Oral anticoagulant therapy (OAC), with direct oral anticoagulants (DOACs) recommended over vitamin K antagonists (VKAs), is considered the standard of care for patients with atrial fibrillation (AF) at high risk of stroke [1–3], but it remains widely underused, particularly in older adults [4–10]. Although clinical inertia and malpractice may contribute to OAC underprescription, it is likely that OAC nonprescription often represents an intentional clinical decision. This reflects persistent uncertainties about its net clinical benefit in patients with limited life expectancy, multiple comorbidities, frailty, and geriatric syndromes [4–7,10–20].
