Austin Reese: Should Anticoagulation for AF Continue When Patients Move into Long-Term Care?
Austin Reese, St.George Anticoagulation Clinic Ambassador and Clinical Pharmacist at Intermountain Healthcare, shared a post on LinkedIn:
“An interesting article I read in JAMA that got me thinking.
Should anticoagulation for AF continue when patients move into long-term care?
Kapoor and colleagues used target trial emulation in 15,426 Medicare beneficiaries with atrial fibrillation entering long-term care.
- Stopping anticoagulation was not associated with more stroke or more bleeding.
- It was associated with higher mortality, which may reflect how sick these patients were rather than an effect of stopping the drug.
Why it matters:
Guidelines tell us when to start anticoagulation for AF, but not necessarily when to stop it. For frail residents with limited life expectancy, these data support individualized deprescribing conversations based on each resident’s goals of care.
They do not support stopping anticoagulation automatically.
As a pharmacist that cares for patients on anticoagulation, I see this as another reason to reassess ongoing anticoagulation at care transitions.”
Title: Stroke and Bleeding Risk in Long-Term Care Residents With Atrial Fibrillation Who Discontinue Anticoagulation
Authors: Alok Kapoor, Zhiyong Chen, Jay Patel, Zehao Ye, Honghuang Lin, Geoffrey Barnes, Sybil Crawford, Jerry H. Gurwitz
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