{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:46:09Z","timestamp":1790685969308,"version":"4.1.0"},"reference-count":38,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T00:00:00Z","timestamp":1733011200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T00:00:00Z","timestamp":1733011200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T00:00:00Z","timestamp":1733011200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T00:00:00Z","timestamp":1733011200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T00:00:00Z","timestamp":1733011200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T00:00:00Z","timestamp":1733011200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T00:00:00Z","timestamp":1733011200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["clinicalkey.fr","clinicalkey.jp","clinicalkey.es","clinicalkey.com.au","clinicalkey.com","internationaljournalofcardiology.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Cardiology"],"published-print":{"date-parts":[[2024,12]]},"DOI":"10.1016\/j.ijcard.2024.132484","type":"journal-article","created":{"date-parts":[[2024,8,25]],"date-time":"2024-08-25T00:01:28Z","timestamp":1724544088000},"page":"132484","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":7,"special_numbering":"C","title":["The use of reduced DOAC doses in atrial fibrillation patients does not always lead to good anticoagulation levels and avoid adverse events"],"prefix":"10.1016","volume":"416","author":[{"given":"Gualtiero","family":"Palareti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Testa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Legnani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oriana","family":"Paoletti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Cini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Antonucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittorio","family":"Pengo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Poli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Ageno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Prandoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Prisco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Tosetto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"7","key":"10.1016\/j.ijcard.2024.132484_bb0005","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.117.005835","article-title":"Effects of non-vitamin K antagonist Oral anticoagulants versus warfarin in patients with atrial fibrillation and Valvular heart disease: a systematic review and Meta-analysis","volume":"6","author":"Pan","year":"2017","journal-title":"J. Am. Heart Assoc."},{"issue":"12","key":"10.1016\/j.ijcard.2024.132484_bb0010","doi-asserted-by":"crossref","first-page":"2933","DOI":"10.1161\/STROKEAHA.118.020232","article-title":"Effectiveness and safety of Oral anticoagulants among Nonvalvular atrial fibrillation patients","volume":"49","author":"Lip","year":"2018","journal-title":"Stroke"},{"issue":"4","key":"10.1016\/j.ijcard.2024.132484_bb0015","doi-asserted-by":"crossref","first-page":"E877","DOI":"10.9778\/cmajo.20200055","article-title":"Comparative effectiveness and safety of direct oral anticoagulants versus vitamin K antagonists in nonvalvular atrial fibrillation: a Canadian multicentre observational cohort study","volume":"8","author":"Durand","year":"2020","journal-title":"CMAJ Open"},{"issue":"3","key":"10.1016\/j.ijcard.2024.132484_bb0020","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCOUTCOMES.119.005894","article-title":"Effectiveness and safety of direct Oral anticoagulants in relation to temporal changes in their use","volume":"13","author":"Lee","year":"2020","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"issue":"4","key":"10.1016\/j.ijcard.2024.132484_bb0025","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1161\/CIRCULATIONAHA.121.056355","article-title":"Direct Oral anticoagulants versus warfarin in patients with atrial fibrillation: patient-level network Meta-analyses of randomized clinical trials with interaction testing by age and sex","volume":"145","author":"Carnicelli","year":"2022","journal-title":"Circulation"},{"issue":"12","key":"10.1016\/j.ijcard.2024.132484_bb0030","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1056\/NEJMoa0905561","article-title":"Dabigatran versus warfarin in patients with atrial fibrillation","volume":"361","author":"Connolly","year":"2009","journal-title":"N. Engl. J. Med."},{"issue":"3","key":"10.1016\/j.ijcard.2024.132484_bb0035","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1161\/CIRCULATIONAHA.112.001139","article-title":"The long-term multicenter observational study of dabigatran treatment in patients with atrial fibrillation (RELY-ABLE) study","volume":"128","author":"Connolly","year":"2013","journal-title":"Circulation"},{"issue":"11","key":"10.1016\/j.ijcard.2024.132484_bb0040","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1056\/NEJMoa1107039","article-title":"Apixaban versus warfarin in patients with atrial fibrillation","volume":"365","author":"Granger","year":"2011","journal-title":"N. Engl. J. Med."},{"issue":"10","key":"10.1016\/j.ijcard.2024.132484_bb0045","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1056\/NEJMoa1009638","article-title":"Rivaroxaban versus warfarin in nonvalvular atrial fibrillation","volume":"365","author":"Patel","year":"2011","journal-title":"N. Engl. J. Med."