Traumatic injury: another unjustified reason to stop oral anticoagulation for atrial fibrillation


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.

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Pokorney SD et al. Eur Heart J. 13 December, 2017. Epub ahead of print.