{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T09:25:17Z","timestamp":1787736317795,"version":"build-2784847793"},"reference-count":47,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Med. Sci.","Medical Sciences"],"abstract":"<jats:p>Background: Frailty complicates anticoagulation management in older patients with atrial fibrillation (AF), particularly when long-term vitamin K antagonist (VKA) therapy is already established. Whether switching to a direct oral anticoagulant (DOAC) improves outcomes in this setting remains uncertain, and guideline recommendations are limited. We performed a systematic review and meta-analysis comparing outcomes of VKA-to-DOAC switching versus VKA continuation in frail elderly patients with AF. Methods: MEDLINE, Scopus, and the Cochrane Library were systematically searched from inception through 4 April 2026. Studies enrolling frail elderly patients with AF receiving VKA therapy and directly comparing switching to a DOAC versus continued VKA treatment were eligible. The primary outcome was a composite of stroke\/systemic embolism, major bleeding, or all-cause mortality. Adjusted hazard ratios (HRs) were pooled using three-level random-effects models. Results: Four studies (five treatment comparisons) comprising 57,099 patients were included. Overall, switching from VKA to DOAC therapy was not associated with a significant difference in the composite outcome compared with continued VKA treatment (HR 1.18, 95% CI 0.84\u20131.67). No significant differences were observed for major bleeding (HR 1.13, 95% CI 0.80\u20131.60), thromboembolism (HR 1.03, 95% CI 0.63\u20131.68), or all-cause mortality (HR 0.95, 95% CI 0.77\u20131.16). In analyses restricted to randomized trials, results remained neutral across all outcomes. Conclusion: In frail elderly patients with AF receiving VKA therapy, switching to a DOAC was not associated with significant reductions in thromboembolism, major bleeding, mortality, or the composite outcome compared with continued VKA treatment.<\/jats:p>","DOI":"10.3390\/medsci14050516","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T15:55:06Z","timestamp":1787673306000},"page":"516","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Switching from Vitamin K Antagonists to Direct Oral Anticoagulants in Frail Elderly Patients with Atrial Fibrillation: Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3561-5713","authenticated-orcid":false,"given":"Paschalis","family":"Karakasis","sequence":"first","affiliation":[{"name":"Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, 546 42 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9909-3555","authenticated-orcid":false,"given":"Ricardo","family":"G\u00f3mez-Huelgas","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Regional University Hospital of M\u00e1laga, Biomedical Research Institute of M\u00e1laga (IBIMA), University of M\u00e1laga (UMA), 29010 Malaga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stylianos","family":"Tzeis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mitera Hospital, 6 Erythrou Stavrou Str., 151 23 Marousi, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7543-3236","authenticated-orcid":false,"given":"Konstantinos","family":"Vlachos","sequence":"additional","affiliation":[{"name":"Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Universit\u00e9, Universit\u00e9 de Bordeaux, INSERM U1045, 33604 Pessac, France"},{"name":"Cardiac Arrhythmia Department, INSERM U1045, CHU de Bordeaux, 33604 Pessac, France"},{"name":"Electrophysiology Department, Hygeia Hospital, 151 23 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos C.","family":"Siontis","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9679-3003","authenticated-orcid":false,"given":"Alberto M.","family":"Marra","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, \u201cFederico II\u201d University, 80131 Naples, Italy"},{"name":"Department of Internal Medicine and Clinical Complexity, \u201cFederico II\u201d University Hospital, 80131 Naples, Italy"},{"name":"Interdepartmental Center for Gender Medicine Research \u201cGENESIS\u201d, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5411-6461","authenticated-orcid":false,"given":"Konstantinos","family":"Pamporis","sequence":"additional","affiliation":[{"name":"First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6604-5581","authenticated-orcid":false,"given":"Antonios P.","family":"Antoniadis","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, 546 42 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleftheria","family":"Lefkou","sequence":"additional","affiliation":[{"name":"Hematology-Transfusion Medicine Department, Faculty of Medicine, Larissa University Hospital, University of Thessaly, 413 34 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentin A.","family":"Kokorin","sequence":"additional","affiliation":[{"name":"Department of Hospital Therapy with Courses in Endocrinology, Hematology and Clinical Laboratory Diagnostics, Peoples\u2019 Friendship University of Russia Named after Patrice Lumumba (RUDN University), Moscow 117198, Russia"},{"name":"Department of Hospital Therapy Named after Academician P.E. Lukomsky, Pirogov Russian National Research Medical University, Moscow 117513, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6899-684X","authenticated-orcid":false,"given":"Dimitrios","family":"Patoulias","sequence":"additional","affiliation":[{"name":"Second Propedeutic Department of Internal Medicine, Faculty of Medicine, School of Health Sciences Aristotle, University of Thessaloniki, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7158-4950","authenticated-orcid":false,"given":"Nikolaos","family":"Fragakis","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, 546 42 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1038\/s41572-022-00347-9","article-title":"Atrial Fibrillation","volume":"8","author":"Brundel","year":"2022","journal-title":"Nat. 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