Population ageing has substantially contributed to the rising number of new cancer cases worldwide. Fifty percent of new diagnoses of colorectal cancer are made in patients aged over 70 years, and 25% are aged 80 years or over. Older patients present with more co-morbidities and frailty than younger patients.

Here we describe the case of a 78-year-old lady with atrial fibrillation (AF) and previous stroke who had a right hemicolectomy for a caecal adenocarcinoma. Unfortunately, whilst off anticoagulation at day 5 post operatively she suffered a catastrophic stroke.

For patients requiring surgical management of colorectal carcinoma who are on anticoagulation for AF, bespoke peri-operative planning is required to assess risks and benefits of bridging anticoagulation.