Physicians' Academy for Cardiovascular Education

Under- and overdosing of DOACs still common in patients with AF

Determinants for under- and overdosing of direct oral anticoagulants and physicians' implementation of clinical pharmacists' recommendations

Literature - Moudallel S, Cornu P, Dupont A et al. - Br J Clin Pharmacol. 2021 Jul 31. doi: 10.1111/bcp.15017.

Introduction and methods

Several studies have shown that inappropriate DOAC prescribing is a common problem [1-19]. This study identified DOAC specific determinants of under- and overdosing in hospitalized patients with AF.

The cross-sectional single center study was conducted at the UZ Brussel in Belgium. All hospitalized patients with AF who were initiated on or continued with dabigatran, apixaban, edoxaban or rivaroxaban between 1 January 2019 and 31 December 2019 were included (n=1688). The primary outcome was the proportion of patients with an inappropriate DOAC prescription (i.e. a deviation from the recommended dose in the Summary of Product Characteristics [SmPC]) and the identification of determinants related with DOAC under- and overdosing. Secondary outcomes included acceptance and implementation rates of pharmacists’ dosing advices.

Main results


This cross-sectional single center study found inappropriate DOAC prescriptions in 16.9% of hospitalized patients with AF. Underdosing was more prevalent than overdosing. Moreover, this study identified DOAC specific determinants of under- and overdosing.


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