Efficacy and Safety Considerations With Dose-Reduced Direct Oral Anticoagulants: A Review

JAMA Cardiology
Review of 72 RCTs found efficacy & safety results for dose-adjusted DOACs in large RCTs of AF were similar to those for full-dose DOACs. No studies investigating dose adjusted DOACs in acute VTE, but authors suggest low-intensity DOACs are appropriate for approved indications.

Antithrombotic Therapy for Venous Thromboembolism (second update of the chest guideline and expert panel report)

Journal of the American Medical Association
This US guidance recommends outpatient treatment for patients with low-risk pulmonary embolism, DOAC treatment for patients in the acute VTE 3 month treatment phase & oral factor Xa inhibitors for acute VTE treatment in cancer patients in initial and extended treatment phases.

Incidence of nonvalvular atrial fibrillation and oral anticoagulant prescribing in England, 2009 to 2019: A cohort study

PLOS Medicine
Study (between 2009 & 2019; n=12,517,191) using UK CPRD database noted incidence of non valvular AF increased between 2009 and 2015, before plateauing, and underprescribing of oral anticoagulants was liked to a range of comorbidities, ethnicity, and socioeconomic factors.

Factors associated with non-adherence to the use of coumarin derivatives or direct oral anticoagulants: a systematic review of observational studies

British Journal of Clinical Pharmacology
Review (9 studies) found factors linked to non-adherence were heterogeneous; few showed consistent results. Variables reported as risk factors were male sex, hospitalization, Charlson score & bleeding. White race, CHA2DS2VASc (2-9) & polypharmacy reported as protective factors.

The above records have been identified by UKMi and feature in the NICE Medicines Awareness Service. Further details on this service can be found at:

http://www.evidence.nhs.uk/about-evidence-services/content-and-sources/medicines-information/new-medicines-awareness-services