Adequacy of Direct Oral Anticoagulant Dosing in Nursing Home Residents: Cross-Sectional Data From the DOAC-FRAIL Study

Direct oral anticoagulants (DOACs) are increasingly prescribed in older adults because of their fixed dosing, predictable pharmacokinetics, and lower risk of intracranial bleeding compared with vitamin K antagonists (VKAs).1 Their use is particularly appealing in frail older adults, for whom frequent International Normalized Ratio (INR) monitoring is impractical.2 Despite these advantages, evidence in very old or multimorbid adults remains mixed: although several large observational studies and meta-analyses show favorable safety profiles, other work has highlighted that switching frail older patients from VKAs to DOACs may be associated with higher bleeding risks, and several analyses report similar rates of thromboembolic and bleeding events for DOACs and VKAs, particularly in individuals with renal impairment, polypharmacy, or high frailty burden.