Direct Oral Anticoagulant Dosing in Patients With Atrial Fibrillation: An Asian Perspective

Tze Fan Chao*, Ngai Yin Chan, Yi Hsin Chan, Min Soo Cho, Rungroj Krittayaphong, Kwang No Lee, Shaowen Liu, Tachapong Ngamukos, Hung Fat Tse

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Optimal dosing of direct oral anticoagulants (DOACs) 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 DOACs, discuss the evidence on dosing of DOACs across Asian regions, and collate opinions from authors across Asia. Nonrecommended dosing of DOACs is common in Asia, primarily due to the fear of bleeding, with the total clinical benefit of higher dosing being overlooked. The ELDERCARE-AF (Edoxaban Low-Dose for Elder Care-Atrial Fibrillation Patients) trial and real-world case studies provide some evidence on the use of low-dose DOACs 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 DOAC doses for gray area patients.

Original languageEnglish
Pages (from-to)707-723
Number of pages17
JournalJACC: Asia
Issue number5
StatePublished - 10 2023
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2023 The Authors


  • Asia
  • atrial fibrillation
  • direct oral anticoagulant
  • dose
  • elderly
  • low body weight


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