Direct oral anticoagulants for stroke prevention in patients aged 85 years and over


  • Consistent with randomized clinical trials performed in younger cohorts, real-world evidence shows that direct oral anticoagulants (DOACs) have a more favorable profile in stroke prevention and all-cause death compared to vitamin K antagonists (VKA) in patients aged ≥85 years.

Why this matters

  • Atrial fibrillation (AF) and ischemic stroke are common in people of advancing age and with an aging population, the rate of AF-related ischemic stroke in patients aged ≥85 is growing.

  • Current guidelines prefer DOAC to VKA for recurrent stroke prevention in adults. However, these recommendations are based on randomized control trials where <5% of the patient population were aged ≥85.

  • Due to the lack of evidence, physicians may be reluctant to prescribe DOAC in older patients citing safety concerns, resulting in poorer outcomes. An investigation of DOAC versus VKA use in patients aged ≥85 is warranted.