Anticoagulant Use for AF Among Persons With Advanced Dementia at the End of Life

Researchers have sought to characterize the use of anticoagulants as prophylaxis against stroke in nursing home residents with atrial fibrillation (AF) and dementia, according to JAMA Internal Medicine. Preventing stroke is particularly important in this population, as advanced dementia already deeply impairs cognition, restricts self-care abilities, and limits life expectancy. Analysis of Medicare data spanning October through December 2020 identified 15,217 nursing community residents with AF and advanced dementia, approximately one-third of whom were still receiving anticoagulant therapy during the last six months of life. Trouble swallowing, weight loss, and pressure ulcers — all indicators of high short-term mortality — were strongly associated with greater odds of anticoagulant use as, surprisingly, was greater bleeding risk. "These findings underscore the fact that, while practical guidelines contain a well-defined threshold for starting anticoagulation for AF, there is no clear standard for stopping it," the study authors concluded. "Our work points to the need for high-quality data to inform decision-making about anticoagulation in this population."