Departments

Anticoagulation for atrial fibrillation (January 2017)

Elise Henning, MD, MED
Cleveland Clinic Journal of Medicine September 2017, 84 (9) 658; DOI: https://doi.org/10.3949/ccjm.84c.09001

TO THE EDITOR: As a geriatric medicine fellow, I eagerly read Hagerty and Rich’s review “Fall risk and anticoagulation for atrial fibrillation in the elderly: A delicate balance”1 and Suh’s editorial, “Whether to anticoagulate: Toward a more reasoned approach”2 in the January 2017 issue. Both pieces were helpful and informative.

I appreciate that Dr. Suh encourages shared decision-making between physicians and patients that balances patient preferences and risk stratification to inform whether to anticoagulate. He states, “Unfortunately, there is no similar screening tool to predict bleeding risk from anticoagulation with greater precision in the middle to lower part of the risk spectrum…The patient’s life expectancy and personal preferences are important independent factors that affect the decision of whether to anticoagulate or not.”

Dr. Mark Eckman’s Atrial Fibrillation Decision Support Tool (AFDST) incorporates patients’ CHA2DS2-VASc and HAS-BLED scores to determine their quality-adjusted life expectancy on or off anticoagulation. The tool helps guide physicians and patients to make shared decisions about anticoagulation.3–5 The AFDST informs clinicians if a patient is undertreated or being treated unnecessarily. Eckman and his colleagues have demonstrated the AFDST’s effective application in clinical practice, including for older adults. I invite readers to learn more about Eckman’s work!

REFERENCES

    1. Hagerty T,
    2. Rich MW
    . Fall risk and anticoagulation for atrial fibrillation in the elderly: a delicate balance. Cleve Clin J Med 2017; 84:35–40.
    1. Suh TT
    . Whether to anticoagulate: toward a more reasoned approach. Cleve Clin J Med 2017; 84:41–42.
    1. Eckman MH,
    2. Lip GYH,
    3. Wise RE,
    4. et al
    . Impact of an atrial fibrillation decision support tool on thromboprophylaxis for atrial fibrillation. Am Heart J 2016; 176:17–27.
    1. Eckman MH,
    2. Wise RE,
    3. Speer B,
    4. et al
    . Integrating realtime clinical information to provide estimates of net clinical benefit antithrombotic therapy for patients with atrial fibrillation. Circ Cardiovasc Qual Outcomes 2014; 7:680–686.
    1. Eckman MH,
    2. Lip TYH,
    3. Wise RE,
    4. et al
    . Using an atrial fibrillation decision support tool for thromboprophylaxis in atrial fibrillation: effect of sex and age. J Am Geriatr Soc 2016; 64:1054–1060.