Man-Son-Hing and Laupacis1 conclude that bleeding risk is a lesser issue during anticoagulation of older persons with atrial fibrillation. Some omissions deserve comment.
The authors did not specify explicit selection criteria for the articles identified by their MEDLINE literature search. They do not mention an Italian multicenter study,2 which found age over 75 years to be associated with a major bleeding rate of 5.1% per year, contrasting with a 1.0% per year rate in younger patients. Palareti et al3 reported even higher yearly rates of major bleeding in those older than 70 years; this study is included in the "References" section in the article by Man-Son-Hing and Laupacis1 but not mentioned in the article's text. It is therefore difficult to follow the authors' assertion that fears of anticoagulant-related bleeding based on advanced age are unfounded.