SynthesisBritish journal of clinical pharmacology2020
Impact of direct oral anticoagulant off-label doses on clinical outcomes of atrial fibrillation patients: A systematic review.
Synthesis in British journal of clinical pharmacology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 7 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
45 citing papers in PubMed, 7 syntheses or guidelines pooled it.
- Clinical outcomes of off-label DOAC underdosing in Japanese patients with atrial fibrillation: a systematic review and meta-analysis.Journal of thrombosis and thrombolysis · 2025Pooled it
- Pooled it
- Potentially inappropriate prescribing in multimorbid and polymedicated older adults with AF: A Systematic Review and Meta-Analysis.Drugs & aging · 2024Pooled it
- Pooled it
- Effect of non-recommended doses versus recommended doses of direct oral anticoagulants in atrial fibrillation patients: A meta-analysis.Clinical cardiology · 2021Pooled it
- Off-Label Underdosing or Overdosing of Non-vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation: A Meta-Analysis.Frontiers in cardiovascular medicine · 2021Pooled it
- Impact of direct oral anticoagulant off-label doses on clinical outcomes of atrial fibrillation patients: A systematic review.British journal of clinical pharmacology · 2020Pooled it
- Access to clinical data for direct oral anticoagulant prescriptions in community pharmacy and implications for medication optimisation: a mixed-methods study.International journal of clinical pharmacy · 2026Article
- Ischemic Stroke in Patients Under Oral Anticoagulation: The Achilles Heel of Atrial Fibrillation Management.Brain sciences · 2025Review
- Clinical characteristics, adherence to anticoagulation therapy and prognosis in patients with atrial fibrillation: a real-life study.BMC cardiovascular disorders · 2025Observational
- Article
- Characterization and anticoagulation treatment patterns of hospitalized patients with nonvalvular atrial fibrillation in Spain: The CARISMA registry.International journal of cardiology. Heart & vasculature · 2025Article
- Does hospitalisation improve oral anticoagulant optimisation in patients with atrial fibrillation?European journal of clinical investigation · 2025Observational
- Safe and effective anticoagulation use: case studies in anticoagulation stewardship.Journal of thrombosis and haemostasis : JTH · 2025Review
- Factors influencing the inappropriate dosing of rivaroxaban and edoxaban in Chinese hospitalized patients with atrial fibrillation.Frontiers in cardiovascular medicine · 2025Article
- Incidence and Predictors of Clinical Outcomes in Real-Life Patients With Atrial Fibrillation Treated With Oral Factor Xa Inhibitors: The Follow-Up Results of the ANATOLIA-AF Study.Clinical cardiology · 2025Observational
- More early bleeds associated with high baseline direct oral anticoagulant levels in atrial fibrillation: the MAS study.Blood advances · 2024Observational
- Safety of direct-acting oral anticoagulant (DOAC) prescribing: OpenSAFELY-TPP analysis of 20.5 million adults' electronic health records.BJGP open · 2024Article
- PrevAleNce and Associated factors of inappropriaTe dosing of direct Oral anticoaguLants In pAtients with Atrial Fibrillation: the ANATOLIA-AF Study.Cardiovascular drugs and therapy · 2024Observational
- Pulmonary embolism in cancer patients. Effectiveness of vitamin K antagonists and direct oral anticoagulants in long-term therapy.Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic surgery · 2024Review
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsWorldwide observational studies are evidencing discordance between guidelines and real-world practice regarding direct oral anticoagulant drug (DOAC) doses. This systematic review summarizes and evaluate DOACs use in real-world practice.
methodsThis review was performed following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines searching PubMed (MEDLINE) and Medscape databases.
resultsData from 75 studies showed that most of the patients treated with DOACs for stroke prevention in atrial fibrillation received doses in accordance to the guidelines. However, a significant number of patients received off-label doses (25-50% in most of the studies evaluated). DOAC overdosing was associated with increased all-cause mortality and worse bleeding events while underdosing was associated with increased cardiovascular hospitalization and, particularly for apixaban, with a nearly 5-fold increased risk of stroke.
conclusionPatients prescribed with off-label DOAC doses did not receive the full benefit of anticoagulation and presented an increased risk of stroke, bleeding and/or adverse effects.
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