Blood Thinners: Risks of Stopping Medication in Seniors
for seniors with atrial fibrillation, stopping blood thinners may elevate stroke risk, a critical finding from the University of Bath. Research reveals that discontinuing anticoagulants can triple the risk of stroke and death, challenging assumptions about bleeding concerns. This study emphasizes the importance of careful consideration before deprescribing blood thinners, especially in older adults. Understand the significance for patients aged 75 and older when considering the impact of stopping blood thinners. Discover why newer direct oral anticoagulants (DOACs) like apixaban offer safer alternatives to warfarin, addressing major bleeding risks and simplifying administration. News Directory 3 provides key insights into these vital findings. Eager to learn about future research? Find out what’s next for atrial fibrillation treatment.
Anticoagulants for Atrial fibrillation: Stroke Risk Outweighs Bleeding Concerns
Updated June 08, 2025
For individuals with atrial fibrillation (AF), halting anticoagulant treatment poses a greater threat of stroke or heart attack than the risk of major bleeding, according to research from the University of Bath. The study, funded by the Dunhill Medical Trust, challenges the common concern among clinicians regarding bleeding risks associated with prescribing blood thinners, especially to older patients.
Atrial fibrillation, a common heart condition, elevates stroke risk fivefold and contributes to an estimated 20,000 strokes annually in the United Kingdom. It also heightens the likelihood of heart attacks and mortality. Anticoagulants are effective in managing AF and preventing complications.
The Heart journal study revealed that discontinuing anticoagulants for patients 75 and older did not alter major bleeding risks. Researchers say these findings should influence prescribing practices.
“Prescribers need to consider the increased risk to patients of coming off anticoagulants, including stroke,” said Dr. Anneka Mitchell, who conducted the research from the University of Bath.
AF cases are increasing, particularly among those 85 and older. Diagnoses doubled in men (11.6% to 22.1%) and women (9.6% to 16.5%) between 2000 and 2016.
Mitchell’s study analyzed data from the UK Clinical Practice Research datalink between 2013 and 2017, focusing on patients aged 75 and older newly prescribed anticoagulants. The research indicated that stroke and death risks tripled when patients were not receiving anticoagulation therapy. Heart attack risk nearly doubled.
Mitchell believes concerns about falls and the historical use of warfarin influence decisions to withhold anticoagulants. Warfarin, previously the only option, involves dietary restrictions and frequent blood tests.
Direct oral anticoagulants (DOACs) have become the primary treatment option sence 2013. doacs are as effective and safe as warfarin, and easier to administer.
“For example, apixaban (a DOAC) has a lower risk of significant bleeding than warfarin, so for many older patients with AF, this would be an excellent medication,” Mitchell said.
Mitchell emphasized the need for clinicians to carefully weigh the risks of stopping anticoagulation therapy. “Despite concerns about bleeding, this study suggests that discontinuing anticoagulation does not significantly affect the risk of major bleeding but does increase the risk of serious events such as stroke and death,” she said.
She added that risks and benefits must be discussed with patients before stopping anticoagulants, ensuring informed decisions. The study highlights the importance of evaluating the consequences of deprescribing anticoagulants, especially in older adults.
dr. Anita McGrogan, who led the research team, noted that older patients were underrepresented in DOAC trials, leading to uncertainty about their safety in this population. The study addresses this gap by analyzing data from over 20,000 patients aged 75 and older.
Dr. Tomas Welsh, an academic geriatrician, hopes the research will provide better evidence for clinicians and patients. He noted that clinicians previously lacked data to quantify the increased stroke risk when advising patients to stop blood thinners.
“These data help patients and clinicians have a firmer grasp of the risks that they are being exposed to,” he said.
Welsh also stressed that new-generation blood thinners were not always suitable for frail, older people, adding that “Suspending any medication or reducing the use of multiple medications in a frailer older patient is always a nuanced and individual discussion.”
What’s next
Future research will likely focus on personalizing anticoagulant therapy based on individual patient risk factors, incorporating frailty assessments, and further evaluating the long-term outcomes of DOACs in very elderly populations to refine treatment guidelines for atrial fibrillation and minimize stroke risk.