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Commentary on: Hernandez I, Zhang Y, Brooks MM, et al. Anticoagulation use and clinical outcomes after major bleeding on dabigatran or warfarin in atrial fibrillation. Stroke 2017;48:159–66.
Anticoagulation decreases the risk of stroke and other thromboembolic complications in patients with atrial fibrillation (AF) at the cost of an increased risk of major bleeding. If patients experience an anticoagulation-related major bleeding complication, the clinician faces the dilemma of whether to resume anticoagulation treatment or not. Evidence-based recommendations are lacking,1 and there is a wide variation in treatment of these patients, with anticoagulants, antiplatelets or no anticoagulation at all, while there is even less experience with non-vitamin K oral anticoagulants (NOACs), such as dabigatran. This study aimed to (1) evaluate anticoagulation use after a major bleeding event on dabigatran or warfarin and (2) compare outcomes between patients discontinuing anticoagulation and those restarting dabigatran or warfarin.
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