New research published in Heart reveals a concerning trend: older adults with atrial fibrillation (Afib) who discontinue anticoagulant medication face significantly increased risks of stroke, heart attack, and death. This study challenges common assumptions about the risks and benefits of these medications and has important implications for nursing home care.
The study, which analyzed data from over 20,000 UK patients aged 75 and older with Afib, found that the risk of stroke and death tripled when individuals stopped taking anticoagulants. The risk of heart attack nearly doubled. These findings underscore the critical need for careful consideration before discontinuing these life-saving medications.
“Prescribers need to consider the increased risk to patients of coming off anticoagulants, including stroke,” said Anneka Mitchell, PhD, lead researcher from the University of Bath. This quote highlights the study’s key takeaway: the dangers of stopping anticoagulants often outweigh the risks associated with continued use.
One common reason for discontinuing anticoagulants is the perceived risk of bleeding, particularly from falls. However, the study found that while bleeding risks exist, discontinuing anticoagulation did not significantly affect the risk of major bleeding but did drastically increase the risk of more severe events like stroke and death. This suggests that the focus should shift from solely preventing falls to also prioritizing the prevention of potentially fatal cardiovascular events.
The study also sheds light on the evolving landscape of Afib treatment. While warfarin, a complex anticoagulant requiring frequent monitoring, was the primary option until 2012, direct oral anticoagulants (DOACs) have since emerged as a safer and more convenient alternative. However, the study authors point out that clinical trials for DOACs often included healthier participants, leading to uncertainty about their safety in older adults. This uncertainty may have contributed to some physicians’ reluctance to prescribe DOACs for this population.
This research has significant implications for nursing homes, where a substantial proportion of residents may be managing Afib. It emphasizes the need for careful assessment of each resident’s individual risk profile before any decision is made to discontinue anticoagulant therapy. Nursing home staff should be well-versed in the latest research on Afib management and work closely with physicians to ensure that residents receive the most appropriate and effective care.
“This study underscores the importance of evaluating the consequences of deprescribing anticoagulants, particularly in older adults who are at higher risk of adverse outcomes,” Mitchell added. As the population ages, understanding and addressing the complexities of Afib management will be crucial for ensuring the health and well-being of nursing home residents.