Frailty and anticoagulation in patients with atrial fibrillation
Keywords:
frailty, atrial fibrillation, direct oral anticoagulants, geriatric cardiology, bleeding riskAbstract
Frailty and atrial fibrillation (AF) frequently coexist in older adults and collectively contribute to a substantial increase in thromboembolic events, bleeding complications, hospitalization, and mortality. Frailty is characterized by diminished physiological reserve, multisystem dysregulation, and increased vulnerability to external stressors, thereby complicating therapeutic decision-making regarding oral anticoagulant (OAC) therapy. Although frail patients carry a disproportionately high risk of ischemic stroke, they are often undertreated because of concerns related to falls, cognitive impairment, polypharmacy, and bleeding risk – a phenomenon commonly referred to as the “risk-treatment paradox.” This review summarizes the current evidence regarding the pathophysiological interplay between frailty, AF, and thrombosis, as well as contemporary approaches to optimizing OAC therapy through multidisciplinary models of care.
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