Overdosing and Underdosing of Novel Direct-Acting Oral Anticoagulants

When prescribing a direct-acting oral anticoagulant (DOAC) for patients with atrial fibrillation (AF) and poor renal function, physicians need to make downward dose adjustments but do not always do so. Conversely, other patients are prescribed lower doses despite normal renal function. Using claims and laboratory data from a large administrative insurance database, these researchers identified almost 15,000 patients with AF who had initiated apixaban, dabigatran, or rivaroxaban between 2010 and 2015 (median follow-up, 3.6 months).

Among almost 1500 patients with a renal indication for dose reduction, 43% received standard dosing. Analyses using propensity-score matching indicated that standard dosing was associated with higher risk for major…