Direct Oral Anticoagulant Dosing in Patients With Atrial Fibrillation: An Asian Perspective

Area of Science:

• Cardiology
• Pharmacology
• Geriatrics

Background:

• Optimal dosing of direct oral anticoagulants (DOACs) for atrial fibrillation (AF) stroke prevention in specific patient groups, particularly in Asia, presents clinical challenges.
• Elderly patients with low body weight and high bleeding risk in Asia often receive nonrecommended DOAC doses due to safety concerns.

Purpose of the Study:

• To review DOAC dose reduction criteria and Asian-specific dosing evidence.
• To collate expert opinions on DOAC management in challenging patient populations across Asia.

Main Methods:

• Literature review summarizing dose reduction guidelines and Asian DOAC dosing evidence.
• Compilation of expert opinions on DOAC adjustment, concomitant medications, and therapeutic drug monitoring.

Main Results:

• Nonrecommended DOAC dosing is prevalent in Asia, often driven by bleeding concerns, potentially diminishing overall clinical benefits.
• The ELDERCARE-AF trial and real-world data offer insights into low-dose DOAC use in elderly patients.

Conclusions:

• Evidence gaps exist regarding optimal DOAC dosing for "gray area" patients in Asia.
• Further research is crucial to establish evidence-based dosing strategies for DOACs in this population.