{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T07:03:43Z","timestamp":1790233423758,"version":"4.1.0"},"reference-count":16,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Geriatrics Gerontology Int"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>In older adults hospitalized with acute heart failure and atrial fibrillation, bleeding concern often drives withholding of oral anticoagulation at discharge. Whether withholding marks a genuinely lower bleeding\u2010risk phenotype or residual clinical vulnerability is uncertain. We examined its association with post\u2010discharge ischemic stroke, major bleeding, and death in a predominantly older cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed a registry of patients hospitalized with acute heart failure and atrial fibrillation. In a discharge\u2010based analysis of patients discharged alive and free of stroke or major bleeding at discharge, we used stabilized inverse\u2010probability\u2010of\u2010treatment weighting for discharge anticoagulation. Ischemic stroke and major bleeding were modeled with weighted Fine\u2013Gray competing\u2010risk regression (death as competing event) and death with weighted Cox regression, contrasting no anticoagulant versus anticoagulant. Age\u2010restricted analyses (\u2265\u200975, \u2265\u200980\u2009years) and absolute risks were prespecified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 560 patients (no anticoagulant 72, anticoagulant 488; mean age 78\u2009years), withholding was associated with higher ischemic stroke (subdistribution hazard ratio 3.14, 95% confidence interval [CI] 1.26\u20137.81) and did not identify a lower bleeding\u2010risk phenotype, with numerically higher major bleeding overall (1.98, 0.95\u20134.14) that reached significance among patients aged \u2265\u200980\u2009years (2.41, 1.05\u20135.54). No significant association with death was observed (hazard ratio 1.34, 0.70\u20132.55). Three\u2010year cumulative incidences of bleeding were 25.6% (no anticoagulant) versus 13.4% (anticoagulant).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Discharge anticoagulation withholding did not identify a lower post\u2010discharge bleeding\u2010risk phenotype but marked residual thromboembolic vulnerability, with a higher bleeding\u2010risk trajectory, particularly among patients aged \u2265\u200980\u2009years, supporting structured post\u2010discharge anticoagulation reassessment in older adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ggi.70817","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T08:22:12Z","timestamp":1787732532000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Withholding Oral Anticoagulation at Discharge and Post\u2010Discharge Stroke and Bleeding Vulnerability in a Predominantly Older Cohort Hospitalized With Acute Heart Failure and Atrial Fibrillation"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7801-876X","authenticated-orcid":false,"given":"Jumpei","family":"Yamamoto","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine Toho University Medical Center Ohashi Hospital  Tokyo Japan"},{"name":"Department of Cardiology, National Center for Global Health and Medicine Japan Institute for Health Security  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keijiro","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Toho University Medical Center Ohashi Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromasa","family":"Hayama","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Center for Global Health and Medicine Japan Institute for Health Security  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshinari","family":"Enomoto","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Center for Global Health and Medicine Japan Institute for Health Security  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaya","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Center for Global Health and Medicine Japan Institute for Health Security  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidehiko","family":"Hara","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Toho University Medical Center Ohashi Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisao","family":"Hara","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Center for Global Health and Medicine Japan Institute for Health Security  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5088-7656","authenticated-orcid":false,"given":"Yukio","family":"Hiroi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Center for Global Health and Medicine Japan Institute for Health Security  Tokyo 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&amp; Gerontology International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ggi.70817","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ggi.70817","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ggi.70817","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T06:31:43Z","timestamp":1790231503000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ggi.70817"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":16,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/ggi.70817"],"URL":"https:\/\/doi.org\/10.1111\/ggi.70817","archive":["Portico"],"relation":{},"ISSN":["1444-1586","1447-0594"],"issn-type":[{"value":"1444-1586","type":"print"},{"value":"1447-0594","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]},"assertion":[{"value":"2026-07-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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