ArticleJournal of thrombosis and haemostasis : JTH2021
Risks associated with discontinuation of oral anticoagulation in newly diagnosed patients with atrial fibrillation: Results from the GARFIELD-AF Registry.
Article in Journal of thrombosis and haemostasis : JTH, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 1 of them a synthesis that pooled it.
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Who cites it
33 citing papers in PubMed, 1 synthesis or guideline pooled it, 47 citations in OpenAlex.
- Residual Stroke Risk Among Patients With Atrial Fibrillation Prescribed Oral Anticoagulants: A Patient-Level Meta-Analysis From COMBINE AF.Journal of the American Heart Association · 2024Pooled it
- Epistaxis Versus Nonepistaxis Bleeding in Anticoagulated Patients With Atrial Fibrillation: Results From the ENGAGE AF-TIMI 48 Trial.Journal of the American Heart Association · 2025Trial
- Inequalities in oral anticoagulant treatment patterns: a two-part model to estimate healthcare costs associated with atrial fibrillation.The European journal of health economics : HEPAC : health economics in prevention and care · 2026Article
- [Prognostic analysis of anticoagulation therapy in elderly patients with cardioembolic stroke].Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences · 2026Article
- Women's cardiovascular health in 2025:Saudi medical journal · 2026Review
- Local Hemostasis as the Critical Enabler for Safe Antithrombotic Therapy in Dentistry-Navigating Future Frontiers and Innovative Concepts.Journal of clinical medicine · 2026Review
- Characterization of anticoagulated patients in a Latin American country: indications, treatment patterns, and complications.Thrombosis journal · 2026Article
- Clinical Event Rates and Patient Satisfaction with Generic Rivaroxaban in Atrial Fibrillation: The Prospective Guardian Study.TH open : companion journal to thrombosis and haemostasis · 2026Article
- Relevance and limitations of clinical follow-up in a pharmacokinetic study on direct oral anticoagulants.Frontiers in pharmacology · 2026Article
- Article
- Rivaroxaban treatment discontinuation rates in patients with nonvalvular atrial fibrillation in Italian clinical practice: RITMUS-AF.PloS one · 2026Observational
- An Uninterrupted DOAC plus Single Antiplatelet Strategy for Carotid Artery Stenting in Patients with Atrial Fibrillation.Journal of neuroendovascular therapy · 2026Article
- Adherence to oral thromboprophylaxis in atrial fibrillation: an overview for clinicians.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Review
- Robot-Assisted Minimally Invasive Strategy for a Large Mobile Thrombus Originating From the Left Atrial Appendage.JACC. Case reports · 2025Article
- Safety and effectiveness of anticoagulation therapy in older people with atrial fibrillation during exposed and unexposed treatment periods.Heart (British Cardiac Society) · 2025Article
- Systemic Embolism From Aortic Arch Thrombus Following Warfarin Discontinuation: A Case Report.Cureus · 2025Article
- Observational
- Prothrombotic Rebound After Discontinuation of Direct Oral Anticoagulants Therapy: A Systematic Review.Journal of clinical medicine · 2024Review
- Laboratory Evaluation of Interferences Associated with Factor XIa Inhibitors Asundexian and Milvexian in Routine Coagulation Assays.Diagnostics (Basel, Switzerland) · 2024Article
- Assays for Monitoring Apixaban and Rivaroxaban in Emergency Settings, State-of-the-Art Routine Analysis, and Volumetric Absorptive Microsamples Deliver Discordant Results.Diagnostics (Basel, Switzerland) · 2024Article
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Authors and funding
18 authors at 13 institutions in 8 countries.
Funding
Abstract
backgroundOral anticoagulation (OAC) in atrial fibrillation (AF) reduces the risk of stroke/systemic embolism (SE). The impact of OAC discontinuation is less well documented.
objectiveInvestigate outcomes of patients prospectively enrolled in the Global Anticoagulant Registry in the Field-Atrial Fibrillation study who discontinued OAC.
methodsOral anticoagulation discontinuation was defined as cessation of treatment for ≥7 consecutive days. Adjusted outcome risks were assessed in 23 882 patients with 511 days of median follow-up after discontinuation.
resultsPatients who discontinued (n = 3114, 13.0%) had a higher risk (hazard ratio [95% CI]) of all-cause death (1.62 [1.25-2.09]), stroke/systemic embolism (SE) (2.21 [1.42-3.44]) and myocardial infarction (MI) (1.85 [1.09-3.13]) than patients who did not, whether OAC was restarted or not. This higher risk of outcomes after discontinuation was similar for patients treated with vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) (p for interactions range = 0.145-0.778). Bleeding history (1.43 [1.14-1.80]), paroxysmal vs. persistent AF (1.15 [1.02-1.29]), emergency room care setting vs. office (1.37 [1.18-1.59]), major, clinically relevant nonmajor, and minor bleeding (10.02 [7.19-13.98], 2.70 [2.24-3.25] and 1.90 [1.61-2.23]), stroke/SE (4.09 [2.55-6.56]), MI (2.74 [1.69-4.43]), and left atrial appendage procedures (4.99 [1.82-13.70]) were predictors of discontinuation. Age (0.84 [0.81-0.88], per 10-year increase), history of stroke/transient ischemic attack (0.81 [0.71-0.93]), diabetes (0.88 [0.80-0.97]), weeks from AF onset to treatment (0.96 [0.93-0.99] per week), and permanent vs. persistent AF (0.73 [0.63-0.86]) were predictors of lower discontinuation rates.
conclusionsIn GARFIELD-AF, the rate of discontinuation was 13.0%. Discontinuation for ≥7 consecutive days was associated with significantly higher all-cause mortality, stroke/SE, and MI risk. Caution should be exerted when considering any OAC discontinuation beyond 7 days.
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