Anticoagulation Myth Busters

MYTH

“If I reduce the NOAC dose prescribed, I can reduce the likelihood of a bleeding complication”

REALITY

“A NOAC dose adjustment may be required on the basis of certain clinical criteria, for example, reduced weight, advance age or renal dysfunction.1-4 However, growing real world data suggests that off-label dosing of NOACs is fairly common, with patients prescribed NOACs at a reduced dose in situations where it isn’t warranted to try to reduce their bleeding risk.”5

Off-label dosing has been shown to be associated with increased hospitalisations and increased all-cause mortality. Furthermore, inappropriate under-dosing does not confer the same degree of protection against an AF-related stroke and is associated with a comparable risk of bleeding to the correctly prescribed dose.6

In line with the manufacturers recommendations, dose reductions are only warranted in the context of increasing age, reduced bodyweight, reducing renal function or due to a drug interaction.1-4

REFERENCES
  1. SmPC Apixaban. medicines.org.uk: medicines.org.uk; 2019.
  2. SmPC Dabigatran. medicines.org.uk; 2019.
  3. SmPC Edoxaban. medicines.org.uk: medicines.org.uk; 2019.
  4. SmPC Rivaroxaban. medicines.org.uk: medicines.org.uk; 2019.
  5. Steinberg BA, Shrader P, Thomas L, Ansell J, Fonarow GC, Gersh BJ, et al. Off-Label Dosing of Non-Vitamin K Antagonist Oral Anticoagulants and Adverse Outcomes: The ORBIT-AF II Registry. Journal of the American College of Cardiology. 2016;68(24):2597-604.
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