Editing Anticoagulant (section)

==Medical uses==
The use of anticoagulants is a decision based on the risks and benefits of anticoagulation.<ref>{{cite journal | vauthors = Djulbegovic M, Lee AI | title = An Update on the "Novel" and Direct Oral Anticoagulants, and Long-Term Anticoagulant Therapy | journal = Clinics in Chest Medicine | volume = 39 | issue = 3 | pages = 583–93 | date = September 2018 | pmid = 30122182 | doi = 10.1016/j.ccm.2018.04.010 | s2cid = 52039169 }}</ref> The biggest risk of anticoagulation therapy is the increased risk of bleeding.<ref name="Parks 514–524">{{cite journal | vauthors = Parks AL, Fang MC | title = Scoring Systems for Estimating the Risk of Anticoagulant-Associated Bleeding | journal = Seminars in Thrombosis and Hemostasis | volume = 43 | issue = 5 | pages = 514–24 | date = July 2017 | pmid = 28359135 | doi = 10.1055/s-0037-1598061 | s2cid = 1981707 }}</ref> In otherwise healthy people, the increased risk of bleeding is minimal, but those who have had recent surgery, [[cerebral aneurysm]]s, and other conditions may have too great a risk of bleeding.<ref>{{cite journal | vauthors = Zhu X | title = The hemorrhage risk of prophylactic external ventricular drain insertion in aneurysmal subarachnoid hemorrhage patients requiring endovascular aneurysm treatment: a systematic review and meta-analysis | journal = Journal of Neurosurgical Sciences | volume = 61 | issue = 1 | pages = 53–63 | date = February 2017 | pmid = 25963956 | doi = 10.23736/S0390-5616.16.03244-6 | url = http://www.minervamedica.it/index2.php?show=R38Y2017N01A0053 }}</ref><ref>{{cite journal | vauthors = Banerjee K, Poddar K, Mick S, White J, Krishnaswamy A, Johnston D, Rodriguez L, Tuzcu EM, Kapadia S | title = Meta-Analysis of Usefulness of Anticoagulation After Transcatheter Aortic Valve Implantation | journal = The American Journal of Cardiology | volume = 120 | issue = 9 | pages = 1612–17 | date = November 2017 | pmid = 28844512 | doi = 10.1016/j.amjcard.2017.07.059 }}</ref> Generally, the benefit of anticoagulation is preventing or reducing the progression of a thromboembolic disease.<ref>{{cite web|url=https://medlineplus.gov/bloodthinners.html|title=Blood Thinners|website=medlineplus.gov|access-date=2020-01-23}}</ref> Some indications for anticoagulant therapy that are known to have benefit from therapy include:
* [[Atrial fibrillation]] – commonly forms an [[Right atrium|atrial appendage]] clot<ref>{{cite journal | vauthors = Sharma M, Cornelius VR, Patel JP, Davies JG, Molokhia M | title = Efficacy and Harms of Direct Oral Anticoagulants in the Elderly for Stroke Prevention in Atrial Fibrillation and Secondary Prevention of Venous Thromboembolism: Systematic Review and Meta-Analysis | journal = Circulation | volume = 132 | issue = 3 | pages = 194–204 | date = July 2015 | pmid = 25995317 | pmc = 4765082 | doi = 10.1161/CIRCULATIONAHA.114.013267 }}</ref>
* [[Coronary artery disease]]<ref>{{cite journal | vauthors = Moustafa A, Ruzieh M, Eltahawy E, Karim S | title = Antithrombotic therapy in patients with atrial fibrillation and coronary artery disease | journal = Avicenna Journal of Medicine | volume = 9 | issue = 4 | pages = 123–28 | date = 2019 | pmid = 31903386 | pmc = 6796304 | doi = 10.4103/ajm.AJM_73_19 | doi-access = free }}</ref>
