Anticoagulation for atrial fibrillation (January 2017)

TO THE EDITOR: As a geriatric medicine fellow, I eagerly read Hagerty and Rich’s review “Fall risk and anticoagulation for atrial fibrillation in the elderly: A delicate balance”¹ and Suh’s editorial, “Whether to anticoagulate: Toward a more reasoned approach”² in the January 2017 issue. Both pieces were helpful and informative.

I appreciate that Dr. Suh encourages shared decision-making between physicians and patients that balances patient preferences and risk stratification to inform whether to anticoagulate. He states, “Unfortunately, there is no similar screening tool to predict bleeding risk from anticoagulation with greater precision in the middle to lower part of the risk spectrum…The patient’s life expectancy and personal preferences are important independent factors that affect the decision of whether to anticoagulate or not.”

Dr. Mark Eckman’s Atrial Fibrillation Decision Support Tool (AFDST) incorporates patients’ CHA₂DS₂-VASc and HAS-BLED scores to determine their quality-adjusted life expectancy on or off anticoagulation. The tool helps guide physicians and patients to make shared decisions about anticoagulation.^3–5 The AFDST informs clinicians if a patient is undertreated or being treated unnecessarily. Eckman and his colleagues have demonstrated the AFDST’s effective application in clinical practice, including for older adults. I invite readers to learn more about Eckman’s work!

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