Atrial fibrillation is an abnormal heart rhythm that increases the risk of stroke. To lower this risk, many people take blood thinners including warfarin or DOACs. In general, DOACs are preferred over warfarin because they require less blood test monitoring and lower the risk of some types of bleeding. Some older people with atrial fibrillation may be advised by their doctor to remain on warfarin, especially those who have many health issues.

We don’t know whether frail, older adults who are doing well on warfarin should switch to a DOAC or continue with their current treatment. Frailty, which includes multiple health problems and a reduced ability to recover from stress, can make people more vulnerable to bleeding. Most randomized controlled trials of DOACs did not include frail patients, so we have very little evidence about what is best for these people.

This study aimed to evaluate whether switching from warfarin to a DOAC is a safe option for older, frail adults with atrial fibrillation. The primary focus was to determine if the switch would decrease the risk of major or significant bleeding. As a secondary objective, the study also assessed the risk of blood clots, including strokes.