Related Experiment Video

Updated: Dec 8, 2025

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
23:33

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

84.2K

Mortality in Patients With Atrial Fibrillation Receiving Nonrecommended Doses of Direct Oral Anticoagulants

Alan John Camm1, Frank Cools2, Saverio Virdone3

  • 1Cardiology Clinical Academic Group Molecular & Clinical Sciences Research Institute, St. George's University of London, London, United Kingdom.

Journal of the American College of Cardiology
|September 18, 2020
PubMed

Insights

Direct oral anticoagulant (DOAC) dosing in atrial fibrillation (AF) patients impacts mortality. Nonrecommended DOAC doses increase all-cause mortality, primarily cardiovascular death, compared to recommended doses.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Direct oral anticoagulants (DOACs) are prescribed to prevent stroke and systemic embolism (SE) in patients with atrial fibrillation (AF).
  • Regulatory authorities provide specific dosing guidelines for DOACs based on clinical evidence.

Purpose of the Study:

  • To assess the impact of direct oral anticoagulant (DOAC) dosing on all-cause mortality, stroke/SE, and major bleeding in patients with newly diagnosed atrial fibrillation (AF).
  • To evaluate the association between recommended and nonrecommended DOAC dosing strategies and patient outcomes at 2-year follow-up.

Main Methods:

  • Analysis of data from 10,426 patients receiving DOACs in the prospective GARFIELD-AF registry (2013-2016).
  • Categorization of patients into recommended, underdosed, and overdosed groups based on prescribed DOAC doses.
  • Comparison of outcomes including all-cause mortality, stroke/SE, and major bleeding between dosing groups.

Main Results:

  • The majority of patients (72.9%) received recommended DOAC dosing; 23.2% were underdosed, and 3.8% were overdosed.
  • Nonrecommended DOAC dosing (underdosing or overdosing) was associated with a significantly higher risk of all-cause mortality (HR: 1.24; 95% CI: 1.04-1.48), primarily cardiovascular death.
  • Underdosed patients had a lower risk of bleeding, while overdosed patients showed a nonsignificant trend toward higher risks of stroke/SE and major bleeding.

Conclusions:

  • Most patients in the GARFIELD-AF registry received guideline-recommended direct oral anticoagulant (DOAC) doses.
  • Prescription of nonrecommended DOAC doses is linked to an increased risk of death, predominantly cardiovascular, compared to recommended dosing.
  • Adherence to recommended DOAC dosing is crucial for optimizing patient outcomes in atrial fibrillation (AF).
Abstract

Keywords:
atrial fibrillationdirect oral anticoagulantsdosingstroke prevention

More Related Videos

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

33.7K
Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology10:46

Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology

Published on: May 26, 2015

13.7K

Related Concept Videos

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants

Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
1.8K
Anticoagulant Drugs: Low-Molecular-Weight Heparins01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
1.3K
Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
173
Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers01:22

Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers

Class I antiarrhythmic drugs are used to treat various types of arrhythmias or irregular heart rhythms. These drugs block the sodium (Na+) channels in the cardiac cells, thereby affecting the movement of electrical impulses across the heart. Class I antiarrhythmic drugs are divided into three subgroups: Class IA, Class IB, and Class IC, each with distinct mechanisms of action and effects on the heart.
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...
2.4K
Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors01:20

Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors

Antiplatelet drugs emerge as frontline defenders against the insidious threat of thromboembolic diseases, where abnormal clots obstruct vital blood vessels. These drugs stand as bulwarks, inhibiting platelet aggregation and clot formation, thereby mitigating the risk of life-threatening conditions like myocardial infarction, coronary artery disease, and thrombotic strokes.
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
913
Atherosclerosis III: Management01:26

Atherosclerosis III: Management

Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
225