* [[Deep vein thrombosis]] – can lead to pulmonary embolism<ref>{{cite journal | vauthors = Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M, King CS, Morris TA, Sood N, Stevens SM, Vintch JR, Wells P, Woller SC, Moores L | title = Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report | journal = Chest | volume = 149 | issue = 2 | pages = 315–52 | date = February 2016 | pmid = 26867832 | doi = 10.1016/j.chest.2015.11.026 }}</ref>
* Ischemic [[stroke]]<ref>{{cite journal | vauthors = Kapil N, Datta YH, Alakbarova N, Bershad E, Selim M, Liebeskind DS, Bachour O, Rao GH, Divani AA | title = Antiplatelet and Anticoagulant Therapies for Prevention of Ischemic Stroke | journal = Clinical and Applied Thrombosis/Hemostasis | volume = 23 | issue = 4 | pages = 301–18 | date = May 2017 | pmid = 27461564 | doi = 10.1177/1076029616660762 | s2cid = 43296498 | doi-access = free }}</ref>
* [[Hypercoagulable]] states (e.g., [[Factor V Leiden]]) – can lead to deep vein thrombosis<ref>{{cite journal | vauthors = Skelley JW, White CW, Thomason AR | title = The use of direct oral anticoagulants in inherited thrombophilia | journal = Journal of Thrombosis and Thrombolysis | volume = 43 | issue = 1 | pages = 24–30 | date = January 2017 | pmid = 27734187 | doi = 10.1007/s11239-016-1428-2 | s2cid = 24650202 }}</ref>
* Mechanical heart valves<ref>{{cite journal | vauthors = Poli D, Antonucci E, Pengo V, Migliaccio L, Testa S, Lodigiani C, Coffetti N, Facchinetti R, Serricchio G, Falco P, Mangione C, Masottini S, Ruocco L, De Caterina R, Palareti G | title = Mechanical prosthetic heart valves: Quality of anticoagulation and thromboembolic risk. The observational multicenter PLECTRUM study | journal = International Journal of Cardiology | volume = 267 | pages = 68–73 | date = September 2018 | pmid = 29957264 | doi = 10.1016/j.ijcard.2018.04.042 | s2cid = 49588203 }}</ref>
* [[Myocardial infarction]]<ref>{{cite journal | vauthors = Almony GT, Lefkovits J, Topol EJ | title = Antiplatelet and anticoagulant use after myocardial infarction | journal = Clinical Cardiology | volume = 19 | issue = 5 | pages = 357–65 | date = May 1996 | pmid = 8723593 | doi = 10.1002/clc.4960190506 | s2cid = 103327 | doi-access = free }}</ref>
* [[Pulmonary embolism]]<ref>{{cite journal | vauthors = Konstantinides SV, Barco S, Lankeit M, Meyer G | title = Management of Pulmonary Embolism: An Update | journal = Journal of the American College of Cardiology | volume = 67 | issue = 8 | pages = 976–90 | date = March 2016 | pmid = 26916489 | doi = 10.1016/j.jacc.2015.11.061 | doi-access = free }}</ref>
* [[Restenosis]] from stents<ref>{{cite journal | vauthors = Dong Z, Zheng J | title = Anticoagulation after coronary stenting: a systemic review | journal = British Medical Bulletin | volume = 123 | issue = 1 | pages = 79–89 | date = September 2017 | pmid = 28910988 | doi = 10.1093/bmb/ldx018 | s2cid = 3800129 | doi-access = free }}</ref>
* Cardiopulmonary bypass (or any other surgeries requiring temporary aortic occlusion)<ref>{{cite journal | vauthors = Lander H, Zammert M, FitzGerald D | title = Anticoagulation management during cross-clamping and bypass | journal = Best Practice & Research. Clinical Anaesthesiology | volume = 30 | issue = 3 | pages = 359–70 | date = September 2016 | pmid = 27650345 | doi = 10.1016/j.bpa.2016.07.002 }}</ref>
