Anticoagulation and Antiplatelet Therapy — Viva Defence

Opening statement (SASPOP, delivered aloud)

"Mrs Brooks is an 82-year-old retired teacher with persistent atrial fibrillation and a CHA₂DS₂-VASc score of at least 4, giving her a substantial annual stroke risk — on the background of stage 3 chronic kidney disease and recurrent falls, one injurious. Her anticoagulation was stopped after a fall, converting a managed bleeding risk into an unmanaged stroke risk. Her problems are: cardioembolic stroke risk that is currently untreated; CKD, which constrains agent choice and mandates scheduled renal review; a falls syndrome that needs its own workup and treatment; and a family whose fear of bleeding needs respectful, numerical answering. My goal today is to re-establish safe anticoagulation with the lowest-bleeding agent her kidneys allow, and to treat the falls rather than surrendering to them." ^{[1] [3]}