Speakers
Prof. Tze-Fan Chao
National Yang-Ming University, Chinese Taipei
Professor Tze-Fan Chao is an Associate Professor at National Yang-Ming University and attending physician at the Division of Cardiology, Taipei Veterans General Hospital, Taiwan. Dr Chao’s main clinical interest is device implantation. His research interests are in the areas of atrial fibrillation, including epidemiology, stroke risk stratification and oral anticoagulants for stroke prevention. He has published more than 80 original articles as first, co-first or corresponding author in SCI journals including Circulation, JACC, European Heart Journal, Stroke, Chest, Heart, Mayo Clinic Proceedings, Heart Rhythm, and etc. Currently, he is the chair of the APHRS practical guideline subcommittee and section editor of “Thrombosis and Haemostasis”. He is also a reviewer for several international journals, including Circulation, JACC, EHJ, and etc. He has been invited to give presentations at important international conferences, including AHA, ACC, ESC, and etc.
Abstract
Dosing strategy of non-vitamin K antagonist oral anticoagulants in stroke prevention in atrial fibrillation
Atrial fibrillation (AF) is associated with a 3-5 fold higher risk of ischemic stroke, and therefore, stroke prevention with oral anticoagulants (OACs) is central to the management of patients with AF. Non-vitamin K antagonist OACs (NOACs) have emerged as the preferred anticoagulant option for stroke prevention in AF (SPAF) in the last decade. Since routine monitoring of drug concentration is not necessary for NOACs, the selection of appropriate dose of NOACs according to the dosage criteria defined in randomized controlled trials (RCT) or labelling is very important. However, prescriptions of off-label dosing NOACs remained as a major problem in the daily practice.
Several factors, such as old age, chronic kidney disease and prior history of bleeding, would impact on clinical physicians’ choices of certain dosing of NOACs. Since the Asian population is associated with a higher bleeding risk such as intracranial hemorrhage, physicians generally tend to prescribe low-dose NOACs for Asian AF patients in the clinical practice. In this lecture, we will discuss the complementary data from RCT and real-world evidence that support NOAC treatment in AF patients. Also, we will discuss data regarding the associations between dosing of NOACs and clinical outcomes, and emphasize the importance of on-labelling dosing NOACs in SPAF.