Under-dosing of direct oral anticoagulants is common, particularly in older and lighter patients, and is linked to more strokes without less bleeding. Each drug has its own dose-reduction criteria, based on age, weight, creatinine or creatinine clearance, and interacting drugs.
Check the criteria for the specific drug at the first review and again whenever kidney function changes.
- Calculate creatinine clearance with the Cockcroft-Gault formula when dosing direct oral anticoagulants.
- Apply each drug's own dose-reduction rules rather than reducing the dose by habit.
- Recheck kidney function at least yearly, and more often in older or frail patients.
- Review interacting drugs, including some antiepileptics that induce drug metabolism.
Why it matters
An anticoagulant prescribed at the wrong dose loses much of the protection the trials promised.
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