Consider frailty status and comorbidities when choosing anticoagulant treatment for older patients with atrial fibrillation

Anticoagulant treatments are used to reduce the risk of stroke in patients with atrial fibrillation (AF) though they are associated with increased risk of bleeding. In most patients with AF, including those who are fit and older, direct oral anticoagulants (DOACs) are likely to have greater treatment benefits than warfarin, a vitamin K antagonist. However, patients with AF who also have advanced age, frailty, increased risk of falling, chronic kidney disease or a history of bleeding are amongst those at higher risk of major bleeding or drug overexposure. Current data suggest that DOACs may retain their treatment benefits in these patient subgroups, although recent guidelines on the management of AF emphasise the importance of taking an individualised, whole person treatment approach when choosing an anticoagulant treatment.