A fictional 74-year-old with newly diagnosed non-valvular atrial fibrillation and hypertension is anxious about anticoagulation after a friend had a gastrointestinal bleed.
What they need from today.
- Understand why treatment is being discussed
- Compare stroke prevention with bleeding risk
- Know what monitoring and warning signs are involved
What you should practise.
- Use stroke and bleeding risk tools to support—not replace—conversation
- Discuss options using balanced, personalised language
- Address modifiable bleeding risks and medicine safety
Listen before you explain.
Atrial fibrillation increases the chance of a clot forming and causing a stroke. Your other health factors make prevention worth discussing. What have you heard about blood-thinning medicines?
Explain the decision and elicit prior beliefs.My friend bled badly. I would rather take aspirin.
That experience understandably shapes how this feels. Let us compare what each option can and cannot do, including no anticoagulant, and look at risks we may be able to reduce.
Validate concern and keep all options explicit.Will falling over make the medicine too dangerous?
Falls matter and we should reduce them, but fall risk alone is not usually a reason to withhold anticoagulation. Kidney function, other medicines, previous bleeding and your priorities all affect the final choice.
Correct a misconception without minimising risk.Choose before the senior view.
The question behind the question.
What must be checked before the first prescription, beyond the risk scores?
Contraindications, renal and hepatic function, interacting medicines, bleeding history, blood pressure, adherence practicalities, appropriate dose and the patient’s informed preference.
CONSULTANT FEEDBACKExactly. Then explain missed doses, bleeding warning signs and who will review treatment.
Recommended phrases
- “Your friend’s experience is important; let us separate their situation from your own risk.”
- “The benefit and harm are not zero with either choice.”
- “What matters most to you when you weigh these options?”
Phrases to avoid
- “Everyone with AF needs a blood thinner.”
- “Falls do not matter.”
- “This medicine prevents strokes.”
Make the next action explicit.
- Give clear advice about significant bleeding, head injury and symptoms of stroke.
- Explain medicine interactions, missed-dose instructions and review arrangements.
- Reassess stroke and bleeding risks and preferences over time.
Where consultations fail.
- Using jargon such as CHA2DS2-VASc without explanation
- Discussing bleeding without stroke risk—or vice versa
- Treating age or falls alone as an exclusion
Did your explanation give equal clarity to the consequences of taking and not taking treatment?