are superior to vitamin K antagonists for preventing stroke. This, together with their higher net clinical benefit, makes DOACs the treatment of choice in this population. However, due to the concerns about bleeding and the need for dose adjustment based on clinical variables, underdosing of DOACs is common and the risk of stroke high. Drugs with more easily adjusted doses are likely associated with a lower risk of dosing errors and, therefore, a greater protective effect. Correct dosing can ensure a maximal net benefit of DOACs in elderly patients with atrial fibrillation.
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Fernández et al. (2020) conducted a review in nonvalvular atrial fibrillation. Direct-acting oral anticoagulants (DOACs) vs. Vitamin K antagonists was evaluated. Underdosing of direct-acting oral anticoagulants is common in elderly patients with atrial fibrillation, increasing stroke risk despite their superiority to vitamin K antagonists.
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