[Falls and atrial fibrillation in elderly patients]

Area of Science:

• Cardiology
• Geriatrics
• Neurology

Context:

• Elderly patients with atrial fibrillation (AF) and a history of falls often have anticoagulants discontinued due to bleeding concerns.
• This practice increases stroke risk, which can be more detrimental than the risk of hemorrhage, even in fall-prone individuals.

Purpose:

• To evaluate the risk-benefit balance of continuing anticoagulation in elderly, fall-prone patients with atrial fibrillation.
• To highlight the importance of managing bleeding risk factors while maintaining stroke prevention.

Summary:

• Discontinuing anticoagulation in elderly, fall-prone patients with AF significantly elevates stroke risk, outweighing bleeding concerns.
• Optimal management involves continuing oral anticoagulation and systematically addressing modifiable bleeding risk factors.
• Left atrial appendage closure is a viable alternative for patients with irreversible intracranial hemorrhage or non-modifiable bleeding risks.

Impact:

• Provides evidence-based guidance for managing anticoagulation in a complex patient population.
• Aims to reduce stroke incidence and improve patient outcomes in elderly individuals with AF and fall risk.
• Offers alternative therapeutic strategies for specific patient subgroups.