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New research · Internal Medicine
Future science OA · 4h
Cohort studyFuture science OA · 2026

Real-world evidence on off-label underdosing of direct oral anticoagulants in Asian patients with atrial fibrillation: prescribing patterns, determinants, and outcomes.

Pajaree Mongkhon, Tanaphorn Koonlachad, Purachai Bvornphattanasakul … Natrawee Bureekam
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Internal MedicineCohort study

One-fifth of Asian atrial fibrillation patients received off-label underdosed anticoagulants

Real-world evidence on off-label underdosing of direct oral anticoagulants in Asian patients with atrial fibrillation: prescribing patterns, determinants, and outcomes.

Pajaree Mongkhon … Natrawee Bureekam
Future science OA · 2026
Background

Off-label underdosing of direct oral anticoagulants (direct oral anticoagulants) is common among Asian patients with atrial fibrillation (atrial fibrillation), partly reflecting concerns about bleeding, yet Southeast Asian data remain limited.

Purpose

This study aimed to characterize direct oral anticoagulants dosing patterns, identify predictors of off-label underdosing, and evaluate associated effectiveness and safety outcomes.

Methods

We conducted a retrospective cohort using electronic health records (electronic health records) from two tertiary hospitals in Thailand (2015-2023).

n = 553 patients
Results

underdosing was not tied to more strokes or bleeding

AHR 1.06 (95% CI 0.30 to 3.73)
null = 10.303.73
CI crosses the null - not significant
More results

Rivaroxaban was most frequently underdosed.

Older age and diabetes mellitus independently predicted underdosing.

Compared to on-label dosing, underdosing was not associated with ISSE (adjusted hazard ratio [aHR] 0.48, 95% CI 0.11-2.16; p = 0.336) or bleeding (aHR 1.06, 95% CI 0.30-3.73; p = 0.924).

“
Conclusion

Off-label underdosing occurred in one-fifth of patients but was not associated with significant differences in ISSE or bleeding. Larger, prospective studies in broader Asian and non-Asian populations are warranted.

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