While the rejection of a paper submitted to a journal is an inevitable event in the activity of a researcher and must be accepted, sometimes the motivations for such rejection appear questionable or even in contrast to accepted recommendations. This is the case of an article we recently submitted to a prestigious, high-ranked, cardiology journal in which we discussed about the use of the two different doses of each direct oral anticoagulant (DOAC) in non-valvular atrial fibrillation (NVAF). Based on the different design of the phase III clinical trials, and in particular of RE-LY [1] with dabigatran compared to ROCKET AF [2], ARISTOTLE [3] and ENGAGE AF-TIMI 48 [4] with the factor-Xa inhibitors rivaroxaban, apixaban, and edoxaban respectively, we argued that the administration of the lower dose of dabigatran should be essentially at the prescriber's discretion, whereas that of factor-Xa inhibitors should be strictly dependent on specific clinical and/or laboratory patient's characteristics, in the absence of which such posology needs to be considered off-label and generally avoided.
