2024-01-29 05:00:00
Goal
To investigate whether vulnerable elderly people with atrial fibrillation (AF) who are currently using a vitamin K antagonist (VKA) would be better off switching to a direct-acting oral anticoagulant (DOAC).
Intent
Randomized clinical trial.
Methods
662 frail elderly people with AF switched to a DOAC and 661 patients continued with VKA treatment. The primary outcome was major or clinically relevant non-major bleeding during a one-year follow-up period. The secondary outcome was a thromboembolic event.
Results
The average age of the participants was 83 years. In the DOAC group, 101 bleeding events (15.3%) occurred; in the VKA group 62 bleeding events (9.4%). This means an increase of 69% in the number of bleedings due to the switch to a DOAC (p = 0.001). The number of thromboembolic events was not significantly different between the two groups.
Conclusion
Switching from a VKA to a DOAC in vulnerable elderly people with AF leads to 69% more bleeding; the risk of a thromboembolic event remains the same.
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