S3E1 (#18) - To Stay or Not To Stay with VKAs: Comparison of VKA or switch to DOAC in frail elderly patients with AFib Podcast Por arte de portada

S3E1 (#18) - To Stay or Not To Stay with VKAs: Comparison of VKA or switch to DOAC in frail elderly patients with AFib

S3E1 (#18) - To Stay or Not To Stay with VKAs: Comparison of VKA or switch to DOAC in frail elderly patients with AFib

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 Welcome to What’s it Worth! Join your host, Dr. Diana Langworthy and student guest host, Meade Avery, as we walk the tightrope of anticoagulation in elderly patients with Atrial Fibrillation (AFib). We'll be reviewing an article that evaluated frail, elderly patients with AFib and compared maintaining INR guided warfarin with switching to a direct acting oral anticoagulant (DOAC). Come along as we decide To Stay or Not To Stay with VKAs! Key Points Atrial fibrillation leads to an increased risk of stroke/systemic embolism (SSE) and maintenance anticoagulation is indicated for patients at elevated riskGuidelines recommend DOACs as first line for prevention of SSE in AFib patients however there is little data to determine whether frail elderly patients are better left on their INR guided warfarinPragmatic, or real-world, studies can be helpful in special populations that are often excluded from key randomized controlled trials however may be limited by unmeasured confounders Should more elderly patients stay on their INR guided warfarin? --> Tune in to find out! CHA₂DS₂-VASc Score for Atrial Fibrillation Stroke Risk Calculator: https://www.mdcalc.com/calc/801/cha2ds2-vasc-score-atrial-fibrillation-stroke-risk Contact Information Podcast email: whatsitworthpodcast@gmail.com Host Information Dr. Diana R. Langworthy, PharmD, BCPS Clinical Associate Professor - University of Minnesota College of Pharmacy Clinical Pharmacist - Inpatient Internal Medicine, M Health Fairview East Bank Hospital Guest Host Information Meade Avery, Student Pharmacist Class of 2025 - University of Minnesota College of Pharmacy References [EPISODE TRIAL] Joosten, L. P. T., van Doorn, S., van de Ven, P. M., Köhlen, B. T. G., Nierman, M. C., Koek, H. L., Hemels, M. E. W., Huisman, M. V., Kruip, M., Faber, L. M., Wiersma, N. M., Buding, W. F., Fijnheer, R., Adriaansen, H. J., Roes, K. C., Hoes, A. W., Rutten, F. H., & Geersing, G. J. (2024). Safety of Switching From a Vitamin K Antagonist to a Non-Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients With Atrial Fibrillation: Results of the FRAIL-AF Randomized Controlled Trial. Circulation, 149(4), 279–289. https://doi.org/10.1161/CIRCULATIONAHA.123.066485McMahan, D. A., Smith, D. M., Carey, M. A., & Zhou, X. H. (1998). Risk of major hemorrhage for outpatients treated with warfarin. Journal of general internal medicine, 13(5), 311–316. https://doi.org/10.1046/j.1525-1497.1998.00096.xJoglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., Gorenek, B., Hess, P. L., Hlatky, M., Hogan, G., Ibeh, C., Indik, J. H., Kido, K., Kusumoto, F., Link, M. S., Linta, K. T., … Peer Review Committee Members (2024). 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 149(1), e1–e156. https://doi.org/10.1161/CIR.0000000000001193 Saviano, A., Brigida, M., Petruzziello, C., Candelli, M., Gabrielli, M., & Ojetti, V. (2022). Gastrointestinal Bleeding Due to NOACs Use: Exploring the Molecular Mechanisms. International journal of molecular sciences, 23(22), 13955. https://doi.org/10.3390/ijms232213955Konicki R, Weiner D, Patterson JH, et al. Rivaroxaban precision dosing strategy for real-world atrial fibrillation patients. Clin Transl Sci 2020;13(4):777-784.Mueck W, Lensing AW, Agnelli G, et al. Rivaroxaban: population pharmacokinetic analyses in patients treated for acute deep-vein thrombosis and exposure simulations in patients with atrial fibrillation treated for stroke prevention. Clin Pharmacokinet 2011;50(10):675-686.Garcia, D. A., Lopes, R. D., & Hylek, E. M. (2010). New-onset atrial fibrillation and warfarin initiation: high risk periods and implications for new antithrombotic drugs. Thrombosis and haemostasis, 104(6), 1099–1105. https://doi.org/10.1160/TH10-07-0491 Healthiest Countries 2024. World Population Review. (n.d.). https://worldpopulationreview.com/country-rankings/healthiest-countries. Accessed September 17, 2024.
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