Abstract
OBJECTIVE: To investigate whether frail elderly people with atrial fibrillation (AF) who are currently using a vitamin K antagonist (VKA) should be switched to a direct-acting oral anticoagulant (DOAC). DESIGN: Randomized clinical trial. METHODS: 662 frail elderly AF patients were switched to a DOAC, and 661 patients continued their VKA. The primary endpoint was a major or clinically relevant non-major bleeding during 1 year of follow-up. Secondary endpoints included thrombo-embolic events. RESULTS: The mean age of the included patients was 83 years. In the 'switch to DOAC arm', 101 bleeding events (15.3%) occurred and in the 'continue with VKA arm', 62 bleeding events (9.4%); an increase of 69% more bleeding events (P-value 0.001). The number of thrombo-embolic events was not significantly different between both groups. CONCLUSION: Switching from a VKA to a DOAC in frail elderly people with AF leads to 69% more bleeding, without a difference in thrombo-embolic events.
Translated title of the contribution | Coumarin or DOAC in frail elderly patients with atrial fibrillation? |
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Original language | Dutch |
Article number | D8026 |
Journal | Nederlands Tijdschrift voor Geneeskunde |
Volume | 168 |
Publication status | Published - 29 Jan 2024 |
Keywords
- Humans
- Aged
- Aged, 80 and over
- Atrial Fibrillation/complications
- Frail Elderly
- Vitamin K
- Administration, Oral
- Anticoagulants/adverse effects
- Hemorrhage/chemically induced
- Coumarins/therapeutic use
- Stroke/complications