Older patients with atrial fibrillation treated with DOACs have fewer strokes and systemic emboli than those treated with vitamin K antagonists

Clinical Question

What is the optimal strategy for preventing strokes in adults 80 years and older who have atrial fibrillation?

Bottom line

In this network meta-analysis that included lower-quality studies, the DOACs provided a better balance of benefits (preventing stroke or systemic emboli) and harms (major bleeding) than vitamin K antagonists in adults 80 years or older with atrial fibrillation. The conclusions are comparable with findings from many other analyses of DOACs that have demonstrated fewer harms and comparable benefits. 2a

Study design: Meta-analysis (other)

Funding: Government

Setting: Various (meta-analysis)


Henry C. Barry, MD, MS
Michigan State University
East Lansing, MI

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Impact assessment



DOAC's better than coumadin for stroke prevention in patient

Good to know. Coumadin is a nightmare for the elderly



atrial fib presumably non valvular


Time in Therapeutic Range once again not considered

Why do these studies persist when their comparator datasets for VKA always fail to report the Time in Therapeutic Range? The results are uninterpretable without this key piece of information, and continuing to publish these analyses does nothing to advance our understanding of the true benefits/harms of DOACs


DOACs vs Vit K antagonists

This study may suggest that DOACs are safer vs vitamin K antagonists (VKAs), but it would be helpful to know what was the time in treatment range (TTR) for patients on the VKAs. Countries that have programs where the TTR is above 80% likely have better outcomes. In some cases this has been achieved with the aid of point of care INR testing, with patients owning their own monitors. The introduction of DOACs, although now in widespread practice for several years, always seemed an issue of bringing in more expensive medications, initially without any real antidotes, to substitute for properly managed anticoagulation programs. That money could have been spent on other priorities, by both patients and healthcare funders.