This study asked whether stopping anticoagulation on entering long-term care alters stroke and bleeding risk in atrial fibrillation. It used 2020–2021 US Medicare claims for 15,426 residents, mean age 82.6 years, who entered care on anticoagulation. A target trial emulation cloned residents into discontinuation and continuation arms, with inverse probability of censoring weighting. Stroke risk was similar for discontinuers (subdistribution HR 1.07; 95% CI 0.93–1.23), as was bleeding risk (1.02; 0.92–1.13). In the weighted analysis, the mortality hazard was higher for discontinuers (HR 1.27; 95% CI 1.23–1.31). The data are observational claims analysed by emulation, and discontinuers had shorter mean follow-up (128.9 vs 279.6 days).
Why it is interesting: Anticoagulation prevents stroke in atrial fibrillation, but its risks lead some to consider stopping at long-term care entry. Here, stopping was not linked to higher stroke or bleeding risk, but mortality hazard was higher among stoppers.
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