Anticoagulation for Atrial Fibrillation Is Common Among People with Advanced Dementia at the End of Life

The potential benefit of long-term anticoagulation for stroke prevention is marginal among older people with atrial fibrillation (AF) and advanced dementia, who have markedly shortened life expectancy. In this cross-sectional study, researchers used U.S. Medicare data to identify anticoagulation use in 15,000 nursing home residents (mean age, 88; 68% women) with advanced dementia and AF who had moderate stroke risk (CHA2DS2-VASc score, ≥2) and who had died between 2014 and 2017.

One third of patients had received anticoagulants during the last 6 months of life. Adjusted for multiple variables, CHA₂DS₂-VASc score >7, ATRIA score >7 (high bleeding risk), nursing home length of stay ≥1 year, not having Medicaid, weight loss, pressure ulcers, an…