Why falling doesn’t mean you should stop blood thinners
Many doctors and families assume that if an older adult is prone to falls, they shouldn’t take blood thinners. It sounds logical: more falls + thinner blood = more bleeding. But this thinking is outdated-and dangerous. The truth is, fall risk alone should never be a reason to avoid anticoagulants if you’re at risk for stroke. Stopping these medications because of falls puts you at far greater risk of a disabling or deadly stroke than the chance of bleeding from a tumble.
Consider this: if you have atrial fibrillation (AFib) and a CHA₂DS₂-VASc score of 3, your chance of having a stroke in one year is about 3.2%. That’s more than 1 in 30. Now, if you’re on a blood thinner like apixaban or rivaroxaban, your stroke risk drops by 60-70%. Meanwhile, the risk of a serious brain bleed from a fall while on these drugs? Just 0.2% to 0.5% per year. You’d have to fall nearly 300 times in a year for the bleeding risk to outweigh the stroke prevention benefit. Most people don’t fall even 10 times a year.
How doctors measure your stroke and bleeding risk
Not everyone with AFib needs a blood thinner. Doctors use two key tools to decide:
- CHA₂DS₂-VASc score - This tells you your stroke risk. Points are added for things like age over 75, high blood pressure, diabetes, heart failure, and prior stroke. A score of 2 or higher in men (or 3 or higher in women) means you’re at moderate to high risk-and anticoagulation is strongly recommended, no matter how often you fall.
- HAS-BLED score - This estimates bleeding risk. Points come from high blood pressure, kidney or liver problems, past bleeding, old age (over 65), and using drugs like aspirin or NSAIDs. A score of 3 or more means you need closer monitoring, but it doesn’t mean you can’t take anticoagulants.
These scores aren’t guesses. They’re backed by data from hundreds of thousands of patients. If your CHA₂DS₂-VASc score says you need a blood thinner, and your HAS-BLED score is high, your doctor should focus on reducing your bleeding risks-not skipping the medicine.
Why DOACs are the best choice for people who fall
There are two main types of blood thinners: warfarin and DOACs (direct oral anticoagulants). Warfarin has been around for decades, but DOACs like apixaban, rivaroxaban, dabigatran, and edoxaban are now the first choice for most people-especially those at risk of falling.
Here’s why:
- DOACs lower your risk of brain bleeds by 30-50% compared to warfarin.
- They don’t need regular blood tests like INR checks.
- They have fewer food and drug interactions.
- They work faster and wear off faster, which helps if you have a fall and need emergency care.
According to 2022 data, about 80% of new prescriptions for AFib in the U.S. are for DOACs. That’s because doctors know they’re safer for older, fall-prone patients. If you’re still on warfarin and you fall often, ask your doctor if switching to a DOAC is right for you.
What you should do to prevent falls-without stopping your medicine
Instead of cutting your blood thinner, fix what’s making you fall. Most falls aren’t random. They’re caused by things you can change.
Start with a full falls assessment. This isn’t a quick chat-it’s a 30- to 60-minute review that includes:
- Medication review - Are you taking sedatives, sleep aids, blood pressure pills, or antidepressants that make you dizzy? Some can be reduced or stopped safely.
- Gait and balance test - The Timed Up and Go test measures how long it takes you to stand up from a chair, walk 3 meters, turn, walk back, and sit down. If it takes more than 12 seconds, you’re at higher risk. Physical therapy can help.
- Eye check - Poor vision is a top cause of falls. Make sure your glasses are up to date and you’re getting regular eye exams.
- Home safety - Remove throw rugs, install grab bars in the bathroom, add nightlights, and clear clutter from hallways.
- Orthostatic hypotension check - Does your blood pressure drop when you stand? This causes dizziness and is common in older adults. Your doctor can adjust meds or recommend compression stockings.
Studies show that when these steps are taken, fall rates drop by 30-50%. You don’t need to live in fear. You need a plan.
When anticoagulants really should be stopped
There are only a few real reasons to avoid or stop blood thinners:
- You’re actively bleeding (like a stomach ulcer or internal hemorrhage).
