Daniel Victor Ortigoza: Should Frail Older Patients With AF Switch From VKA to DOACs?
Daniel Victor Ortigoza, Vicepresidente del Comité de Cardio Oncología de FAC at Federación Argentina de Cardiología, shared a post on LinkedIn about a recent article by Paschalis Karakasis et al., published in Medical Sciences, adding:
“Switching from Vitamin K Antagonists to Direct Oral Anticoagulants in Frail Elderly Patients with Atrial Fibrillation:
Systematic Review and Meta-Analysis by Paschalis Karakasis, et al. Med. Sci. 2026, 14(5), 516.
The meta-analysis included four studies (two RTCs and two nationwide observational cohort studies) involving 57,099 patients with atrial fibrillation (mean age plus or minus 82 years; mean CHA₂DS₂-VASc score plus or minus 5) who were followed for two years.
There were no significant differences among the five types of comparative treatments for the four study groups.
The very high heterogeneity (I²: 86–94%) limits the robustness of the study.
Studies such as GARFIELD-AF, ORBIT-AF, RE-LY, and Bonde, A.N. et al. reported a TTR less than 64% (a suboptimal value) and lower adherence to warfarin treatment.
Figure Central: Forest plots depicting individual and pooled HRs with 95% CIs for the comparison between switching from VKA therapy to DOAC treatment and remaining on VKA therapy for (A) the composite endpoint of stroke/systemic embolism, major bleeding, or all-cause mortality; (B) major bleeding; (C) thromboembolism; and (D) all-cause mortality.”
Title: Switching from Vitamin K Antagonists to Direct Oral Anticoagulants in Frail Elderly Patients with Atrial Fibrillation: Systematic Review and Meta-Analysis
Authors: Paschalis Karakasis, Ricardo Gómez-Huelgas, Stylianos Tzeis, Konstantinos Vlachos, Konstantinos C. Siontis, Alberto M. Marra, Konstantinos Pamporis, Antonios P. Antoniadis, Eleftheria Lefkou, Valentin A. Kokorin, Dimitrios Patoulias, Nikolaos Fragakis
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