Withholding Anticoagulation in Elderly HF-AF Marks Vulnerability, Not Safety

This retrospective weighted cohort reframes discharge anticoagulation withholding as a risk-treatment paradox signaling residual stroke and bleeding vulnerability rather than a protected low-risk phenotype.

📅 Journal publication: Sep 2026 · Last updated: Oct 7, 2026

oral anticoagulationDOACwarfarinatrial fibrillationheart failurestroke preventionmajor bleedingolder adultsfrailtyconfounding by indicationretrospective cohortpropensity weightingsecondary prevention Anticoagulation / Hematology

Also in Geriatrics

Background Information

Withholding anticoagulation raises stroke risk in older heart failure patients.

Understanding anticoagulation withholding impacts is crucial for preventing stroke and bleeding in elderly heart failure and atrial fibrillation patients. Withholding anticoagulation at discharge was linked to higher ischemic stroke risk (hazard ratio 3.14) and higher bleeding risk, especially in patients aged 80 and above. The study highlights the need for reassessment of anticoagulation therapy in older patients post-discharge, despite concerns over bleeding. Anticoagulation withholding in elderly heart failure patients increases thromboembolic and bleeding risk, urging careful post-discharge evaluation.

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Authors: Yamamoto J, Nakamura K, Hayama H, Enomoto Y, Yamamoto M, Hara H, Hara H, Hiroi Y

Citation: Yamamoto J, Nakamura K, Hayama H, et al. Withholding Oral Anticoagulation at Discharge and Post-Discharge Stroke and Bleeding Vulnerability in a Predominantly Older Cohort Hospitalized With Acute Heart Failure and Atrial Fibrillation. Geriatrics & gerontology international. 2026;26(9):e70817. doi:10.1111/ggi.70817

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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