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Sukanick and Isherwood
on rivaroxaban, 24.2% were underdosed and 12.1% were
overdosed; and of those on dabigatran, 14.3% were underdosed and 0% were overdosed.
To our knowledge, this is first study specifically examining current prescribing patterns of oral anticoagulants among
extremely elderly patients, defined in our study as those aged
80 years or older. The results of this study raise several
important points to guide future research and practice. First,
as DOAC use in the extremely elderly rises, it will become
increasingly important to obtain high-quality clinical trial
data on safety and efficacy of these anticoagulants in this setting to better guide clinical decision making. In addition, clinicians often struggle with selecting a dose of a DOAC in the
extremely elderly; only about two-thirds of patients prescribed a DOAC in our study were receiving appropriate
dosing. Finally, pharmacists can be advocates for positive
anticoagulant outcomes in this population by participating in
risk-versus-benefit and shared-informed decision-making
discussions with patients and other clinicians.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

References
1.

Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. 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. Chest.
2010;137:263-272.
Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip
GY. A novel user-friendly score (HAS-BLED) to assess one
year risk of major bleeding in atrial fibrillation patients: the
Euro Heart Survey. Chest. 2010;138:1093-1100.
Gage BF, Yan Y, Milligan PE, et al. Clinical classification schemes for predicting hemorrhage: results from the
National Registry of Atrial Fibrillation (NRAF). Am Heart J.
2006;151:713-719.
Chai-Adisaksopha C, Crowther M, Isayama T, Lim W. The
impact of bleeding complications in patients receiving targetspecific oral anticoagulants: a systematic review and metaanalysis. Blood. 2014;124:2450-2458.
Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med.
2009;361:1139-1151.
Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med.
2011;365:883-891.
Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med.
2011;365:981-992.
Guigliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med.
2013;369:2093-2104.

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