Underdosing of non-vitamin K oral anticoagulants (NOACs) is common in patients with atrial fibrillation (AF), and may be associated with an increased risk of stroke without reducing the risk of major bleeding. At the Advances in Medicine 2022 conference, Professor Martin Grond of Kreisklinikum Siegen in Siegen, Germany, discussed optimal selection of NOACs for lowering risks of stroke, major bleeding, and renal function decline in the real-world setting.
Potential risk of NOAC underdosing
“Dose reduction of NOACs may be considered in AF patients with certain conditions, such as renal impairment. However, a proportion of patients may receive inappropriate dose reduction of NOACs [irrespective of recommended dose reduction criteria] in clinical practice,” Grond pointed out. “For example, a US registry [n=7,925] showed that 63 percent of AF patients on reduced-dose apixaban [n=639] were underdosed.” [J Am Heart Assoc 2018;7:e007633]
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