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

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 ¹.

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 ¹.

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 ¹.

If a DOAC is contraindicated or not tolerated, consider warfarin with careful INR monitoring, but do not exclude anticoagulation solely due to falls risk ¹.