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- Page navigation anchor for Anticoagulant prescribing cautions are not absolute contraindicationsAnticoagulant prescribing cautions are not absolute contraindicationsWe broadly agree with the view that underuse of anticoagulants in atrial fibrillation is a greater problem than overuse and have recently published a paper illustrating this point in relation to paroxysmal atrial fibrillation.1 We included both relative and absolute contraindications in our paper. In the methods we explain that our definition of contraindications required that the relevant diagnoses had been recorded within the previous two years. The great majority of patients with contraindications had therefore experienced major bleeding within two years. This may fall within the definition of recent bleeding to which Patel and Edwards refer, although they did not provide a definition of recent. We were careful to point out that the balance of risks and benefits of using anticoagulants in atrial fibrillation patients with contraindications is not known and suggested further research to answer this question empirically. We also cited some recent evidence suggesting that resuming anticoagulant therapy may be beneficial in patients with AF who survive warfarin-related intracranial haemorrhage.2,3 A retrospective cohort study of atrial fibrillation patients with contraindications who are prescribed and not prescribed anticoagulants would shed some light on the question.References1. Isaew A, Adderley NJ, Ryan R, et al. The treatment of paroxysmal atrial fibrillation in UK primary...Show MoreCompeting Interests: None declared.
- Page navigation anchor for Anticoagulant prescribing cautions are not absolute contraindicationsAnticoagulant prescribing cautions are not absolute contraindicationsAdderley et al. (2017) compared the proportion of patients on anticoagulants with a wide variety of “contraindications” against the proportion of patients on anticoagulants without any of these “contraindications” listed in their primary care record. They found that the proportion of patients prescribed anticoagulants in each group was similar and concluded, “this represents a significant concern for patient safety”.Contraindications to anticoagulation used to define the contraindication group were: haemorrhagic stroke, major bleeding (gastrointestinal, intracranial, intraocular, retroperitoneal), bleeding disorders (haemophilia, other haemorrhagic disorders, thrombocytopenia), peptic ulcer, oesophageal varices, aneurysm, or proliferative retinopathy, a record of allergy or adverse reaction, pregnancy, and severe hypertension.Within the British National Formulary, only “significant risk of major bleeding” contraindicates prescription of an anticoagulant in AF patients across all licensed medications,1 with emphasis on patients with a recent bleed. The other factors used to define the “contraindication” group in this study are categorised as cautions, and may paradoxically be associated with higher stroke risk due to their association with other co-morbidities. Cautions require the clinician to individualise treatment by balancing...Show MoreCompeting Interests: None declared.