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NOAC dosing and monitoring: really as simple as it seems?
  1. Xiaoxi Yao1,2,3,
  2. Peter Noseworthy3
  1. 1 Robert D and Patricia E Kern Centre for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Division of Health Care Policy and Research Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
  3. 3 Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Xiaoxi Yao, Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA; yao.xiaoxi{at}

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Non-vitamin K antagonist oral anticoagulants (NOACs) have been recommended in preference to vitamin K antagonists (VKA) for atrial fibrillation (AF) stroke prevention since 2016. Most patients with AF these days are treated with NOACs instead of VKA. A major advantage of this new class of drugs is that unlike VKA, NOACs are fixed-dose drugs and do not need regular dose adjustment. However, all the NOACs rely on the kidney for drug elimination and require dose reduction in patients with severe kidney disease.

One would assume that NOAC dosing is straightforward. Each NOAC only has two doses for AF stroke prevention, and the dose reduction criteria, listed on the drug labels, are fairly simple. However, over the past few years, a number of studies have demonstrated that nearly 20% of patients in routine practice are either underdosed or overdosed (table 1).

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Table 1

Prevalence of overdosing and underdosing of NOACs in patients with AF

Further complicating this matter is that kidney function decline is very common among …

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  • Contributors XY and PN both contriubted to the writing and revision of this editorial.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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