* Heart failure<ref>{{Citation|last1=Thomas|first1=Isac|title=Anticoagulation Therapy and NOACs in Heart Failure|date=2016|work=Heart Failure|volume=243|pages=515–35|editor-last=Bauersachs|editor-first=Johann|publisher=Springer International Publishing|doi=10.1007/164_2016_126|pmid=28233177|isbn=978-3-319-59658-7|last2=EncisoSilva|first2=Jorge|last3=Schlueter|first3=Michelle|last4=Greenberg|first4=Barry|editor2-last=Butler|editor2-first=Javed|editor3-last=Sandner|editor3-first=Peter}}</ref>

In these cases, anticoagulation therapy [[Thrombosis prophylaxis|prevents the formation]] or growth of dangerous clots.<ref>{{cite journal | vauthors = Raschi E, Bianchin M, De Ponti R, De Ponti F, Ageno W | title = Emerging therapeutic uses of direct-acting oral anticoagulants: An evidence-based perspective | journal = Pharmacological Research | volume = 120 | pages = 206–18 | date = June 2017 | pmid = 28366835 | doi = 10.1016/j.phrs.2017.03.026 | s2cid = 36716760 }}</ref>

The decision to begin therapeutic anticoagulation often involves the use of multiple bleeding risk predictable outcome tools as non-invasive pre-test stratifications due to the potential for bleeding while on blood thinning agents.<ref name="Parks 514–524"/> Among these tools are [[HAS-BLED]],<ref name="urlHAS-BLED Score">{{cite web | url = http://www.mdcalc.com/has-bled-score-for-major-bleeding-risk/| title = HAS-BLED Score for Major Bleeding risk| publisher = MDCalc | access-date = 2014-08-15}}</ref> ATRIA,<ref name="urlATRIA Bleeding Risk">{{cite web | url = http://www.mdcalc.com/atria-bleeding-risk-score/| title = ATRIA Bleeding Risk | publisher = MDCalc | access-date = 2014-08-15}}</ref> HEMORR2HAGES,<ref>{{cite web|url=https://www.mdcalc.com/hemorr2hages-score-major-bleeding-risk|title=HEMORR₂HAGES Score for Major Bleeding Risk|website=MDCalc|language=en|access-date=2020-01-23}}</ref> and [[CHA2DS2-VASc]].<ref name="urlCHA2DS2-VASc">{{cite web | url = http://www.mdcalc.com/cha2ds2-vasc-score-for-atrial-fibrillation-stroke-risk/| title = CHA2DS2-VASc | publisher = MDCalc | access-date = 2014-08-15}}</ref> The risk of bleeding using the risk assessment tools above must then be weighed against thrombotic risk to formally determine the patient's overall benefit in starting anticoagulation therapy.<ref>{{cite journal | vauthors = Zhu W, He W, Guo L, Wang X, Hong K | title = The HAS-BLED Score for Predicting Major Bleeding Risk in Anticoagulated Patients With Atrial Fibrillation: A Systematic Review and Meta-analysis | journal = Clinical Cardiology | volume = 38 | issue = 9 | pages = 555–61 | date = September 2015 | pmid = 26418409 | pmc = 6490831 | doi = 10.1002/clc.22435 }}</ref>

There is no evidence to indicate that adding anticoagulant therapy to standard treatment has a benefit for people with cerebral small vessel disease but not dementia, and there is an increased risk of a person with this disease experiencing a bleed with this approach.<ref>{{cite journal |last1=Kwan |first1=Joseph |last2=Hafdi |first2=Melanie |last3=Chiang |first3=Lorraine L W |last4=Myint |first4=Phyo K |last5=Wong |first5=Li Siang |last6=Quinn |first6=Terry J |date=2022-07-13 |editor-last=Cochrane Dementia and Cognitive Improvement Group |title=Antithrombotic therapy to prevent cognitive decline in people with small vessel disease on neuroimaging but without dementia |journal=Cochrane Database of Systematic Reviews |language=en |volume=2022 |issue=7 |page=CD012269 |doi=10.1002/14651858.CD012269.pub2 |pmc=9281623 |pmid=35833913}}</ref>