My father who did NOT have Afib but did have 2 clotting factors which increased his risk of clots many fold. He had a history of TIAs, or what is referred to as a mini strokes. So he was on warfarin (pre -DOAC) for the clots. So he also had a history of falling due to pinched nerve in lower back also known as spinal stenosis. He also had poor safety judgment. He died age 86. He was in otherwise great health. But he was recovering from a fall and had almost completely recovered. He was ready to come home from rehab. But he stood to void his bladder without help and he fell backwards and hit his head. He was sent to the ER of a very large university based hospital where I worked. He had a brain bleed but they thought that he had enough space in his skull for a mild bleed. Older folks often have some atrophy in the brain hence they thought they could let him bleed thinking he would clot before any issues arose. About 8 hours later he suffered a seizure. After a stat Cat scan it revealed he had bled too much and was getting pressure on the brain. So they immediately reversed his warfarin using plasma. He was admitted to intensive care. He began to recover with mild cognitive improvement daily. Then a week after the fall due to his clotting factor disorder he developed clots. I received a midnight phone call and my father was in respiratory distress and was critical. I had to make the decision to DNR my father. I am crying as I write this. This was his 3rd brain bleed in 7 months. The last brain bleed resulted in coming off blood thinners thus he died of pulmonary embolisms from his clotting factor disorder. He was caught between a rock and a hard place. He was gone before I could get to the hospital . I have inherited one of his clotting factors. If I had both it would raise my risk higher and I have had 2 ablations for Afib. So as I read this story about a 93 year old active man with a risk of falling and a single Afib event of very short duration I think this is a balancing act on deciding what to do.
If it was me I would want more reason to be on blood thinner than a single short duration Afib event. I am presently on DOACs as I am post ablation X 4 months. That said whether he takes DOACs or not I would highly recommend that if he is not in physical therapy for strength and conditioning he should be. The literature is overwhelming that strength and conditioning significantly helps geriatrics reduce their risk of falls. This risk reduces bleeding and broken bones and generally improves quality of life. I would also stress learning to have good safety judgment when ambulating. These last areas are my and my wife's areas expertise in physical rehabilitation. We have a combined 75 years experience in this field and have treated many thousands of people all to improve their quality of living. We have seen and experienced a lot of medicine in our lives: both good and bad medicine. I was a Certified Orthotist who designed and made braces for people with neurological and or orthopedic problems and my wife was a geriatric physical therapist. Oh speaking of safety judgment I am 77 and am going to go out after I write this and cut firewood. 🙂 So go figure. I am extremely careful and have cut firewood most of my adult life.
One last thought is to get a Kardia device and he can check his Afib status all day long to see if he can replicate it.