Healthcare Professionals' perspectives on prescribing DOACs to frail older patients; The DOAC-FRAIL questionnaire

Background DOACs are increasingly prescribed for atrial fibrillation and venous thromboembolism due to their ease of use and lack of monitoring requirements. Prescribing DOACs to frail older patients remains challenging due to higher bleeding and thrombo-embolic risks, comorbidities, polypharmacy, and underrepresentation in clinical trials. This study explored prescribing behavior of healthcare professionals (HCPs) in this complex clinical context. Methods An online questionnaire was distributed to HCPs involved in the care of frail older patients. The survey consisted of 27 items divided into three sections: demographics, factors influencing anticoagulant choice, and DOAC management. Descriptive statistics were used to evaluate outcomes. Results 355 HCPs completed the questionnaire. HCPs considered frailty(56.9%), fall risk(47.1%) and cognitive impairment (40.0%) when choosing an anticoagulant. Apixaban was the preferred DOAC(56.6%). 74.9% of HCPs did not measure DOAC levels in clinically stable patients, whereas 62.8% measured DOAC levels during acute hospitalizations. A large group of HCPs(46.4%) actively switched from VKA to DOAC, but expressed reservations due to fear for an increased bleeding risk. Almost half(48.1%) of HCPs indicated the need for clearer, tailored guidelines for DOAC use in frail older patients. Conclusions This study highlights the complexity of prescribing DOACs to frail older patients. While HCPs take multiple factors into account, a standardized approach to prescribing DOACs in this population remains lacking. In addition, almost half of HCPs expressed a need for guidelines regarding DOAC use in frail older patients. Hence, more research is needed to fill this knowledge gap and guide HCPs in clinical practice.