Anticoagulation in the octogenarian with atrial fibrillation

BI's baseline annual risk of stroke was 12.5% by CHADS2 score; her 5-year stroke risk by the Framingham tool was 59%. Risk factors for bleeding included diabetes, aspirin use and ibuprofen use, and a moderate fall risk by physical therapy assessment due to her osteoarthritis and deconditioned state. Given her fall risk, she and her family decided against anticoagulation with warfarin. She was discharged to an acute rehabilitation facility on aspirin alone. The decision to utilize warfarin for anticoagulation in the elderly patient with AF remains an art, involving judicious use of tools to evaluate baseline risk of stroke, careful evaluation for risk factors for bleeding, and diligent consideration of the patient, and his or her comorbidities, medications and ability to comply with treatment and monitoring.