Key result
The advantages of stroke prevention with oral anticoagulation outweigh the risk of bleeding from falls in atrial fibrillation patients, especially with non-vitamin K oral anticoagulants.
Why the study?
Although anticoagulation reduces thromboembolism in AF, many patients with high falls risk do not receive oral anticoagulation.
Does oral anticoagulation provide a net clinical benefit in atrial fibrillation patients with a high risk of falls?
Does oral anticoagulation provide a net clinical benefit in atrial fibrillation patients with a high risk of falls?
In AF patients with a high risk of falls, the benefits of stroke prevention with oral anticoagulation, particularly NOACs, generally outweigh the bleeding risks.
Highlights persistent underuse of OAC in high-fall-risk AF; leaves open evidence-based thresholds for safe initiation.
INTRODUCTION: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and can lead to serious consequences such as ischemic stroke and systemic thromboembolism. The risk of thromboembolism can be reduced by anticoagulation, however many patients with high falls risk do not receive oral anticoagulation. AREAS COVERED: In this narrative literature review, performed with searches of the PubMed database, we discuss the factors predisposing AF patients to falls, ways to optimize bleeding risk with individualized assessment, and clarify misconceptions around falls risk and anticoagulation therapy. EXPERT OPINION: In general, the advantages of stroke prevention with oral anticoagulation outweigh the risk of bleeding resulting from falls, especially with the increasing use of non-vitamin K oral anticoagulants, which are associated with fewer intracranial hemorrhages and thromboembolic complications than vitamin K anticoagulants. Most studies in this field are observational and randomized controlled studies would be beneficial.
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Latt et al. (2023) conducted a review in Atrial fibrillation with a history of falls. Oral anticoagulation vs. Vitamin K antagonists or no anticoagulation was evaluated. The advantages of stroke prevention with oral anticoagulation outweigh the risk of bleeding from falls in atrial fibrillation patients, especially with non-vitamin K oral anticoagulants.
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