ArticleJournal of the American Heart Association2023
Benefits and Harms of Standard Versus Reduced-Dose Direct Oral Anticoagulant Therapy for Older Adults With Multiple Morbidities and Atrial Fibrillation.
Article in Journal of the American Heart Association, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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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.
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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
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.
- Outcomes of deprescribing for people with life-limiting conditions: A systematic review.Palliative medicine · 2026Pooled it
- Drug-Drug Interactions in Nursing Home Residents With vs Without Dementia.Journal of the American Medical Directors Association · 2026Observational
- Postbleeding antithrombotic management in cardiovascular patients: insights from the Attica Bleeding Snapshot study.Research and practice in thrombosis and haemostasis · 2026Observational
- Healthcare professionals' perspectives on prescribing DOACs to frail older patients; the DOAC-FRAIL questionnaire.BMC geriatrics · 2026Article
- Improvement of Oral Anticoagulant Prescription and Long-Term Clinical Outcomes of Patients With Atrial Fibrillation After Implementation of a Clinical Decision Support System in Outpatient Practice.Journal of the American Heart Association · 2025Observational
- Impact of Age and Factor Xa Inhibitor Concentrations on Bleeding Risk in Patients with Atrial Fibrillation.Clinical pharmacology and therapeutics · 2025Article
- Clinical Management of Cerebral Amyloid Angiopathy.Journal of clinical medicine · 2025Review
- Inappropriate dosing of direct oral anticoagulants among very older inpatients with atrial fibrillation.BMC geriatrics · 2025Article
- Procedural and Antithrombotic Therapy Optimization in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Narrative Review.Journal of cardiovascular development and disease · 2025Review
- Reduced-dose versus full-dose direct oral anticoagulants in extended treatment of venous thromboembolism: a systematic review and meta-analysis of randomized controlled trials.Proceedings (Baylor University. Medical Center) · 2025Review
- Real-World Comparative Study of Ultra-Low-Dose Rivaroxaban in Very Elderly Patients with Atrial Fibrillation.Clinical interventions in aging · 2025Article
- Direct Oral Anticoagulants Versus Vitamin K Antagonist in Elderly Patients With Atrial Fibrillation: Sometimes Less Is More, but Sometimes More Is More.Journal of the American Heart Association · 2023Article
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Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
Abstract
Background Dose reduction of direct oral anticoagulant (DOAC) medications is inconsistently applied to older adults with multiple morbidities, potentially due to perceived harms and unknown benefits of standard dosing. Methods and Results Using 2013 to 2017 US Medicare claims linked to Minimum Data Set records, we conducted a retrospective cohort study. We identified DOAC initiators (apixaban, dabigatran, rivaroxaban) aged ≥65 years with nonvalvular atrial fibrillation residing in a nursing home. We estimated inverse-probability of treatment weights for DOAC dose using propensity scores. We examined safety (hospitalization for major bleeding) and effectiveness outcomes (all-cause mortality, thrombosis [myocardial infarction, stroke, systemic embolism, venous thromboembolism]). We estimated hazard ratios (HRs) and 95% CIs using cause-specific hazard-regression models. Of 21 878 DOAC initiators, 48% received reduced dosing. The mean age of residents was 82.0 years, 66% were female, and 31% had moderate/severe cognitive impairment. After estimating inverse-probability of treatment weights, standard dosing was associated with a higher rate of bleeding (HR, 1.18 [95% CI, 1.03-1.37]; 9.4 versus 8.0 events per 100 person-years). Standard-dose therapy was associated with the highest rates of bleeding among those aged >80 years (9.1 versus 6.7 events per 100 person-years) and with a body mass index <30 kg/m
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.