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Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
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Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
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Anticoagulation in Atrial Fibrillation and Dementia.

Jonah Rocheeld1, Josef Kusayev2, William H Frishman1

  • 1From the Department of Medicine, New York Medical College, Valhalla, NY.

Cardiology in Review
|July 30, 2025
PubMed
Summary

Anticoagulation for atrial fibrillation (AF) appears beneficial for patients with mild dementia, reducing mortality. However, its use in advanced dementia requires careful, individualized assessment due to mixed outcomes and bleeding risks.

Keywords:
anticoagulationatrial fibrillationbleeding riskcognitive impairmentdementiastroke prevention

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Area of Science:

  • Geriatrics
  • Cardiology
  • Neurology

Background:

  • Atrial fibrillation (AF) and dementia frequently co-occur in aging populations.
  • Anticoagulants for AF prevent thromboembolism but increase bleeding risk, posing challenges in the elderly.
  • Managing AF in patients with dementia requires balancing stroke prevention with bleeding concerns.

Purpose of the Study:

  • To review the literature on anticoagulation in patients with both AF and dementia.
  • To clarify clinical guidance for managing AF in this patient subset, considering bleeding risks.
  • To evaluate the net benefit of anticoagulation in elderly patients with varying degrees of cognitive impairment.

Main Methods:

  • Narrative review of existing literature.
  • Analysis of observational cohort studies, meta-analyses, and registry data.
  • Evaluation of clinical outcomes, including mortality and bleeding events.

Main Results:

  • Anticoagulation is supported by multiple studies in patients with mild-to-moderate dementia.
  • Outcomes in advanced dementia are mixed, with most studies showing neutral to modest mortality benefits.
  • Direct oral anticoagulants may offer advantages over warfarin due to easier use and lower intracranial hemorrhage risk.

Conclusions:

  • Anticoagulation likely provides a net mortality benefit for patients with AF and early-stage dementia.
  • Use in very elderly patients with advanced dementia necessitates individualized risk-benefit assessment and consideration of patient goals.
  • Further research, including RCTs with dementia subgroups and quality-of-life measures, is crucial.