High fluctuation between anticoagulants, frequent off-label dosing and no difference concerning outcomes: results of a real life cohort study

At first glance, there seems to be abundant data comparing safety and effectiveness of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs)1. However, this assumed knowledge comprehends multiple obstacles. Firstly, its transfer into clinical practice remains a challenge as the comparability of the studied populations with the average patient on an oral anticoagulant is questionable. Secondly, results of previous studies diverge2. Thirdly, the use of off-label doses in DOACs is much more common than thought3.