Direct Oral Anticoagulants vs. Vitamin K Antagonists in the Oldest Old with Atrial Fibrillation After Stroke

For patients with atrial fibrillation, direct oral anticoagulants (DOACs) are generally preferred over vitamin K antagonists (VKAs) for secondary stroke prevention. But whether this applies to the growing ranks of the oldest of the old (age ≥85) with atrial fibrillation and recent stroke is less clear because these patients have been chronically unrepresented or excluded from clinical trials. Some clinicians are reluctant to use DOACs in this population due to assumed concerns about safety and timing after stroke, frailty and falls, or altered pharmacokinetics.

To address this practical clinical question, investigators pooled individual patient-level data from seven prospective stroke cohorts that included 5984 patients with recent ischemic …