Bleeding Tolerance Among Patients With Atrial Fibrillation on Oral Anticoagulation

The Introduction of Direct Oral Anticoagulants Has Not Resolved Treatment Gaps for Frail Patients With Nonvalvular Atrial Fibrillation

“…13,[28][29][30][31] It is also worth noting that patients are much more willing to accept anticoagulant bleeding risks as a trade-off for preventing strokes than are physicians. 32,33 In our study population, frailty was strongly associated with non-prescription of an anticoagulant even when indicated. Although results have been mixed in previous studies, with some finding frailty negatively associated with anticoagulant prescriptions 15,24,25 and others not, 14,16 this is not surprising because of the lack of consensus on how to assess frailty and the marked variability in frailty prevalence when different tools are used.…”

Bleeding in anticoagulated patients with atrial fibrillation: practical considerations

“…Results from a survey suggest that patients with AF who initiate oral anticoagulation are willing to sustain 4 major bleeds to avoid 1 se rious stroke. 98 About half of the patients, main ly older, with minor or major bleeds on antico agulation and without history of cerebrovascu lar events, accept a low number of bleeds (0-3). Our recent findings confirmed that patients with AF fear a major stroke more than bleeding, but they are less willing to accept such adverse events after a serious bleed in the past as well as in the presence of persistent minor bleed ing, for example, easy bruising.…”

“…Our recent findings confirmed that patients with AF fear a major stroke more than bleeding, but they are less willing to accept such adverse events after a serious bleed in the past as well as in the presence of persistent minor bleed ing, for example, easy bruising. 98 From a prac tical point of view, it is important to remem ber that only 1 out of 2 patients with AF treat ed with NOACs or VKAs is aware that the saf est painkiller is paracetamol, and 1 out of 4 pa tients knows what to do when an anticoagulant dose is missed. Among patients with AF, women, patients with diabetes, prosthetic heart valve, and minor bleedings were found to be better in formed about those issues.…”

Bleeding in anticoagulated patients with atrial fibrillation: practical considerations

“…Results from a survey suggest that patients with AF who initiate oral anticoagulation are willing to sustain 4 major bleeds to avoid 1 serious stroke. 98 About half of the patients, mainly older, with minor or major bleeds on anticoagulation and without history of cerebrovascular events, accept a low number of bleeds (0-3). Our recent findings confirmed that patients with AF fear a major stroke more than bleeding, but they are less willing to accept such adverse events after a serious bleed in the past as well as in the presence of persistent minor bleeding, for example, easy bruising.…”

“…Our recent findings confirmed that patients with AF fear a major stroke more than bleeding, but they are less willing to accept such adverse events after a serious bleed in the past as well as in the presence of persistent minor bleeding, for example, easy bruising. 98 From a practical point of view, it is important to remember that only 1 out of 2 patients with AF treated with NOACs or VKAs is aware that the safest painkiller is paracetamol, and 1 out of 4 patients knows what to do when an anticoagulant dose is missed. Among patients with AF, women, patients with diabetes, prosthetic heart valve, and minor bleedings were found to be better informed about those issues.…”