Rationalising anticoagulants used to prevent stroke or thromboembolism in palliative care

Follow the principles of rationalising anticoagulants when rationalising anticoagulants in palliative care.

For patients who take anticoagulant therapy to prevent stroke or thromboembolism (eg those with atrial fibrillation), base the decision to continue, change or stop the drug on an assessment of expected reduction in risk of stroke or thromboembolism compared to elevated risk of bleeding, alongside the potential burden to the patient. Risk calculators such as CHA2DS2VASc for stroke risk in patients with atrial fibrillation can help guide these decisions. Seek specialist advice before stopping anticoagulation in patients with valvular heart disease, or prosthetic or mechanical heart valves.