Abstract
Direct oral anticoagulants (DOACs) have changed the paradigm of anticoagulation management,
improving patient convenience as well as possibly reducing the incidence of spontaneous
intracranial hemorrhage. However, concerns remain with these agents because of the
lack of monitoring capacity and availability of readily accessible specific antidotes.
This is particularly pertinent in the older population, specifically the frail older
adults who have multiple comorbidities, higher risk of falls, and increased bleeding
risk. This group has not been specifically studied in the DOAC randomized controlled
trials and, hence, extrapolation of these data into this population should be done
cautiously. We provide a review of the use of DOACs in the older frail population
from both hematological and geriatric perspectives, as well as propose an algorithm
for how these agents may be used in this frail population.
Keywords
direct oral anticoagulants - older adults - frailty - bleeding
