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Anticoagulant-Related Bleeding Risk in Older Persons: Unfounded Fears?—Reply
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In reply
Based on the perception of an unacceptably high risk of major bleeding in many older persons receiving anticoagulant therapy, Dr Pechlaner concludes that many older patients with atrial fibrillation might not derive overall benefit for anticoagulant therapy. A number of references used to support his conclusions are open to critique in the context of today's clinical practice. For example, the study by Beyth et al1 was performed in the 1980s, a time when higher-intensity anticoagulation was the norm. In fact, the mean international normalized ratios of persons in this study were greater than 3.0, a level clearly shown to increase bleeding risk without providing incremental stroke protection benefit. Therefore, the estimates of bleeding risk from this study are likely higher than that found in current practice, with the recommended target international normalized ratio being 2.5 (range, 2.0-3.0), and the clinical usefulness of their bleeding risk stratification scheme is . . . [Full Text of this Article]
Malcolm Man-Son-Hing, MD, MSc, FRCPC
Ottawa, Ontario
Andreas Laupacis, MD, MSc, FRCPC
Toronto, Ontario
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Arch Intern Med. 2003;163(13):1580-1586.
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