Horizontal vs. vertical dose reduction of direct oral anticoagulants in patients with non-valvular atrial fibrillation: definition and implications for practice

Andrea Rubboli

Post-marketing surveillance is being showing a widespread use of the lower doses of direct oral anticoagulants (DOACs), namely dabigatran 110 mg, rivaroxaban 15 mg, apixaban 2.5 mg, and edoxaban 30 mg, for the prevention of stroke/systemic embolism in patients with non-valvular atrial fibrillation (NVAF) [1]. Use of the lower doses has been reported inappropriate, that is, inconsistent with drug labeling, in as many as 57% of cases [1]. Inappropriate dosing, and especially underdosing, has been associated in turn, with unfavourable outcomes [1].

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Eur J Intern Med. 19 January, 2019. pii: S0953-6205(19)30017-2. Epub ahead of print.