{"id":"a7b00d7c736c","type":"article","url":"https://hartvaat.nl/2023/01/11/inadequate-noac-dosering-bij-af-uitkomsten-en-oorzaken-meta-analyse/","title":"Inadequate NOAC-dosering bij AF: uitkomsten en oorzaken — meta-analyse","title_en":"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.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-321114","source_url":"https://doi.org/10.1136/heartjnl-2022-321114","authors":["Valeria Caso","Joris R de Groot","Marcelo Sanmartin Fernandez","Tomás Segura","Carina Blomström-Lundqvist","David Hargroves","Sotiris Antoniou","Helen Williams","Alice Worsley","James Harris","Amrit Caleyachetty","Burcu Vardar","Paul Field","Christian T Ruff"],"significance":7,"published":"2023-01-11","source_date":"2023-01-11","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/antistolling-bij-ouderen/"],"congress":"","summary_en":"This systematic review documented that inappropriate NOAC dosing (particularly underdosing) in AF is prevalent and associated with worse outcomes, highlighting the importance of adherence to recommended dose criteria for stroke prevention.","created":"2026-07-03T10:30:10Z","updated":"2026-07-03T13:29:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review toonde dat inadequate NOAC-dosering bij AF frequent voorkomt (vooral onderdosering) en geassocieerd is met slechtere uitkomsten. Onderdosering verhoogt het CVA-risico zonder de bloedingen te verminderen. Correcte dosering verdient meer aandacht.","abstract_original":"OBJECTIVE: There has been limited systematic evaluation of outcomes and drivers of inappropriate non-vitamin K antagonist oral anticoagulants (NOACs) dosing among patients with atrial fibrillation (AF). This review identified and systematically evaluated literature on clinical and economic outcomes of inappropriate NOAC dosing and associated patient characteristics. METHODS: MEDLINE, Embase, Cochrane Library, International Pharmaceutical Abstracts, Econlit, PubMed and NHS EEDs databases were searched for English language observational studies from all geographies published between 2008 and 2020, examining outcomes of, or factors associated with, inappropriate NOAC dosing in adult patients with AF. RESULTS: One hundred and six studies were included in the analysis. Meta-analysis showed that compared with recommended NOAC dosing, off-label underdosing was associated with a null effect on stroke outcomes (ischaemic stroke and stroke/transient ischaemic attack (TIA), stroke/systemic embolism (SE) and stroke/SE/TIA). Meta-analysis of 15 studies examining clinical outcomes of inappropriate NOAC dosing found a null effect of underdosing on bleeding outcomes (major bleeding HR=1.04, 95% CI 0.90 to 1.19; p=0.625) but an increased risk of all-cause mortality (HR=1.28, 95% CI 1.10 to 1.49; p=0.006). Overdosing was associated with an increased risk of major bleeding (HR=1.41, 95% CI 1.07 to 1.85; p=0.013). No studies were found examining economic outcomes of inappropriate NOAC dosing. Narrative synthesis of 12 studies examining drivers of inappropriate NOAC dosing found that increased age, history of minor bleeds, hypertension, congestive heart failure and low creatine clearance (CrCl) were associated with an increased risk of underdosing. There was insufficient evidence to assess drivers of overdosing. CONCLUSIONS: Our analysis suggests that off-label underdosing of NOACs does not reduce bleeding outcomes. Patients prescribed off-label NOAC doses are at an increased risk of all-cause mortality. These data underscore the importance of prescriber adherence to NOAC dosing guidelines to achieve optimal clinical outcomes for patients with AF. PROSPERO REGISTRATION NUMBER: CRD42020219844."}