Antithrombotic Therapy in an Elderly Patient With Atrial Fibrillation

An 81-year-old woman with a history of hypertension, chronic kidney disease, and diabetes presents to the office for evaluation after a recent mechanical fall. She denies hitting her head or loss of consciousness. She denies any fatigue, palpitations, or dyspnea on exertion. She is an active person and lives independently while performing all activities of daily living. On exam, she is 63 inches, weighs 61 kilograms, blood pressure 135/85 mm Hg, and her rhythm is irregularly irregular with rate in the 80s.

Routine electrocardiogram performed in the office reveals a new diagnosis of atrial fibrillation. Recent laboratory results included a creatinine clearance of 55 mL/min and normal liver function tests.

Her medical history is notable for an upper gastrointestinal bleed from a duodenal ulcer 10 years ago. She ambulates with a cane and has had no previous falls. The patient wishes to avoid frequent lab testing and does not want medical procedures.

Which of the following is the next step in anticoagulation management?

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