Arrhythmias & electrophysiology
Effectiveness and safety of direct oral anticoagulation vs. warfarin in frail patients with atrial fibrillation
Authors' conclusion
Our findings indicate comparable thromboembolism risk and significantly lower bleeding risk with both standard and reduced DOAC regimens compared with warfarin in frail AF patients in routine care.
Study context
- Population
- Anticoagulation-naïve frail patients (hospital frailty risk score) with incident atrial fibrillation (AF), 2012–20
- Participants
- 6,747 / 17,076 / 9,179
- Exposure
- Direct oral anticoagulant (DOAC) vs warfarin
- Warfarinn = 6,747reference
- Standard-dose DOACn = 17,076
- Reduced-dose DOACn = 9,179
- Outcome
- Thromboembolism and major bleeding
Methodological detailsinverse probability of treatment weighting, marginal structural models
- Inverse probability of treatment weighting
- Marginal structural models
Main finding
As reported in the abstract
Thromboembolism
Each group vs warfarinWeighted hazard ratio (95% CI)
Standard-dose DOAC
0.95(0.80–1.13)
Reduced-dose DOAC
0.97(0.77–1.23)
- 1-year thromboembolic event-free survival difference, DOAC regardless of dosing vs warfarin
- −0.2%
Observational data: associations, not effects.
Safety
| Outcome | wHR (95% CI) | |
|---|---|---|
| Major bleedingStandard-dose DOAC vs Warfarin · IPTW pseudo-populations | 0.69 (0.59–0.87) | |
| Major bleedingReduced-dose DOAC vs Warfarin · IPTW pseudo-populations | 0.67 (0.55–0.81) | |
| 0.512Weighted hazard ratio (log scale) |
- Major bleeding — 1-year bleeding risk difference with DOAC
- −1.3% to −3.0%
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Effectiveness and safety of direct oral anticoagulation vs. warfarin in frail patients with atrial fibrillation. Eur Heart J Cardiovasc Pharmacother. Published 22 November 2023. doi:10.
Summarised from the published abstract; every number is checked against it