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DOAC vs Warfarin Burden in Palliative AF — SCE Palliative Medicine MCQ

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ModerateNon-Malignant Palliative CareDOAC vs Warfarin Burden in Palliative AFSCE Palliative Medicine

A 78‑year‑old man with advanced heart failure and atrial fibrillation is on warfarin. His INR control has been labile, despite monitoring. He is now on the palliative pathway with an estimated prognosis of months. His cardiologist considers switching to a direct oral anticoagulant (DOAC). Which consideration is most relevant in his palliative care context?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — DOACs may reduce treatment burden through fixed dosing, no INR monitoring, and fewer food and drug interactions

Option A is correct because the palliative approach emphasises reducing treatment burden and improving quality of life. DOACs simplify anticoagulant management—no regular INR checks, predictable dosing, fewer dietary/drug restrictions—addressing the patient’s labile INR problem. Option D is false: there is no age cutoff at 75. Option E is incorrect: DOACs may be appropriate when benefits align with care goals. Option C is misleading: while warfarin is reversible, reversibility is less critical when prophylactic anticoagulation is continued without major bleeding. Option B is overly generalising: anticoagulation decisions depend on individual risk–benefit and goals of care—not palliative status alone.

Reference: NICE NG196 (2021): recommendations 1.6.3 on DOACs simplifying care; QOF guidance (2026): DOACs reduce monitoring and improve quality of life. URLs in evidence. https://www.nice.org.uk/guidance/NG196/chapter/recommendations