NOACs are the preferred first-line anticoagulation therapy for stroke prevention in older adults with atrial fibrillation, requiring individualized, shared decision-making.
Supports NOAC preference in eligible older AF patients; leaves open need for dedicated geriatric outcome trials.
Non-vitamin K antagonist OACs are the preferred first-line OAC in older adults with AF, including high-risk subpopulations, after individual assessment of stroke and bleeding risk, except those with mechanical heart valves and moderate-to-severe mitral stenosis. Head-to-head comparisons of NOACs are not available, therefore the choice of drug (and dose) should be based on an individual's risk (stroke and bleeding) and incorporate their treatment preferences. Treatment decisions must be person-centered and principles of shared decision-making applied.
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Verma et al. (2023) studied this question.
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