A 78-year-old woman presented to the cardiology outpatient clinic for anticoagulation management after being diagnosed with non-valvular atrial fibrillation (AF). Her medical history included hypertension, type 2 diabetes mellitus, and a transient ischaemic attack (TIA) 2 years earlier. She weighed 68 kg, and her serum creatinine was 1.2 mg/dL (estimated glomerular filtration rate 58 mL/min/1.73 m²). Her CHA₂DS₂-VASc score was 6, indicating a high risk of stroke, while her HAS-BLED score was 2, suggesting an acceptable bleeding risk. She had no history of major bleeding or recent falls. Physical examination revealed a blood pressure of 132/78 mmHg and an irregularly irregular pulse of 82 beats/min. Laboratory investigations, including haemoglobin, platelet count, liver function, and coagulation profile, were within normal limits. Although she met none of the apixaban dose-reduction criteria, there was concern about bleeding because of her advanced age. The treating physician considered prescribing apixaban 2.5 mg twice daily instead of the standard dose. Current AF guidelines recommend dose reduction only when at least two predefined criteria are present, making appropriate dose selection essential for balancing stroke prevention and bleeding risk.