{
  "abstract": "Importance: Atrial fibrillation (AF) leads to more than 100 000 cases of stroke yearly and is particularly prevalent in long-term care (LTC) residents. Anticoagulation (AC) is the mainstay of stroke prevention, but given its risks, clinicians and residents may consider discontinuation at the time of LTC entry.\n\nObjective: To estimate the association between AC discontinuation and stroke and bleeding risk among LTC residents with AF.\n\nDesign, Setting, and Participants: This comparative effectiveness research study with target trial emulation used claims data (2020-2021) from LTC facilities in the US serving Medicare beneficiaries. Medicare beneficiaries with AF receiving AC who entered LTC between April 1 and December 31, 2020, were included; those with additional indications for AC, including prosthetic heart valve or venous thromboembolism, were excluded. Analysis was performed in August 2026.\n\nExposure: Discontinuer vs continuer assignment.\n\nMain Outcomes and Measures: The main outcomes were stroke (including ischemic stroke, transient ischemic attack, and systemic embolism) and bleeding, assessed using Medicare claims. A target trial emulation was conducted with clone censor weighting (CCW) analysis. Specifically, eligible LTC residents were assigned (cloned) to each of 2 strategies: AC discontinuation or AC continuation. Clones were then censored when they deviated from their assigned strategy, and inverse probability of censoring weighting was applied to address informative censoring: residents who deviated differing systematically from those who did not. Subdistribution hazard ratios (sHRs) for stroke and bleeding were then calculated to account for competing mortality and a cause-specific hazard ratio (HR) for death.\n\nResults: This study included 15 426 LTC residents (mean [SD] age, 82.6 [7.6] years). Most were female (62.6%). AC discontinuers had 187 strokes, 297 bleeding events, and 3684 deaths over a mean (SD) of 128.9 (177.9) days. AC continuers had 321 strokes, 493 bleeding events, and 5475 deaths over a mean (SD) of 279.6 (204.9) days. Discontinuers had similar stroke risk (sHR, 1.07; 95% CI, 0.93-1.23) and bleeding risk (sHR, 1.02; 95% CI, 0.92-1.13) compared with continuers, but discontinuers had higher mortality risk (HR, 1.27; 95% CI, 1.23-1.31).\n\nConclusions and Relevance: In this target trial emulation with CCW in a cohort of LTC residents with AF, AC discontinuation was not associated with higher stroke or bleeding risk. Very high mortality, unmeasured confounding, and reliance on claims-based outcome ascertainment may have limited the ability to better understand the consequences of AC discontinuation on stroke and bleeding.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Hospital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester",
    "Division of Health System Sciences, Department of Medicine, University of Massachusetts Chan Medical School, Worcester",
    "Pritzker School of Medicine, University of Chicago, Chicago, Illinois",
    "Division of Cardiovascular Medicine, Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor",
    "Graduate School of Nursing, University of Massachusetts Chan Medical School, Worcester"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
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        0,
        1
      ],
      "name": "Alok Kapoor"
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    {
      "affs": [
        1
      ],
      "name": "Zhiyong Chen"
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    {
      "affs": [
        2
      ],
      "name": "Jay Patel"
    },
    {
      "affs": [
        1
      ],
      "name": "Zehao Ye"
    },
    {
      "affs": [
        1
      ],
      "name": "Honghuang Lin"
    },
    {
      "affs": [
        3
      ],
      "name": "Geoffrey Barnes"
    },
    {
      "affs": [
        4
      ],
      "name": "Sybil Crawford"
    },
    {
      "affs": [
        1
      ],
      "name": "Jerry H. Gurwitz"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/17qfqn2vw4gdy.bib",
  "cited_by": 0,
  "doi": "10.1001/jamanetworkopen.2026.40964",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13711132/",
  "id": "17qfqn2vw4gdy",
  "issns": [
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  ],
  "landing_url": "https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855823",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Comments"
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      "heading",
      "Geriatrics"
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      "Online Only"
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    [
      "openalex",
      "2705|Atrial Fibrillation Management and Outcomes"
    ]
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  "openalex": "W7223678771",
  "pdf_url": null,
  "pmcid": "PMC13711132",
  "pmid": "42931771",
  "published": "2026-10-26",
  "publisher": "American Medical Association (AMA)",
  "ris": "https://research.draconitic.com/paper/17qfqn2vw4gdy.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:46Z",
      "native_id": "10.1001/jamanetworkopen.2026.40964",
      "source": "crossref",
      "url": "https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855823"
    },
    {
      "first_seen": "2026-10-31T12:21:58Z",
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Atrial Fibrillation Management and Outcomes",
      "subfield": "cardiovascular"
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  ],
  "title": "Stroke and Bleeding Risk in Long-Term Care Residents With Atrial Fibrillation Who Discontinue Anticoagulation",
  "title_text": "Stroke and Bleeding Risk in Long-Term Care Residents With Atrial Fibrillation Who Discontinue Anticoagulation",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:21:58Z",
  "url": "https://research.draconitic.com/paper/17qfqn2vw4gdy",
  "venue": "JAMA Network Open",
  "versions": []
}