A new study from the University of Bath has found that for older adults with atrial fibrillation (AF), stopping blood thinners significantly raises the risk of stroke, heart attack, and death.
The research, published in Heart, challenges the common concern that blood thinners are too risky for older patients due to the possibility of bleeding.
Instead, the study suggests that the dangers of stopping these medications are far greater than the risk of major bleeding.
AF is a common heart condition that causes an irregular and often rapid heartbeat. It increases the risk of stroke by five times and is linked to approximately 20,000 strokes per year in the UK.
To reduce this risk, patients with AF are often prescribed anticoagulants (blood thinners) to prevent the formation of dangerous blood clots. However, many doctors hesitate to prescribe these medications to older adults due to concerns about falls and serious bleeding events.
What the Study Found
The study analyzed data from over 20,000 UK patients aged 75 and older who were prescribed anticoagulants between 2013 and 2017. The key findings included:
- Patients who stopped taking anticoagulants were three times more likely to have a stroke or die compared to those who continued treatment.
- The risk of heart attacks nearly doubled when anticoagulation therapy was stopped.
- The rate of major bleeding was not significantly different between those who stopped and those who continued taking blood thinners.
These results suggest that fears about bleeding may be causing some doctors to discontinue anticoagulants unnecessarily, putting patients at much higher risk of life-threatening events.
Changing How Doctors Think About Blood Thinners
Dr. Anneka Mitchell, the study’s lead researcher, emphasized that doctors should reconsider the decision to stop blood thinners in older patients. “Prescribers need to be aware of the increased risk of stroke when stopping anticoagulants,” she said. “This study highlights the need to carefully weigh the benefits and risks with patients before making a decision.”
The study also highlights a shift in how blood thinners are prescribed. Until 2012, warfarin was the primary anticoagulant used for AF patients. While effective, warfarin requires frequent blood tests and dietary restrictions, making it difficult for many older patients to manage.
Since 2013, newer drugs called direct oral anticoagulants (DOACs) have become the preferred option for most AF patients. DOACs, such as apixaban, are easier to take and have fewer dietary restrictions. Some, like apixaban, even carry a lower risk of bleeding than warfarin, making them a safer choice for older patients.
The Importance of Informed Decision-Making
Dr. Mitchell stressed that decisions about stopping anticoagulants should not be made lightly. “Both doctors and patients need to fully understand the risks before making a decision to stop treatment,” she said. “This study reinforces the importance of discussing the potential consequences, especially in older adults.”
Dr. Anita McGrogan, who led the research team, noted that older patients were underrepresented in earlier clinical trials of DOACs, leading to uncertainty about their safety. “Because of this, many doctors were hesitant to prescribe them for older people,” she said. However, the new study helps fill this gap by providing real-world evidence from a large group of elderly patients.
Dr. Tomas Welsh, an academic geriatrician at Royal United Hospitals Bath, added that this research now gives doctors clearer data on the risks of stopping anticoagulants. “Until now, we couldn’t quantify how much the risk increased when patients stopped taking blood thinners,” he said. “These findings give both doctors and patients better information to make informed decisions.”
What This Means for Older Patients
While anticoagulants remain highly effective in reducing stroke risk, they are not the right choice for every elderly patient. Dr. Welsh emphasized that decisions about stopping or continuing these medications should always be personalized. “In frailer older patients, the decision to stop medication should be made carefully, considering all health factors,” he said.
Doctors must now balance the risk of bleeding against the significantly higher risk of stroke and death when deciding whether to continue or stop anticoagulant therapy. The study provides strong evidence that, in most cases, continuing blood thinners is the safer option for older adults with AF.
This research could help change medical guidelines and encourage doctors to keep patients on blood thinners longer unless there is a strong medical reason to stop. It also highlights the need for better patient education, ensuring that older adults and their families understand the potential dangers of stopping treatment.
With cases of AF rising, particularly in people over 85, ensuring that patients receive the best possible treatment will be essential in reducing strokes and improving long-term health outcomes.
If you care about heart health, please read studies about top 10 foods for a healthy heart, and how to eat right for heart rhythm disorders.
For more health information, please see recent studies about how to eat your way to cleaner arteries, and salt and heart health: does less really mean more?
The research findings can be found in Heart.
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