Two new studies appear to support the use of extended anticoagulant treatment in elderly patients – finding that excess bleeding risk reduces with time, and may be outweigh by other risks associated with not taking blood thinners.
Swedish research, published in the Journal of Internal Medicine, found a reduction in treatment-induced risk of bleeding after six months of treatment.
Researchers studied outcomes for 36,000 patients in Sweden who had had a venous thromboembolism (VTE) and were being treated with direct oral anticoagulants (DOACs). They were compared to age- and sex-matched group of patients who had not had a VTE and were not on blood-thinners.
The analysis showed that age was a significant factor for excess risk of bleeding in the first six months of treatment.
But after six months, the increased risks from age or gender decreased. Overall, the excess risk of bleed for those on DOACs reduced from 2% extra to 0.7% extra compared to controls, the researchers report.
Research Katarina Glise Sandblad, an internal medicine specialist at Sahlgrenska University Hospital, Sweden, said: “When I treat patients with blood clots, the decision whether to discontinue treatment after the initial phase or to continue with lifelong treatment can be difficult. This study shows that the share of the bleeding risk due to blood thinners is low during extended treatment and doesn't seem to increase with age. This is reassuring for both me and my patients.”
A second study, from the University of Bath, UK, has found that for old patients with atrial fibrillation, the increased risk of complications from stopping anticoagulants outweighs the risk of bleeding.
Published in Heart, the study sought to measure patient outcomes in older patients with atrial fibrillation when anticoagulant medicine was stopped. Researchers studied 20,000 patients in general practice databases. They found significantly increased risk of stroke, heart disease and death when patients over the age of 75 stopped taking anticoagulants. However, stopping anticoagulation treatment did not significantly reduce the risk of major bleeding – although minor bleeding was reduced by stopping blood thinners.
Researcher Dr Anneka Mitchell said: “Our findings highlight the critical need for clinicians to carefully consider the risks of stopping anticoagulation therapy in older patients. 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.”
Source:
Glise Sandblad K, Rosengren A, Schulman S, Roupe M, Sandström TZ, Philipson J, Svennerholm K, Tavoly M. (2025) “Excess risk of bleeding in patients with venous thromboembolism on direct oral anticoagulants during initial and extended treatment versus population controls.” Journal of Internal Medicine, 13 February 2025, doi: 10.1111/joim.20067.
Link: https://onlinelibrary.wiley.com/doi/10.1111/joim.20067
Source: Mitchell A, Watson MC, Welsh TJ, McGrogan A. (2025) “Safety and effectiveness of anticoagulation therapy in older people with atrial fibrillation during exposed and unexposed treatment periods.” Heart, 17 February 2025, doi: 10.1136/heartjnl-2024-324763.
Link: https://heart.bmj.com/content/early/2025/02/14/heartjnl-2024-324763
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