Routine Switching of Warfarin to DOACs in Older Adults May Not Be Justified

Atrial fibrillation (AF) is most common in older adults. Additionally, many older adults are frail, increasing their risk for bleeding, and are burdened by requirements of AF treatment with vitamin-K antagonists (VKAs), which include changes in medical regimens and frequent follow-up visits to achieve a therapeutic International Normalized Ratio (INR). While some of these burdens might be eliminated with the alternative use of direct oral anticoagulants (DOACs), evidence of their comparative efficacy and safety in older, frail patients is lacking.

In a multicenter, open-label, randomized trial funded by the Dutch government and multiple pharmaceutical companies, investigators randomized 1330 patients aged ≥75 years who met validated criteria…