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Physicians cite excessive bleeding risk as one reason they omit OAC for their older patients with AF. Improved understanding of the pathophysiology of age-related bleeding may improve risk\u2013benefit assessments for warfarin and newer antithrombotic agents. We reviewed the literature to identify age-related pathophysiological elements that can exacerbate the likelihood of bleeding. In the context of the Hypertension, Abnormal renal\/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly, Drugs\/alcohol concomitantly (HAS-BLED) bleeding risk framework, we highlight age-related physiological dynamics that predispose to hemorrhage. The combination of increased age (&gt;65 years) with the other elements of the risk factor stratification model identifies patients with AF who are especially susceptible to OAC-related bleeding, irrespective of the agent used. Empirically adjusting OAC dose relative to these common bleeding risks may help to achieve an improved risk\u2013benefit therapeutic ratio.<\/jats:p>","DOI":"10.1177\/1076029613492010","type":"journal-article","created":{"date-parts":[[2013,6,10]],"date-time":"2013-06-10T23:37:32Z","timestamp":1370907452000},"page":"5-15","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Oral Anticoagulation Therapy for Elderly Patients With Atrial Fibrillation"],"prefix":"10.1177","volume":"20","author":[{"given":"Daniel E.","family":"Forman","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richert E.","family":"Goyette","sequence":"additional","affiliation":[{"name":"Consultant, Hematology\/Oncology, Knoxville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2013,6,9]]},"reference":[{"key":"bibr1-1076029613492010","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.18.2370"},{"key":"bibr2-1076029613492010","doi-asserted-by":"publisher","DOI":"10.1378\/chest.08-0678"},{"key":"bibr3-1076029613492010","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afr097"},{"key":"bibr4-1076029613492010","doi-asserted-by":"publisher","DOI":"10.1177\/2040622312438934"},{"key":"bibr5-1076029613492010","unstructured":"Boehringer Ingelheim. 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