Morning Report

NOACs for AFib: The Right Dose Matters

Arefa Cassoobhoy, MD, MPH


June 23, 2017

Hello. I'm Dr Arefa Cassoobhoy, a practicing internist, Medscape advisor, and senior medical director for WebMD. Welcome to Morning Report, our 1-minute news story for primary care.

Inappropriate Dosing of Anticoagulants

To reduce the risk for stroke, many patients with atrial fibrillation are prescribed non–vitamin K antagonist oral anticoagulants (NOACs).

But it seems that inappropriate dosing of these drugs is common. Data from almost 15,000 patients with atrial fibrillation showed that more than 13% of patients were underdosed, even though there was no indication for a lower dose. This potentially undermines effectiveness. The risk for stroke was increased almost fivefold in those taking apixaban.

Also from that group, 1500 had severe kidney disease, but 43% continued receiving the standard dose instead of a reduced dose. This impacted safety. Their risk for a major bleed was doubled.

This study serves as an important wake-up call—we need to look closely at NOAC dosing for each of our patients with atrial fibrillation.

For Medscape and WebMD, I'm Dr Arefa Cassoobhoy.

Follow Dr Cassoobhoy on Twitter at @ArefaMD


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.