Oral anticoagulant therapy in atrial fibrillation older patients with previous bleeding

  • Mario Bo | mario.bo@unito.it Section of Geriatrics, Departement of Medical Sciences, University of Turin, Città della Salute e della Scienza, Molinette Hospital, Turin, Italy. http://orcid.org/0000-0003-2945-0243
  • Francesco Giannecchini Section of Geriatrics, Departement of Medical Sciences, University of Turin, Città della Salute e della Scienza, Molinette Hospital, Turin, Italy.
  • Martina Papurello Section of Geriatrics, Departement of Medical Sciences, University of Turin, Città della Salute e della Scienza, Molinette Hospital, Turin, Italy.
  • Enrico Brunetti Section of Geriatrics, Departement of Medical Sciences, University of Turin, Città della Salute e della Scienza, Molinette Hospital, Turin, Italy. https://orcid.org/0000-0003-2028-2319

Abstract

Oral anticoagulant therapy (OAT) with direct oral anticoagulant (DOACs) is the established treatment to reduce thromboembolic risk in patients with atrial fibrillation (AF). Bleeding risk scores are useful to identify and correct factors associated with bleeding risk in AF patients on OAT. However, the clinical scenario is more complex in patients with previous bleeding event, and the decision about whether and when starting or re-starting OAT in these patients remains a contentious issue. Major bleeding is associated with a subsequent increase in both short- and long-term mortality, and even minimal bleeding may have prognostic importance because it frequently leads to disruption of antithrombotic therapy. There is an unmet need for guidance on how to manage antithrombotic therapy after bleeding has occurred. While waiting for observational and randomized data to accrue, this paper offers a perspective on managing antithrombotic therapy after bleeding in older patients with AF.

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Published
2020-03-09
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Issue
Section
Cardiology - Reviews
Keywords:
elderly, atrial fibrillation, oral anticoagulant therapy, bleeding
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How to Cite
Bo, M., Giannecchini, F., Papurello, M., & Brunetti, E. (2020). Oral anticoagulant therapy in atrial fibrillation older patients with previous bleeding. Monaldi Archives for Chest Disease, 90(1). https://doi.org/10.4081/monaldi.2020.1252