},{"issue":"22","key":"10.1016\/j.ijcard.2024.132484_bb0050","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1056\/NEJMoa1310907","article-title":"Edoxaban versus warfarin in patients with atrial fibrillation","volume":"369","author":"Giugliano","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"10.1016\/j.ijcard.2024.132484_bb0055","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.thromres.2015.12.001","article-title":"Plasma levels of direct oral anticoagulants in real life patients with atrial fibrillation: results observed in four anticoagulation clinics","volume":"137","author":"Testa","year":"2016","journal-title":"Thromb. Res."},{"issue":"5","key":"10.1016\/j.ijcard.2024.132484_bb0060","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1111\/bjh.17899","article-title":"Assessment of exposure to direct oral anticoagulants in elderly hospitalised patients","volume":"195","author":"Kampouraki","year":"2021","journal-title":"Br. J. Haematol."},{"issue":"1","key":"10.1016\/j.ijcard.2024.132484_bb0065","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1111\/jth.15563","article-title":"Inter- and intra-individual concentrations of direct oral anticoagulants: the KIDOAC study","volume":"20","author":"Toorop","year":"2022","journal-title":"J. Thromb. Haemost."},{"issue":"3","key":"10.1016\/j.ijcard.2024.132484_bb0070","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1007\/s40262-023-01222-w","article-title":"Insights into the pharmacokinetics and pharmacodynamics of direct Oral anticoagulants in older adults with atrial fibrillation: a structured narrative review","volume":"62","author":"Edwina","year":"2023","journal-title":"Clin. Pharmacokinet."},{"issue":"2","key":"10.1016\/j.ijcard.2024.132484_bb0075","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1111\/jth.13577","article-title":"Interindividual variability in dabigatran and rivaroxaban exposure: contribution of ABCB1 genetic polymorphisms and interaction with clarithromycin","volume":"15","author":"Gouin-Thibault","year":"2017","journal-title":"J. Thromb. Haemost."},{"issue":"10","key":"10.1016\/j.ijcard.2024.132484_bb0080","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1111\/jth.14541","article-title":"Rivaroxaban pharmacodynamics in healthy volunteers evaluated with thrombin generation and the active protein C system: modeling and assessing interindividual variability","volume":"17","author":"Siguret","year":"2019","journal-title":"J. Thromb. Haemost."},{"issue":"4","key":"10.1016\/j.ijcard.2024.132484_bb0085","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1055\/a-1981-1763","article-title":"Assessment of DOAC in GEriatrics (ADAGE study): rivaroxaban\/apixaban concentrations and thrombin generation profiles in NVAF very elderly patients","volume":"123","author":"Foulon-Pinto","year":"2023","journal-title":"Thromb. Haemost."},{"issue":"6","key":"10.1016\/j.ijcard.2024.132484_bb0090","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.119.014108","article-title":"Rates of potentially inappropriate dosing of direct-acting Oral anticoagulants and associations with geriatric conditions among older patients with atrial fibrillation: the SAGE-AF study","volume":"9","author":"Sanghai","year":"2020","journal-title":"J. Am. Heart Assoc."},{"issue":"24","key":"10.1016\/j.ijcard.2024.132484_bb0095","doi-asserted-by":"crossref","first-page":"2597","DOI":"10.1016\/j.jacc.2016.09.966","article-title":"Off-label dosing of non-vitamin K antagonist Oral anticoagulants and adverse outcomes: the ORBIT-AF II registry","volume":"68","author":"Steinberg","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"issue":"12","key":"10.1016\/j.ijcard.2024.132484_bb0100","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCOUTCOMES.123.010062","article-title":"Off-label dosing of direct Oral anticoagulants among inpatients with atrial fibrillation in the United States","volume":"16","author":"Sandhu","year":"2023","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"issue":"6","key":"10.1016\/j.ijcard.2024.132484_bb0105","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.121.024402","article-title":"Association between inappropriately dosed anticoagulation therapy with stroke severity and outcomes in patients with atrial fibrillation","volume":"11","author":"Vinding","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"10.1016\/j.ijcard.2024.132484_bb0110","doi-asserted-by":"crossref","DOI":"10.1182\/bloodadvances.2023012408","article-title":"Thrombotic events associated with low baseline direct oral anticoagulant levels in atrial fibrillations: the MAS study","author":"Testa","year":"2024","journal-title":"Blood Adv."},{"issue":"4","key":"10.1016\/j.ijcard.2024.132484_bb0115","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1111\/j.1538-7836.2005.01204.x","article-title":"Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients","volume":"3","author":"Schulman","year":"2005","journal-title":"J. Thromb. Haemost."