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ACC 2024: COMBINE-AF (Part 1)

Author: Kseniia Eruslanova, MD, MSc, PhD, Russian clinical and research geriatric center

Hello, everybody. My name is Kseniia, I am a member of an early carrier geriatrician group. I came to geriatric medicine from the cardiology field. One of my favorite activities in my free time is attending international congresses. It’s a chance to learn something new, to study from leaders' opinions, to meet interesting people and, last, but not least, a chance to visit a new place.

This April I visited a conference of the American College of Cardiology. It’s one of two large American annual cardiology conferences. 

This year it was in Atlanta, Georgia. It’s a home place for Coca-Cola and Delta (one of the biggest American airline companies). In 1996, it was a “home” for the summer Olympic Games. More or less, that is all my knowledge about this city. And luckily, we are here to discuss geriatrics, not city history.

I would like to tell you about a meeting of the cardio-geriatric group of ACC. The meeting was held on the first day. There were cardiologists who are interested in geriatric medicine, members of the American Institute of aging and a special guest:  professor M. Boustani ( one of the fathers of the “Aging Brain Care program”). 

On this meeting was presented the winner of nomination of the best study of older adults: COMBINE-AF analysis. COMBINE-AF – is a meta-analysis of a pivotal trial with DOACs (rivaraxaban, dabigantran, edoxaban and apixaban) vs warfarin for stroke prevention in patients with atrial fibrillation; last year they published data regardless kidney function [1]). On the meeting they showed the results of secondary analysis regarding frailty (basically, performing the same analysis which was done on FRAIL-AF [2]). And yes, warfin is safer compared to DOAC. However, if we use only “geriatric-friendly” apixaban and edoxaban, warfarin has lost its priority. Let’s wait for official publication, currently, we have only a conference abstract [3].


  1. Harrington J, Carnicelli AP, Hua K, et al. Direct Oral Anticoagulants Versus Warfarin Across the Spectrum of Kidney Function: Patient-Level Network Meta-Analyses From COMBINE AF. Circulation. 2023;147(23):1748-1757. doi:10.1161/CIRCULATIONAHA.122.062752

  2. Joosten LPT, van Doorn S, van de Ven PM, et al. Safety of Switching From a Vitamin K Antagonist to a Non-Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients With Atrial Fibrillation: Results of the FRAIL-AF Randomized Controlled Trial. Circulation. 2024;149(4):279-289. doi:10.1161/CIRCULATIONAHA.123.066485

  3. NICOLAU, A, Afilalo, J, Gencer, B. et al. FRAILTY STATUS AND OUTCOMES IN 58,634 PATIENTS WITH ATRIAL FIBRILLATION RANDOMIZED TO DOAC VS WARFARIN. J Am Coll Cardiol. 2024 Apr, 83 (13_Supplement) 22.

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