When is long-term anticoagulation contraindicated in older patients with atrial fibrillation (AF)?

Updated: Dec 18, 2018
  • Author: Salvador Cruz-Flores, MD, MPH, FAHA, FCCM, FAAN, FACP, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Answer

Long-term anticoagulation should not be used in patients with an increased risk of bleeding due to factors such as the following:

  • Poor compliance

  • Uncontrollable hypertension

  • Aortic dissection

  • Bacterial endocarditis

  • Alcohol dependency

  • Liver disease

  • Bleeding lesions

  • Malignant tumor

  • Retinopathy with bleeding risk

  • Advanced microvascular changes in the brain

  • Known aneurysm of a cerebral artery

  • Previous spontaneous cerebral hemorrhage

  • Bleeding diathesis (eg, coagulopathies, thrombocytopenia).

In these cases, aspirin (325 mg/d) may be favorable as a long-term treatment.


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