Based on observations, selecting a low dose direct oral anticoagulant (DOAC) might be linked with poor functional results in patients without renal dysfunction.

• Pooled prospective multicenter registry data of stroke patients receiving anticoagulant agents, including ischemic stroke (IS) patients with non-valvular atrial fibrillation and prior DOAC usage, were assessed to propose a novel criterion for selecting the DOAC dose and examine clinical features of IS under this criterion.

• Four groups of patients were defined: no alternative low-dose (selecting low-dose appropriately with all DOACs applicable for reduction criteria), selected low-dose (selecting low-dose appropriately or inappropriately despite at least one DOAC inapplicable for reduction criteria), selected standard-dose (appropriate standard-dose use), and absolute overdose (inappropriate standard-dose irrespective of criteria).

• Overall 322 patients were analyzed, and prevalence of no alternative low-dose, selected low-dose, selected standard-dose, and absolute over-dose was estimated to be 74 (23%), 144 (45%), 89 (27%), and 15 (5%), respectively.

• In multivariable analysis, significantly poorer functional outcomes were evident in the selected low-dose group, vs the selected standard-dose group, only in patients without renal dysfunction (OR, 2.60; 95% CI, 1.17–6.00).