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Recent studies suggest that harms of anticoagulation in cognitively impaired patients with atrial fibrillation (AF) sometimes outweigh benefits (NEJM JW Gen Med Mar 15 2023 and J Am Geriatr Soc 2023; 71:394). When risk associated with anticoagulation is deemed to be unacceptable, some clinicians reach for antiplatelet medications (e.g., aspirin) as an alternative.
To understand antithrombotic prescribing in nursing homes better, researchers reviewed electronic health records of ≈4750 nursing home residents with AF and CHA2DS2VASc scores of ≥1 for men and ≥2 for women (mean CHA2DS2VASc score, 4.6). Twenty-seven percent of patients received an oral anticoagulant only, 12% received an oral anticoagulant plus an antiplatelet agent, and 32% recei…