Vascular Health and Risk Management (Sep 2019)
When to withhold oral anticoagulation in atrial fibrillation – an overview of frequent clinical discussion topics
Abstract
Jaap Seelig,1 Ron Pisters,1 Martin E Hemels,1,2 Menno V Huisman,3 Hugo ten Cate,4,5 Marco Alings6 1Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands; 2Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands; 3Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands; 4Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; 5Anticoagulation Clinic Maastricht, Maastricht, The Netherlands; 6Department of Cardiology, Amphia Hospital, Breda, The NetherlandsCorrespondence: Martin E HemelsDepartment of Cardiology, Rijnstate Hospital, Wagnerlaan 55, Arnhem, AD 6815, The NetherlandsTel +31 64 126 8279Email [email protected]: Stroke prevention with oral anticoagulants in patients with atrial fibrillation predisposes for bleeding. As a result, in select patient groups anticoagulation is withheld because of a perceived unfavorable risk-benefit ratio. Reasons for withholding anticoagulation can vary greatly between clinicians, often leading to discussion in daily clinical practice on the best approach. To guide clinical decision-making, we have reviewed available evidence on the most frequently reported reasons for withholding anticoagulation: previous bleeding, frailty and age, and an overall high bleeding risk.Keywords: hemorrhage, frail elderly, age, anticoagulants, atrial fibrillation
