Patients with AF will also have a bleeding risk assessment. This should not be used as a reason not to give anticoagulants to a patient, but rather to identify any bleeding risk factors that can be modified to reduce the patient’s risk. Modifiable bleeding risk factors include:

• Ensuring good blood pressure control as high blood pressure increases the risk of cerebral haemorrhage
• If prescribed warfarin, ensuring that the international normalised ratio (INR) is maintained within the desired therapeutic range 
• Review of medication – are there any other medicines prescribed that increase bleeding risk? Can these be stopped? For example, NSAIDs, aspirin or other antiplatelet agents or selective serotonin reuptake inhibitors (SSRI) antidepressants
• Can the patient reduce his/her alcohol intake?

Starting anticoagulation treatment

The choice of anticoagulant depends on the patient history and also on patient preference. NICE guidelines expect an informed discussion between the prescriber and the patient regarding the benefits and any potential risks of treatment.