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Switching frail older people with AF from a vitamin K antagonist to a DOAC

https://doi.org/10.1136/dtb.2024.000037

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    Key messages

    • Guidelines recommend considering switching adults with atrial fibrillation (AF) on vitamin K anticoagulant (VKA) therapy to a direct oral anticoagulant (DOAC).

    • A randomised trial assessed the safety and efficacy of switching to a DOAC in older frail patients with AF.

    • There was an increased risk of bleeding complications in patients switched to a DOAC relative to those who remained on VKAs.

    The authors of an open-label randomised trial found that switching from international normalised ratio (INR)-guided vitamin K anticoagulant (VKA) treatment to a direct oral anticoagulant (DOAC) in frail older patients with atrial fibrillation (AF) was associated with more bleeding complications than continuing VKA treatment.1

    Overview

    The FRAIL-AF trial was a multicentre, pragmatic, open-label, randomised superiority trial conducted in the Netherlands that recruited patients aged ≥75 years with AF managed by INR-guided VKA treatment and who scored ≥3 on the Groningen Frailty Indicator (GFI).1 Exclusion criteria included estimated glomerular …

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    Footnotes

    • Contributors DTB Team.

    • Provenance and peer review Commissioned; internally peer reviewed.