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This systematic review summarizes and evaluate DOACs use in real\u2010world practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This review was performed following the preferred reporting items for systematic reviews and meta\u2010analyses (PRISMA) guidelines searching PubMed (MEDLINE) and Medscape databases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data from 75 studies showed that most of the patients treated with DOACs for stroke prevention in atrial fibrillation received doses in accordance to the guidelines. However, a significant number of patients received off\u2010label doses (25\u201350% in most of the studies evaluated). DOAC overdosing was associated with increased all\u2010cause mortality and worse bleeding events while underdosing was associated with increased cardiovascular hospitalization and, particularly for apixaban, with a nearly 5\u2010fold increased risk of stroke.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients prescribed with off\u2010label DOAC doses did not receive the full benefit of anticoagulation and presented an increased risk of stroke, bleeding and\/or adverse effects.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bcp.14127","type":"journal-article","created":{"date-parts":[[2019,10,21]],"date-time":"2019-10-21T04:59:42Z","timestamp":1571633982000},"page":"533-547","source":"Crossref","is-referenced-by-count":93,"title":["Impact of direct oral anticoagulant off\u2010label doses on clinical outcomes of atrial fibrillation patients: A systematic 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