Real-world rivaroxaban use in fragile Asian patients with atrial fibrillation: The impact of plasma concentration on clinical outcomes

Non-vitamin K antagonist oral anticoagulants (NOACs) are considered the preferred choice of anticoagulants in patients with non-valvular atrial fibrillation (NVAF) [1]. Routine laboratory tests are not recommended for rivaroxaban, while the metabolism of rivaroxaban may be influenced by kidney function, body weight, gene polymorphism, and other factors. Pharmacokinetics, and therefore, recommended dosing, of rivaroxaban is different in Asian populations compared to other regions in the world. Besides, in real-world practice, off-label use of a reduced dose of NOACs is not uncommon [2,3].