Morning Report

NOACs for AFib: The Right Dose Matters

Arefa Cassoobhoy, MD, MPH

Disclosures

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

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