- You have a known bleeding disorder like hemophilia.
- Your blood pressure is uncontrolled-above 180/110 mmHg.
- You’re in the final months of life and the benefit of stroke prevention is unlikely to matter.
That’s it. If you’re just worried about falling, that’s not a medical reason to stop. In fact, stopping your blood thinner when you have AFib and a high stroke risk can be more harmful than the fall itself.
What patients say-and what doctors get wrong
Many older adults turn down anticoagulants because they’re scared of bleeding. One 78-year-old man, Mr. H, chose not to take a blood thinner after his doctor warned him about falls. He had a CHA₂DS₂-VASc score of 3. A year later, he had a stroke that left him unable to speak or walk.
On the other hand, Mrs. L, 82, had the same score and fell twice last year. But her doctor helped her do a falls assessment. She stopped a sedative, got a walker, had her home modified, and started balance exercises. She’s still on apixaban-and hasn’t fallen since.
The problem? About half of primary care doctors still believe fall risk alone means you shouldn’t take blood thinners. That’s not what the guidelines say. The American College of Physicians, the American Heart Association, and the Society of Hospital Medicine all agree: don’t stop anticoagulants just because someone falls.
What to ask your doctor
If you’re on a blood thinner or being considered for one, ask these questions:
- What’s my CHA₂DS₂-VASc score? Am I at high risk for stroke?
- What’s my HAS-BLED score? What’s making my bleeding risk higher?
- Am I on a DOAC or warfarin? Would switching help me?
- Can we do a full falls assessment? What can we change to make me safer?
- Are any of my medications making me dizzy or weak?
- What should I do if I fall? Do I need to come in?
These questions shift the conversation from fear to action. You’re not choosing between bleeding and stroke-you’re choosing safety and life.
Final thought: Safety isn’t about avoiding risk-it’s about managing it
Life after 70 isn’t about avoiding all danger. It’s about knowing what matters most. For most people with AFib, preventing a stroke is more important than avoiding every possible fall. With the right blood thinner, the right home setup, and the right care team, you can live longer, stronger, and safer.
You don’t need to stop your medicine to stay safe. You need a smarter plan. And that plan starts with asking the right questions-and refusing to let fear make the decision for you.
Should I stop my blood thinner if I fall often?
No. Falling often is not a medical reason to stop anticoagulants. The risk of stroke from untreated atrial fibrillation is much higher than the risk of a serious bleed from a fall. Guidelines from the American College of Physicians and other major societies say you should not discontinue blood thinners solely because of fall risk. Instead, focus on preventing falls through medication review, balance training, and home safety changes.
Are DOACs safer than warfarin if I fall?
Yes. DOACs (like apixaban, rivaroxaban, and dabigatran) reduce the risk of brain bleeding by 30-50% compared to warfarin. They also don’t require frequent blood tests and have fewer interactions with food and other drugs. For people at risk of falling, DOACs are now the first-line recommendation for atrial fibrillation, unless there’s severe kidney disease or a mechanical heart valve.
Can I reduce my DOAC dose to lower bleeding risk?
No. Reducing the dose of a DOAC below the recommended level doesn’t significantly lower bleeding risk-it just makes the drug less effective at preventing stroke. Studies show this practice offers no safety benefit and increases the chance of stroke. Always take your DOAC exactly as prescribed.
What’s the most important thing I can do to prevent falls?
Start with a comprehensive falls assessment. This includes reviewing your medications for dizziness-causing drugs, testing your balance with a Timed Up and Go test, checking your vision, removing home hazards like rugs and poor lighting, and treating low blood pressure when standing. Working with a physical therapist or geriatric care team can cut your fall risk by up to 50%.
When should I consider stopping anticoagulants?
Only in rare cases: if you’re actively bleeding, have a severe bleeding disorder, have uncontrolled high blood pressure (over 180/110), or are in the final months of life where stroke prevention is unlikely to benefit you. For most older adults-even those who fall frequently-staying on anticoagulants is the safer choice.