 |
 |

Anticoagulant-Related Bleeding in Older Persons With Atrial Fibrillation
Physicians' Fears Often Unfounded
Malcolm Man-Son-Hing, MD, MSc;
Andreas Laupacis, MD, MSc
Arch Intern Med. 2003;163:1580-1586.
Background Many studies have documented the underuse of anticoagulant (ie, warfarin sodium) therapy as stroke prophylaxis in older persons with atrial fibrillation. Failure to prescribe anticoagulant agents to these patients is often due to physicians' perceiving the risk of major bleeding as unacceptably high because of the presence of such clinical risk factors as hypertension, falls, a history of gastrointestinal tract bleeding, and lack of assurance about compliance.
Objectives To critically appraise whether the presence of additional clinical factors that increase the risk of bleeding affects the chance of anticoagulant-related hemorrhage, and to develop an approach to the use of anticoagulant agents in older patients with atrial fibrillation who have any of these factors.
Methods Systematic MEDLINE literature search from January 1966 to March 2002.
Results Many of the factors that are purported to be barriers to anticoagulant therapy in older persons with atrial fibrillation probably should not influence the choice of stroke prophylaxis in these patients. These include previous episodes of upper gastrointestinal tract bleeding, predisposition to falling, and old age in itself. For some other factors, such as alcoholism, participation in activities that predispose to trauma, the presence of a bleeding diathesis or thrombocytopenia, and noncompliance with monitoring, there is little or conflicting evidence about their effect on anticoagulant-related bleeding. However, they should be considered in the clinical decision-making process.
Conclusions For many older patients with atrial fibrillation, physicians' fears of the risk of bleeding in association with anticoagulant therapy are often exaggerated and unfounded. Therefore, the salient issue in selecting older patients with atrial fibrillation for anticoagulation is accurately estimating their stroke risk, with bleeding risk during anticoagulation being a lesser issue, relevant to only a few patients.
From the Clinical Epidemiology Program, Ottawa Health Research Institute; Geriatric Assessment Unit, Ottawa Hospital; Division of Geriatric Medicine, University of Ottawa; and Institute on Health of the Elderly, Sisters of Charity Ottawa Health Service; Ottawa (Dr Man-Son-Hing); and the Institute for Clinical Evaluative Sciences and Faculty of Medicine, University of Toronto, Toronto (Dr Laupacis); Ontario, Canada. The authors have no relevant financial interest in this article.
RELATED LETTERS
Anticoagulant-Related Bleeding Risk in Older Persons: Unfounded Fears?
Christoph Pechlaner
Arch Intern Med. 2004;164(1):106-107.
EXTRACT
| FULL TEXT
Anticoagulant-Related Bleeding Risk in Older Persons: Unfounded Fears?Reply
Malcolm Man-Son-Hing and Andreas Laupacis
Arch Intern Med. 2004;164(1):107.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
 |
Review: Stroke prevention: modifying risk factors
Romero et al.
Therapeutic Advances in Cardiovascular Disease 2008;2:287-303.
ABSTRACT
Use of Anticoagulation in Elderly Patients with Atrial Fibrillation Who Are at Risk for Falls
Garwood and Corbett
The Annals of Pharmacotherapy 2008;42:523-532.
ABSTRACT
| FULL TEXT
Anticoagulation for elderly patients with atrial fibrillation: not to be neglected
Taggar and Lip
Europace 2008;10:1-2.
FULL TEXT
Barriers to the Use of Anticoagulation for Nonvalvular Atrial Fibrillation: A Representative Survey of Australian Family Physicians
Gattellari et al.
Stroke 2008;39:227-230.
ABSTRACT
| FULL TEXT
'Rules of thumb' or reflective practice? Understanding senior physicians' decision-making about anti-thrombotic usage in atrial fibrillation
Anderson et al.
QJM 2007;100:263-269.
ABSTRACT
| FULL TEXT
Not All Patients With Atrial Fibrillation-Associated Ischemic Stroke Can Be Started on Anticoagulant Therapy
Somerfield et al.
Stroke 2006;37:1217-1220.
ABSTRACT
| FULL TEXT
Hospitalized Patients With Atrial Fibrillation and a High Risk of Stroke Are Not Being Provided With Adequate Anticoagulation
Waldo et al.
J Am Coll Cardiol 2005;46:1729-1736.
ABSTRACT
| FULL TEXT
Direct thrombin inhibitors: novel antithrombotics on the horizon in the thromboprophylactic management of atrial fibrillation
Katira et al.
Postgrad. Med. J. 2005;81:370-375.
ABSTRACT
| FULL TEXT
Prognostic Implications of Warfarin Cessation After Major Trauma: A Population-Based Cohort Analysis
Hackam et al.
Circulation 2005;111:2250-2256.
ABSTRACT
| FULL TEXT
Risk of bleeding with long-term antithrombotic therapy in atrial fibrillation
Schulman and Beyth
Eur Heart J Suppl 2005;7:C34-C40.
ABSTRACT
| FULL TEXT
Managing Complications of Anticoagulant Therapy
Smythe et al.
Journal of Pharmacy Practice 2004;17:327-346.
ABSTRACT
Anticoagulant-Related Bleeding Risk in Older Persons: Unfounded Fears?
Pechlaner
Arch Intern Med 2004;164:106-107.
FULL TEXT
Stroke Prevention in Atrial Fibrillation
Waldo
JAMA 2003;290:1093-1095.
FULL TEXT
|