Introduction: The Challenge of Anticoagulation in an Aging Population
The management of atrial fibrillation (AF) in older adults presents one of the most significant paradoxes in contemporary clinical cardiology. While advanced age is a potent risk factor for thromboembolic stroke, it is simultaneously a primary driver of major bleeding complications associated with traditional anticoagulants. Current standard-of-care agents, specifically Direct Oral Anticoagulants (DOACs) like rivaroxaban, have significantly improved outcomes compared to vitamin K antagonists. However, the risk of intracranial and gastrointestinal hemorrhage remains a persistent barrier to optimal therapy, particularly in patients aged 75 and older who often present with frailty, renal impairment, and multiple comorbidities.
