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Anticoagulation in frailty with falls — SCE Geriatric Medicine MCQ

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HardCardiovascular medicineAnticoagulation in frailty with fallsSCE Geriatric Medicine

A 79-year-old woman with severe frailty, AF, CKD3 and recurrent falls attends clinic. She has CHA₂DS₂-VASc 6 and HAS-BLED 2; she fell twice last month without head injury. Her daughter asks for anticoagulation to be stopped because she is worried about bleeding. What is the most appropriate management?

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Correct answer: A — Continue anticoagulation while addressing modifiable falls and bleeding risks through shared decision-making

A high stroke risk with manageable bleeding risk generally favours anticoagulation; falls alone rarely justify stopping it. The correct approach is shared decision-making, review of renal function and dose criteria, medication optimisation and falls prevention. Aspirin is not an adequate substitute for AF stroke prevention. The pearl is to quantify both stroke and bleeding risks rather than making decisions based on age or falls anxiety alone.

Reference: NICE NG196; NICE CG161; NICE NG56