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

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.