21st March 2024

Anticoagulants and antiplatelets

The use of anticoagulants and antiplatelets must be weighed with the bleeding risk. Any concurrent risk factors such as uncontrolled hypertension, bleeding diathesis and recent non-trivial spontaneous bleeding should be taken into account with potentially stopping agents (aspirin, clopidogrel, dipyridamole, warfarin and more).

Anticoagulation for deep vein thrombus and pulmonary embolism (without continuing provoking risk factors) does not need to be continued for more than 6 months and 12 months respectively as there is no proven added benefit. Direct thrombin inhibitors (dabigatran) and factor Xa inhibitors (apixaban) are mainly renally excreted and thus if the eGFR levels are below 30 and 15, the drugs should be stopped respectively.

In those aged 65 and above with atrial fibrillation the CHA2DVASc and HAS-BLED scores are used to assess commencing anticoagulation and bleeding risk. The ORBIT tool is now recommended by NICE in place of the HAS-BLED tool to identify bleeding risk to help make decisions on anticoagulation. It is as follows: