What are the precautions to be taken while prescribing antithrombotic therapy for elderly patients with atrial fibrillation?
In elderly patients with atrial fibrillation, antithrombotic therapy should be prescribed with caution. The patient should be assessed for risk factors such as cognitive impairment or dementia, anemia, reduced platelet count or function, renal impairment, liver function abnormalities, and prior bleeding. Risk scores such as HAS-BLED, ATRIA, and SAMe-TT2R should be calculated to assess the bleeding risk. In addition, causes of renal impairment should be investigated and reversed where possible. Patients with abnormal clotting tests should be monitored closely, and the risk of bleeding should be weighed against the ischemic stroke reduction in cirrhotic patients. NSAIDs and CYP inhibitors should be avoided. INR should be monitored regularly, and the dose of OAC should be adjusted accordingly. 