Direct Oral Anticoagulant Dosing in Patients With Atrial Fibrillation: An Asian Perspective
Issued Date
2023-10-01
Resource Type
eISSN
27723747
Scopus ID
2-s2.0-85173790583
Journal Title
JACC: Asia
Volume
3
Issue
5
Start Page
707
End Page
723
Rights Holder(s)
SCOPUS
Bibliographic Citation
JACC: Asia Vol.3 No.5 (2023) , 707-723
Suggested Citation
Chao T.F., Chan N.Y., Chan Y.H., Cho M.S., Krittayaphong R., Lee K.N., Liu S., Ngamukos T., Tse H.F. Direct Oral Anticoagulant Dosing in Patients With Atrial Fibrillation: An Asian Perspective. JACC: Asia Vol.3 No.5 (2023) , 707-723. 723. doi:10.1016/j.jacasi.2023.08.007 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/90668
Title
Direct Oral Anticoagulant Dosing in Patients With Atrial Fibrillation: An Asian Perspective
Other Contributor(s)
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.