Anticoagulant Use for Atrial Fibrillation Among Persons With Advanced Dementia at the End of Life
Study of 15,217 nursing home residents with AF and advanced dementia in US found ~30% remained on anticoagulation (AC) in last 6 months of life, underscoring fact that whilst there is well-defined threshold for starting AC for AF, there is no clear standard for stopping it.
Source:
JAMA Internal Medicine
SPS commentary:
The researchers note that clinicians are asked to engage in shared decision-making with patients and their families and data about the benefits and harms of therapy are essential to that process, but for patients with dementia, little such evidence is available, although the magnitudes of benefits and harms are likely to change substantially as the disease progresses.
According to an editorial, these findings highlight the lack of a rational strategy for managing anticoagulation in those with limited life expectancy owing to age or illness. It notes guidelines suggest periodic reevaluation of anticoagulation to reassess stroke and bleeding risks, but there is a dearth of information on how to implement this because seriously ill, frail patients are understudied in both clinical trials and observational research.