Table 7

Components of the Clinician-Patient Discussion

Factors to ConsiderDiscussion Points
TimingDiscussion of reinitiation of anticoagulation should be done in advance of restarting to give the patient time to formulate questions
Associated risksClinical and site-specific signs of bleeding for which the patient should remain vigilant (e.g., melena after a GI bleed)
Recurrent bleeding thrombotic event (personalized risk assessment if possible, e.g., CHA2DS2-VASc prediction of thromboembolism risk)
Discussion of the sequelae of a thromboembolic event (e.g., higher mortality for ischemic strokes with AF)
Associated benefitsImproved mortality with no increase in bleeding after certain types of bleeds on anticoagulant (e.g., GI bleeding)

AF = atrial fibrillation; GI = gastrointestinal.