Would you change an elderly, frail patient with atrial fibrillation who is already on a NOAC to VKA treatment?

I wouldn't on the basis of this study. Aside from the other limitations of the FRAIL-AF trial, this study only addressed the utility of switching a stable patient from VKA to NOAC and not vice versa. A patient who is doing well on an appropriately dosed NOAC may experience difficulty achieving adequ...

One could use a slightly lower than standard dose, e.g., Eliquis 2.5 mg bid or Xarelto 15 mg daily. I see no advantage, only detriment, to the use of warfarin.

No.

This was a study of patients who were stable and doing well on warfarin. That’s not representative of the general patient population that needs anticoagulation, many of whom are lacking in their follow-up, don’t follow a diet, and will therefore be difficult to control. So this study was potentially...