Should Frail Older Patients with Atrial Fibrillation on Warfarin Switch to a DOAC?

Clinical Takeaway

: Data from the COMBINE-AF substudy suggests it may be safe and beneficial to switch them to a DOAC. But we still need primary randomized controlled trial data.

Context

In the FRAIL AF trial, switching frail, older patients with atrial fibrillation (AF) who were being treated with warfarin to a direct-acting oral anticoagulant (DOAC) resulted in increased bleeding risk without reducing stroke or systemic embolism risk. This finding suggested that automatic transitions to DOAC in this population may not be safe. Because this issue remains controversial, investigators compared outcomes of 5913 patients who were frail, were older (age, ≥75), and received warfarin and 52,721 patients who did not meet all three criteria, using COMBINE-AF trial data. Patients were randomized to continue warfarin or switch to a DOAC and were followed for a median of 27 months.

Key Results

Patients randomized to DOAC in both …

Reviewing Author

Karol E. Watson, MD, PhD, FACC

Disclosures

Consultant/Advisory BoardBoehringer Ingelheim; Amgen; Novartis; Lilly; Amarin

Speaker’s BureauBoehringer Ingelheim

Grant/Research SupportNIH

Editorial BoardsCirculation (Associate Editor)