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Anticoagulation and Falls Risk — RACP Adult Medicine MCQ

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ModerateGeriatric MedicineAnticoagulation and Falls RiskRACP Adult Medicine

A 65-year-old man with atrial fibrillation is being assessed for stroke risk. He has hypertension and diabetes. His CHA₂DS₂-VA score is 3. He has a history of recurrent falls (5 falls in the past year). What is the recommended approach regarding anticoagulation?

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Correct answer: C — Assess for reversible fall risk factors first, then anticoagulate

Falls alone are NOT a contraindication to anticoagulation in AF. Modelling studies show a patient would need to fall ~295 times per year before the bleeding risk from falls on anticoagulation exceeds the benefit of stroke prevention. However, the best approach is to assess and address reversible fall risk factors (postural hypotension, polypharmacy, visual impairment, environmental hazards, deconditioning) WHILE commencing anticoagulation. DOACs are preferred over warfarin in fall-prone patients due to lower ICH risk. The Australian AF guidelines and 2025 ACS guideline emphasise that anticoagulation should not be withheld solely due to falls risk.

Reference: NHF/CSANZ – 2018 – AF Guidelines; eTG – 2025 – Cardiovascular