Optimal dosing of non–vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in “gray-area” patients with atrial fibrillation (AF) remains a challenge for clinicians. In Asia, this is concerning in patients who are very elderly, have low body weight, and are at a high risk of bleeding. This review aims to summarize the dose-reduction criteria for NOACs, discuss the evidence on dosing of NOACs across Asian regions, and collate opinions from authors across Asia. Nonrecommended dosing of NOACs is common in Asia, primarily due to the fear of bleeding, with the total clinical benefit of higher dosing being overlooked. The ELDERCARE AF and real-world case studies provide some evidence on the use of low-dose NOACs in “gray-area” patients. Opinions on dose adjustment guidance, concomitant medication adjustments, and therapeutic drug monitoring were collated. Research is needed to fill the evidence gaps on optimal NOAC doses for “gray-area” patients.

JACC: Asia Editor-in-Chief 

Jian’an Wang, MD, PhD, FACC

CME Editor 

Kenneth A. Ellenbogen, MD

Authors
Christopher Giulano, MPH, PharmD

Important Dates

Date of Release: October 17, 2023
Term of Approval/Date of CME/MOC Expiration: October 16, 2024