How do I determine the appropriate anticoagulation strategy for a patient with atrial fibrillation and a history of falls?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Assess the person's stroke risk using the CHA2DS2-VASc score, and their bleeding risk using the ORBIT bleeding risk score if considering anticoagulation, managing modifiable risk factors for bleeding such as uncontrolled hypertension, frailty, and falls risk where possible .

Do not withhold anticoagulation solely based on falls risk, as falls are rarely a cause of major haemorrhage, and the benefits of stroke prevention generally outweigh the bleeding risk .

Offer anticoagulation with a direct-acting oral anticoagulant (DOAC) first-line if indicated, considering individual risk profiles and preferences, and ensure appropriate dose and management of bleeding risk factors .

If a DOAC is contraindicated or not tolerated, consider warfarin with careful INR monitoring, but do not exclude anticoagulation solely due to falls risk .

Related Knowledge Topics

Educational content only. Always verify information and use clinical judgement.