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Table 1 Causes of permanent discontinuation and temporary interruption of anticoagulant therapy and conditions that do not justify anticoagulation withdrawal

From: Antithrombotic treatment in elderly patients with atrial fibrillation: a practical approach

Temporary interruption Acute major bleeding (life-threatening hemorrhage, bleeding leading to hospital admission or need for blood transfusion).
Before elective surgery.
Before endoscopic procedures with high risk of hemorrhage
Permanent discontinuation Hypersensitivity or intolerance to the drug.
Refusal of patient.
Medication non-adherence.
Poor short-term prognosis.
Advanced or terminal cancer.
Poor functional status with total dependency.
Advanced cognitive impairment.
Lack of social support that assure adequate drug compliance.
High risk of bleeding.
Retinopathy with high risk of bleeding.
Hepatic disease associated with coagulopathy and clinically relevant bleeding risk.
Alcohol abuse.
Conditions that do not justify anticoagulation withdrawal (but caution should be taken). Comorbidities or frailty do not contraindicate anticoagulation. However, life expectancy, functionality or cognitive impairment, among others, should be considered.
Risk of falls.
Age (elderly).
Previous intracranial bleeding is not an absolute contraindication, except when high risk of recurrence persists. If anticoagulation is considered, DOACs should be preferred over VKA.
History of bleeding, particularly when the cause is eliminated.
Need for dual antiplatelet therapy (i.e. after stent implantation).
Concomitant use of nonsteroidal anti-inflammatory drugs.
  1. New direct oral anticoagulants DOACs, vitamin K antagonists, VKA
  2. Data taken from references #33,85-90