Evidence map›Paper›PMID 41712168›Full record

ArticleJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2026

Outcomes of individual DOACs vs. VKAs in AF patients with frailty: a systematic review and meta-analysis.

Travis Quevillon, Justin Chiu, Peter Amlogu, Faith Michael, William F McIntyre, Ratika Parkash, Jason G Andrade, Cynthia A Jackevicius, Jeff S Healey, Dennis T Ko and 1 more

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In one paragraph

Article in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Travis Quevillon *Cardiology Department, Health Sciences North, Health Sciences North Research Institute, Northern Ontario School of Medicine University, 41 Ramsey Lake Rd, Sudbury, ON, P3E 5J1, Canada.
Justin Chiu *Cardiology Department, Health Sciences North, Health Sciences North Research Institute, Northern Ontario School of Medicine University, 41 Ramsey Lake Rd, Sudbury, ON, P3E 5J1, Canada.
Peter AmloguCardiology Department, Health Sciences North, Health Sciences North Research Institute, Northern Ontario School of Medicine University, 41 Ramsey Lake Rd, Sudbury, ON, P3E 5J1, Canada.
Faith MichaelCardiology Department, Health Sciences North, Health Sciences North Research Institute, Northern Ontario School of Medicine University, 41 Ramsey Lake Rd, Sudbury, ON, P3E 5J1, Canada.
William F McIntyrePopulation Health Research Institute, McMaster University, Hamilton, ON, Canada.
Ratika ParkashDivision of Cardiology, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, NS, Canada.
Jason G AndradeHeart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, Canada.
Cynthia A JackeviciusDepartment of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA.
Jeff S HealeyPopulation Health Research Institute, McMaster University, Hamilton, ON, Canada.
Dennis T KoInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Mohammed ShurrabCardiology Department, Health Sciences North, Health Sciences North Research Institute, Northern Ontario School of Medicine University, 41 Ramsey Lake Rd, Sudbury, ON, P3E 5J1, Canada. shurrabm@hotmail.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAtrial fibrillation (AF) patients with frailty represent a particularly complex and medically vulnerable population. These patients are simultaneously at increased risk for ischemic stroke and bleeding complications, complicating decisions around anticoagulant therapy. This systematic review and meta-analysis sought to evaluate the comparative safety and efficacy of individual direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in AF patients with frailty.

methodsWe systematically searched MEDLINE, Embase, and CENTRAL for studies published to July 2, 2024. Included studies compared individual DOACs to VKAs in AF patients with frailty. Outcomes were stroke/systemic embolism (SSE) and major bleeding. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model.

resultsA total of six studies (one randomized trial and five cohort studies) met inclusion criteria, encompassing 272,545 patients (108,666 treated with VKAs and 163,879 with DOACs). Among DOAC-treated patients, 62,961 were treated with apixaban, 21,954 with dabigatran, 10,813 with edoxaban and 68,151 with rivaroxaban. Of the six included studies, four reported stroke or systemic embolism in patients taking apixaban, five reported this outcome for dabigatran, four for edoxaban, and five for rivaroxaban. Four studies reported major bleeding in patients taking apixaban, five reported major bleeding for dabigatran, four for edoxaban, and five for rivaroxaban. Among DOACs, apixaban was associated with significant reductions in SSE (OR 0.56, 95% CI 0.33–0.95, p = 0.03) and major bleeding (OR 0.52, 95% CI 0.29–0.95, p = 0.03) compared with VKAs. Other DOACs demonstrated numerical trends toward reduced SSE and major bleeding but did not reach statistical significance.

conclusionsThese findings suggest that apixaban is associated with a more favorable safety and efficacy profile than VKAs in AF patients with frailty. This analysis supports the preferential use of apixaban in this population, while highlighting the need for individualized risk assessment and clinical judgment.

Indexed as

Atrial fibrillationDirect oral anticoagulantsFrailtyVitamin k antagonists

Identifiers

PMID41712168

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.