Are there patients for whom common sense suggests that the downsides of anticoagulation clearly outweigh the benefits? This is the premise suggested by Ouellet et al1 in this issue of JAMA Internal Medicine. In a decedent cohort of older nursing home residents with advanced dementia and atrial fibrillation, they found that one-third remained on therapeutic anticoagulation during the last 6 months of life. Those who had longer duration of nursing home residence or had markers of more severe dementia were more likely to remain on anticoagulation at the end of life.
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Parks AL, Covinsky KE. Anticoagulation at the End of Life: Time for a Rational Framework. JAMA Intern Med. 2021;181(8):1123. doi:10.1001/jamainternmed.2021.1804
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