AI Article Synopsis
- Optimal dosing of direct oral anticoagulants (DOACs) for stroke prevention in "gray area" patients with atrial fibrillation (AF) is challenging, especially in very elderly or low-weight individuals at high bleeding risk in Asia.
- A review highlights the prevalence of nonrecommended DOAC dosages due to concerns about bleeding, neglecting the potential benefits of higher doses.
- The ELDERCARE-AF trial and real-world case studies suggest the efficacy of low-dose DOACs, but more research is necessary to define optimal dosing strategies for these high-risk patients.
Article Abstract
Optimal dosing of direct oral anticoagulants (DOACs) for stroke prevention in "gray area" patients with atrial fibrillation (AF) remains a challenge for clinicians. In Asia, this is concerning in patients who are very elderly, have low body weight, and are at a high risk of bleeding. This review aims to summarize the dose reduction criteria for DOACs, discuss the evidence on dosing of DOACs across Asian regions, and collate opinions from authors across Asia. Nonrecommended dosing of DOACs is common in Asia, primarily due to the fear of bleeding, with the total clinical benefit of higher dosing being overlooked. The ELDERCARE-AF (Edoxaban Low-Dose for Elder Care-Atrial Fibrillation Patients) trial and real-world case studies provide some evidence on the use of low-dose DOACs in gray area patients. Opinions on dose adjustment guidance, concomitant medication adjustments, and therapeutic drug monitoring were collated. Research is needed to fill the evidence gaps on optimal DOAC doses for gray area patients.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10715890 | PMC |
| http://dx.doi.org/10.1016/j.jacasi.2023.08.007 | DOI Listing |
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