},{"issue":"11","key":"10.1016\/j.ijcard.2024.132484_bb0120","first-page":"2119","article-title":"Subcommittee on control of a","volume":"13","author":"Kaatz","year":"2015","journal-title":"Definition of clinically relevant non-major bleeding in studies of anticoagulants in atrial fibrillation and venous thromboembolic disease in non-surgical patients: communication from the SSC of the ISTH, J Thromb Haemost"},{"issue":"2","key":"10.1016\/j.ijcard.2024.132484_bb0125","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1378\/chest.09-1584","article-title":"Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation","volume":"137","author":"Lip","year":"2010","journal-title":"Chest"},{"issue":"5","key":"10.1016\/j.ijcard.2024.132484_bb0130","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1378\/chest.10-0134","article-title":"A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the euro heart survey","volume":"138","author":"Pisters","year":"2010","journal-title":"Chest"},{"issue":"12","key":"10.1016\/j.ijcard.2024.132484_bb0135","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1161\/CIRCULATIONAHA.123.064556","article-title":"Development and validation of the DOAC score: a novel bleeding risk prediction tool for patients with atrial fibrillation on direct-acting Oral anticoagulants","volume":"148","author":"Aggarwal","year":"2023","journal-title":"Circulation"},{"issue":"16","key":"10.1016\/j.ijcard.2024.132484_bb0140","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1093\/eurheartj\/ehy136","article-title":"The 2018 European heart rhythm association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation","volume":"39","author":"Steffel","year":"2018","journal-title":"Eur. Heart J."},{"key":"10.1016\/j.ijcard.2024.132484_bb0145","doi-asserted-by":"crossref","DOI":"10.1182\/bloodadvances.2024013126","article-title":"More early bleeds associated with high baseline direct Oral anticoagulant levels in atrial fibrillation: the mas study","author":"Palareti","year":"2024","journal-title":"Blood Adv."},{"issue":"7","key":"10.1016\/j.ijcard.2024.132484_bb0150","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1001\/jamacardio.2022.1292","article-title":"Efficacy and safety considerations with dose-reduced direct Oral anticoagulants: a review","volume":"7","author":"Bikdeli","year":"2022","journal-title":"JAMA Cardiol."},{"issue":"7","key":"10.1016\/j.ijcard.2024.132484_bb0155","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1111\/jth.14457","article-title":"Drug levels and bleeding complications in atrial fibrillation patients treated with direct oral anticoagulants","volume":"17","author":"Testa","year":"2019","journal-title":"J. Thromb. Haemost."},{"issue":"3","key":"10.1016\/j.ijcard.2024.132484_bb0160","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1111\/bcp.14127","article-title":"Impact of direct oral anticoagulant off-label doses on clinical outcomes of atrial fibrillation patients: a systematic review","volume":"86","author":"Santos","year":"2020","journal-title":"Br. J. Clin. Pharmacol."},{"issue":"4","key":"10.1016\/j.ijcard.2024.132484_bb0165","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.117.007633","article-title":"Frequency and outcomes of reduced dose non-vitamin K antagonist anticoagulants: results from ORBIT-AF II (the outcomes registry for better informed treatment of atrial fibrillation II)","volume":"7","author":"Steinberg","year":"2018","journal-title":"J. Am. Heart Assoc."},{"issue":"2","key":"10.1016\/j.ijcard.2024.132484_bb0170","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1093\/ehjcvp\/pvy041","article-title":"Outcomes associated with non-recommended dosing of rivaroxaban: results from the XANTUS study","volume":"5","author":"Amarenco","year":"2019","journal-title":"European heart journal Cardiovascular pharmacotherapy"},{"issue":"4","key":"10.1016\/j.ijcard.2024.132484_bb0175","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1002\/clc.23586","article-title":"Effect of non-recommended doses versus recommended doses of direct oral anticoagulants in atrial fibrillation patients: a meta-analysis","volume":"44","author":"Liu","year":"2021","journal-title":"Clin. Cardiol."},{"issue":"12","key":"10.1016\/j.ijcard.2024.132484_bb0180","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1016\/j.jacc.2020.07.045","article-title":"Mortality in patients with atrial fibrillation receiving nonrecommended doses of direct Oral anticoagulants","volume":"76","author":"Camm","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"issue":"3","key":"10.1016\/j.ijcard.2024.132484_bb0185","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1136\/heartjnl-2022-321114","article-title":"Outcomes and drivers of inappropriate dosing of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation: a systematic review and meta-analysis","volume":"109","author":"Caso","year":"2023","journal-title":"Heart"},{"issue":"7","key":"10.1016\/j.ijcard.2024.132484_bb0190","doi-asserted-by":"crossref","DOI":"10.3390\/jcm13072009","article-title":"Inappropriate Underdosing of direct Oral anticoagulants in atrial fibrillation patients: results from the START2-AF registry","volume":"13","author":"Poli","year":"2024","journal-title":"J. Clin. Med."}],"container-title":["International Journal of Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0167527324011069?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0167527324011069?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T09:32:59Z","timestamp":1732527179000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0167527324011069"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12]]},"references-count":38,"alternative-id":["S0167527324011069"],"URL":"https:\/\/doi.org\/10.1016\/j.ijcard.2024.132484","relation":{},"ISSN":["0167-5273"],"issn-type":[{"value":"0167-5273","type":"print"}],"subject":[],"published":{"date-parts":[[2024,12]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"The use of reduced DOAC doses in atrial fibrillation patients does not always lead to good anticoagulation levels and avoid adverse events","name":"articletitle","label":"Article Title"},{"value":"International Journal of Cardiology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ijcard.2024.132484","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2024 Published by Elsevier B.V.","name":"copyright","label":"Copyright"}],"article-number":"132484"}}