Pall T. Onundarson: Would Modern Monitoring Alter VKAs Role in High-Risk COPD with AF Patients
Pall T. Onundarson, Professor Emeritus at Landspitali University Hospital, shared on LinkedIn:
”Gundersen B-EVV, et al. in Denmark (BMJ Open Respir Res 2026;13:e003814. doi:10.1136/bmjresp-2025-003814) just published an observational study suggesting that VKAs are superior to DOAC drugs in moderate and severe COPD patients with concomitant atrial fibrillation.
The results are contrary to their hypothesis that VKA patients would fare worse as a consequence of loss of a protective effect of vitamin K in the lungs.
This adds to the data supporting a continued role for warfarin and VKAs in specific high-risk patient groups.
Albeit at the cost of inconvenience, RCTs have found that conventionally treated VKAs (mainly warfarin) are superior to DOAC drugs in certain high-risk conditions such as MHV, RHD, APLAS, frail elderly.
A caveat is that Gundersen´s study is not an RCT but there is still much to learn about warfarin/VKAs.
One wonders what the data would look like if warfarin had been monitored with a modern test and not the old PT-INR…”
Title: COPD and vitamin K antagonism: a cohort study of 1- year all- cause mortality and risk of hospitalisation due to a severe exacerbation
Authors: Bård-Emil Vang Vang Gundersen, Anna Kubel Vognsen, Josefin Eklöf, Pradeesh Sivapalan, Allan Linneberg, Tor Biering-Sørensen, Jens-Ulrik Stæhr Jensen
Read the Full Article on BMJ Open Respiratory Research
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