When to withhold oral anticoagulation in atrial fibrillation - an overview of frequent clinical discussion topics

Jaap Seelig; Ron Pisters; Martin E. Hemels; Menno V. Huisman; Hugo ten Cate; Marco Alings

doi:10.2147/VHRM.S187656

When to withhold oral anticoagulation in atrial fibrillation - an overview of frequent clinical discussion topics

Jaap Seelig
, Ron Pisters
, Martin E. Hemels^*
, Menno V. Huisman
, Hugo ten Cate
, Marco Alings

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

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.

Original language	English
Pages (from-to)	399-408
Number of pages	10
Journal	Vascular health and risk management
Volume	15
DOIs	https://doi.org/10.2147/VHRM.S187656
Publication status	Published - 2019

Keywords

hemorrhage
frail elderly
age
anticoagulants
atrial fibrillation
INTRACRANIAL HEMORRHAGE
BLEEDING RISK
ANTITHROMBOTIC THERAPY
PREDICTING STROKE
ELDERLY-PATIENTS
WARFARIN
OUTCOMES
DABIGATRAN
SCORE
ASSOCIATION

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10.2147/VHRM.S187656Licence: CC BY-NC

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@article{38fef9544d254d4faf7d61d49e306628,

title = "When to withhold oral anticoagulation in atrial fibrillation - an overview of frequent clinical discussion topics",

abstract = "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, INTRACRANIAL HEMORRHAGE, BLEEDING RISK, ANTITHROMBOTIC THERAPY, PREDICTING STROKE, ELDERLY-PATIENTS, WARFARIN, OUTCOMES, DABIGATRAN, SCORE, ASSOCIATION",

author = "Jaap Seelig and Ron Pisters and Hemels, \{Martin E.\} and Huisman, \{Menno V.\} and \{ten Cate\}, Hugo and Marco Alings",

note = "Funding Information: J Seelig receives funding from the Netherlands Federation of Anticoagulation clinics. ME Hemels discloses speaker fees from Bayer, Bristol-Myers Squibb, Pfizer, Boehringer Ingelheim, Daiichi Sankyo, Roche and received a research grant from Netherlands Federation of Anticoagulation clinics. M.V. Huisman reports research grants from Dutch Healthcare Fund, Bayer, Bristol-Myers Squibb, Pfizer, Boehringer Ingelheim, and Daiichi Sankyo. H ten Cate received research grants from Bayer and Pfizer; advisory boards for Bayer, Pfizer, Leo; consultancy for Alveron. H ten Cate is an unpaid chairman of the board of the Netherlands Federation of Anticoagulation clinics. M Alings discloses speaker fees from Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Pfizer, Daiichi Sankyo, and Milestone Pharmaceuticals. The authors report no other conflicts of interest in this work. Publisher Copyright: {\textcopyright} 2019 Seelig et al.",

year = "2019",

doi = "10.2147/VHRM.S187656",

language = "English",

volume = "15",

pages = "399--408",

journal = "Vascular health and risk management",

issn = "1176-6344",

publisher = "Dove Medical Press Ltd.",

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T1 - When to withhold oral anticoagulation in atrial fibrillation - an overview of frequent clinical discussion topics

AU - Seelig, Jaap

AU - Pisters, Ron

AU - Hemels, Martin E.

AU - Huisman, Menno V.

AU - ten Cate, Hugo

AU - Alings, Marco

N1 - Funding Information: J Seelig receives funding from the Netherlands Federation of Anticoagulation clinics. ME Hemels discloses speaker fees from Bayer, Bristol-Myers Squibb, Pfizer, Boehringer Ingelheim, Daiichi Sankyo, Roche and received a research grant from Netherlands Federation of Anticoagulation clinics. M.V. Huisman reports research grants from Dutch Healthcare Fund, Bayer, Bristol-Myers Squibb, Pfizer, Boehringer Ingelheim, and Daiichi Sankyo. H ten Cate received research grants from Bayer and Pfizer; advisory boards for Bayer, Pfizer, Leo; consultancy for Alveron. H ten Cate is an unpaid chairman of the board of the Netherlands Federation of Anticoagulation clinics. M Alings discloses speaker fees from Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Pfizer, Daiichi Sankyo, and Milestone Pharmaceuticals. The authors report no other conflicts of interest in this work. Publisher Copyright: © 2019 Seelig et al.

PY - 2019

Y1 - 2019

N2 - 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.

AB - 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.

KW - hemorrhage

KW - frail elderly

KW - age

KW - anticoagulants

KW - atrial fibrillation

KW - INTRACRANIAL HEMORRHAGE

KW - BLEEDING RISK

KW - ANTITHROMBOTIC THERAPY

KW - PREDICTING STROKE

KW - ELDERLY-PATIENTS

KW - WARFARIN

KW - OUTCOMES

KW - DABIGATRAN

KW - SCORE

KW - ASSOCIATION

U2 - 10.2147/VHRM.S187656

DO - 10.2147/VHRM.S187656

M3 - Article

C2 - 31571891

SN - 1176-6344

VL - 15

SP - 399

EP - 408

JO - Vascular health and risk management

JF - Vascular health and risk management

ER -

When to withhold oral anticoagulation in atrial fibrillation - an overview of frequent clinical discussion topics

Abstract

Keywords

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