The Lead Episode 28: Results of the FRAIL-AF Randomized Controlled Trial-Circulation

Circulation

Pdf Summary

The FRAIL-AF randomized controlled trial aimed to investigate the safety of switching from a vitamin K antagonist (VKA) to a non-vitamin K antagonist oral anticoagulant (NOAC) in frail older patients with atrial fibrillation (AF). The trial included 1,323 patients who were randomized to either switch to a NOAC or continue with VKA treatment. The primary outcome was the occurrence of major or clinically relevant non-major bleeding complications. The trial found that switching to a NOAC was associated with a 69% increase in bleeding complications compared to continuing VKA treatment. There was no significant difference in thromboembolic events between the two treatment arms. The results suggest that switching from VKA to a NOAC in frail older patients with AF may not be safe and may increase the risk of bleeding complications without a reduction in thromboembolic events. These findings highlight the importance of carefully considering the choice of anticoagulant treatment in this patient population. The trial was limited by the small number of events for some outcomes and the choice of NOAC was at the discretion of the treating physician. Further research is needed to confirm these findings and determine the optimal anticoagulant strategy for frail older patients with AF.

Keywords

FRAIL-AF

randomized controlled trial

vitamin K antagonist

non-vitamin K antagonist oral anticoagulant

frail older patients

atrial fibrillation

bleeding complications

thromboembolic events

anticoagulant treatment

optimal anticoagulant strategy