This editorial refers to “Resumption of oral anticoagulation following traumatic injury and risk of stroke and bleeding in patients with atrial fibrillation: a nationwide cohort study” by L Staerk et al.
The authors note that oral anticoagulants (OACs) are underused for many reasons – they are not prescribed to patients with previous bleeding episodes, high bleeding risk or frequent falls and there is a misperception that aspirin is effective for stroke prevention in atrial fibrillation. In addition, restarting OACs following interruption is challenging, resulting in long-term underuse.
Staerk et al showed that resumption of OACs following traumatic injury was associated with lower all-cause mortality and ischaemic stroke, and was not associated with the recurrence of traumatic injury. Resumption of non-vitamin K antagonist OAC treatment was not linked with higher major bleeding. Encouragingly, the rate of OAC resumption increased over the course of the study.
The authors conclude that programmes addressing patient-, provider- and system-level barriers should include a focus on ensuring that patients resume anticoagulation.