New research from the University of Bath suggests that stopping blood thinners in older patients with atrial fibrillation (AF) significantly increases their risk of stroke and heart attack—outweighing the potential dangers of bleeding. The study, published in Heart, challenges a long-standing concern among clinicians that anticoagulants should be withheld in older adults due to fall risks.
The study found that patients aged 75 and over who stopped taking anticoagulants had a threefold increase in stroke and death risk, while their risk of heart attack nearly doubled. Researchers emphasize that the decision to discontinue anticoagulation should involve a thorough discussion between doctor and patient, taking into account the potential consequences.
“Prescribers need to consider the increased risk to patients of coming off anticoagulants, including stroke,” said Dr. Anneka Mitchell, lead author of the study and a visiting researcher at the University of Bath’s Department of Life Sciences.
AF Patients Face Higher Risk Without Anticoagulants
Atrial fibrillation is a common heart condition that leads to an irregular heartbeat and is associated with a fivefold increase in stroke risk. In the UK alone, AF contributes to an estimated 20,000 strokes per year. Blood-thinning medications, known as anticoagulants, are widely used to prevent these complications.
However, many clinicians have been hesitant to prescribe anticoagulants to older patients due to concerns about falls and bleeding risks. While falls are a leading cause of injury among adults over 65, the study found that stopping anticoagulants did not significantly change the likelihood of major bleeding events.
The researchers analyzed data from the UK Clinical Practice Research Datalink, reviewing records from 2013 to 2017 for over 20,000 patients aged 75 and older who were newly prescribed anticoagulants. The data showed that patients not receiving anticoagulation therapy faced substantially higher risks of stroke, heart attack, and death.
Modern Blood Thinners Offer Safer Alternatives
One reason many doctors hesitate to prescribe anticoagulants to older patients is the historical experience with warfarin, which was the standard treatment for AF until 2012. Warfarin requires strict dietary monitoring, frequent blood tests, and careful dosing, making it challenging for older patients to manage.
However, a newer class of anticoagulants—direct oral anticoagulants (DOACs)—has become the preferred option since 2013. These medications, including apixaban, are not only as effective as warfarin but also have a lower risk of serious bleeding and are easier to take.
“For many older patients with AF, apixaban would be an excellent medication choice due to its lower risk of significant bleeding compared to warfarin,” Dr. Mitchell explained.
Despite these advantages, older patients were largely underrepresented in the clinical trials that led to the approval of DOACs. Because of this, many doctors have remained cautious about prescribing them to patients over 75.
Improving Decision-Making for Older Adults: Blood Thinners
The study’s authors stress the importance of shared decision-making when considering whether to stop anticoagulation therapy. Blood Thinners
“Both the risks and benefits of medication must be discussed fully with patients before stopping anticoagulants,” said Dr. Mitchell. “This study underscores the importance of evaluating the consequences, particularly for older adults who are at higher risk of adverse outcomes.”
Dr. Tomas Welsh, an academic geriatrician at Royal United Hospitals Bath, added that while the study provides valuable data, decisions regarding anticoagulation should still be individualized for frail older patients.
“Suspending any medication in a frailer older patient is always a nuanced and individual discussion,” he said.
By filling a critical knowledge gap with real-world patient data, this research provides stronger evidence to guide both clinicians and patients in making informed choices about anticoagulation therapy.
Reference: Mitchell A, Watson MC, Welsh TJ, et al. Safety and effectiveness of anticoagulation therapy in older people with atrial fibrillation during exposed and unexposed treatment periods. Heart, 2025.
