• NEWS . 23 Nov 2020
  • Lower-dose DOAC regimen related to improved survival in patients with established atherosclerosis

  • Antithrombotic/anticoagulation effects of direct oral anticoagulants (DOACs) are dose dependent. However, recent observations suggest that administering lower-dose DOACs may better protect against all-cause mortality. Considering this, a study was conducted to ascertain the effects of DOAC dose selection on the risk of all-cause mortality in patients with established atherosclerosis. Analysis included data from randomized controlled trials evaluating lower-dose DOAC, higher-dose DOAC or control therapy in patients with established atherosclerosis. 

    Atherosclerosis manifested as acute coronary syndrome (n=17,220), stable coronary artery disease (CAD) and/or peripheral artery disease (PAD) (n=27,395), or CAD associated with atrial fibrillation (n=4,510). Compared with patients in the control group, patients receiving lower-dose DOACs, but not those receiving higher-dose DOACs, had a significant reduction in all-cause mortality (relative risk [RR], 0.80; 95% confidence interval [CI], 0.73–0.89; p<0.0001; I²=0% vs RR 0.95; 95% CI, 0.87–1.05; p=0.3074; I²=0%). The benefits from lower-dose DOACs remained after sensitivity analysis or direct comparison with higher-dose DOACs (RR, 0.84; 95% CI, 0.76–0.93; p=0.0009; I²=0%).

    These findings indicate that patients with established atherosclerosis could benefit from lower-dose antithrombotic/anticoagulation regimens of DOACs for all-cause mortality protection. 

    Cappato R, et al. Lower dose direct oral anticoagulants and improved survival: A combined analysis in patients with established atherosclerosis. Eur J Intern Med 2020. doi: 10.1016/j.ejim.2020.09.007. [Epub ahead of print].