Randomized controlled trials of switching to a new medication vs continuing a chronic medication may underestimate the risk of adverse events in those continuing because of asymmetric depletion of susceptibles

For older adults with atrial fibrillation (AF), direct oral anticoagulants (DOACs) reduce a person's risk of stroke and bleeding, compared with vitamin k antagonists (VKAs) [1 –3]. However, a recently published randomized controlled trial (RCT) of frail older adults who were on a VKA and randomized to continue a VKA or switch to a DOAC was stopped early for futility due to greater risk of bleeding in adults switched to a DOAC [4]. Some have interpreted this to mean that VKAs are safer than DOACs in frail older adults [5].
Source: Journal of Clinical Epidemiology - Category: Epidemiology Authors: Tags: Letter to the Editor Source Type: research