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In all four trials of direct-acting oral anticoagulants (DOACs) against warfarin for stroke prevention in atrial fibrillation, DOACs showed a numerical reduction in major bleeding, and two of the four showed a statistically significant reduction in major bleeds. However, the role of frailty — which may affect efficacy and safety of anticoagulation — was not examined.
In a retrospective analysis of Medicare claims data, researchers compared outcomes in new users of DOACs dabigatran (≈79,000), rivaroxaban (≈138,000), and apixaban (≈109,000) versus propensity score–matched patients initiating warfarin, stratified by frailty level (nonfrail, prefrail, frail). Frailty was assessed using a claims-based frailty index derived from codes for diagnosi…