FRAIL-AF

Safety of Switching From a Vitamin K Antagonist to a Non-Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients With Atrial Fibrillation

Paciente / Población Intervención / Exposición Comparación Desenlace

In 1,330 frail elderly patients with atrial fibrillation stable on a vitamin K antagonist, switching to a DOAC increased major or clinically relevant bleeding compared with continuing the vitamin K antagonist.

1330

Diseño

Open-label superiority RCT with blinded adjudication, stopped early

Desenlace

Composite of major or clinically relevant non-major bleeding

Relevancia

Resultado15.3% vs 9.4% (HR 1.69, 95% CI 1.23-2.32); switching to a DOAC caused more bleeding than continuing a VKA, without offsetting thromboembolism reduction.

Joosten LPT, et al. Circulation. 2024;149(4):279-289. 10.1161/CIRCULATIONAHA.123.066485

Discusión y crítica

Applies to frail patients already stable on a VKA and does not argue against starting DOACs de novo. Challenged routine VKA-to-DOAC switching in frail elderly AF patients.