Appropriate Anticoagulant Use for Atrial Fibrillation at the End of Life

Heather Mason

May 18, 2021

A research letter published in  JAMA Internal Medicine  reports that almost one-third of nursing home residents with atrial fibrillation (AF) and advanced dementia remained on anticoagulation during their last six months of life.

The cross-sectional analysis included 15,217 nursing home residents, of whom 5,033 (33.1 per cent) received an anticoagulant in the last six months of life. The authors note that as dementia progresses, cognitive function is gradually but irreversibly lost so that the potential benefits of preventing a stroke become increasingly reduced.

They found that higher stroke risk scores (CHA2DS2VASC and ATRIA), nursing home length of stay of at least one year, weight loss, pressure ulcers, and difficulty swallowing were factors associated with greater odds of anticoagulant use. On the other hand, older age, female sex, and being enrolled in hospice were associated with lower odds of anticoagulant use.

Surprisingly, nursing home length of stay of at least one year were more strongly associated with anticoagulant use than CHA2DS2VASC score.

These findings highlight that while guidelines contain a well-defined threshold for starting anticoagulation for AF, there is no clear standard for stopping it, the authors conclude.

References:

Ouellet GM, Fried TR, Gilstrap LG, O’Leary JR, Austin AM, Skinner JS, et al. Anticoagulant Use for Atrial Fibrillation Among Persons With Advanced Dementia at the End of Life. JAMA Intern Med 2021. https://doi.org/10.1001/jamainternmed.2021.1819.

This article originally appeared on Univadis, part of the Medscape Professional Network

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