BACKGROUND: The risk of falls is the most commonly cited reason for not providing oral anticoagulation, although the risk of bleeding associated with falls on oral anticoagulants is still debated. We aimed to evaluate whether patients on oral anticoagulation with high falls risk have an increased risk of major bleeding. METHODS: We prospectively studied consecutive adult medical patients who were discharged on oral anticoagulants. The outcome was the time to a first major bleed within a 12-month follow-up period adjusted for age, sex, alcohol abuse, number of drugs, concomitant treatment with antiplatelet agents, and history of stroke or transient ischemic attack. RESULTS: Among the 515 enrolled patients, 35 patients had a first major bleed during follow-up (incidence rate: 7.5 per 100 patient-years). Overall, 308 patients (59.8%) were at high risk of falls, and these patients had a nonsignificantly higher crude incidence rate of major bleeding than patients at low risk of falls (8.0 vs 6.8 per 100 patient-years, P=.64). In multivariate analysis, a high falls risk was not statistically significantly associated with the risk of a major bleed (hazard ratio 1.09; 95% confidence interval, 0.54-2.21). Overall, only 3 major bleeds occurred directly after a fall (incidence rate: 0.6 per 100 patient-years). CONCLUSIONS: In this prospective cohort, patients on oral anticoagulants at high risk of falls did not have a significantly increased risk of major bleeds. These findings suggest that being at risk of falls is not a valid reason to avoid oral anticoagulants in medical patients.
BACKGROUND: The risk of falls is the most commonly cited reason for not providing oral anticoagulation, although the risk of bleeding associated with falls on oral anticoagulants is still debated. We aimed to evaluate whether patients on oral anticoagulation with high falls risk have an increased risk of major bleeding. METHODS: We prospectively studied consecutive adult medical patients who were discharged on oral anticoagulants. The outcome was the time to a first major bleed within a 12-month follow-up period adjusted for age, sex, alcohol abuse, number of drugs, concomitant treatment with antiplatelet agents, and history of stroke or transient ischemic attack. RESULTS: Among the 515 enrolled patients, 35 patients had a first major bleed during follow-up (incidence rate: 7.5 per 100 patient-years). Overall, 308 patients (59.8%) were at high risk of falls, and these patients had a nonsignificantly higher crude incidence rate of major bleeding than patients at low risk of falls (8.0 vs 6.8 per 100 patient-years, P=.64). In multivariate analysis, a high falls risk was not statistically significantly associated with the risk of a major bleed (hazard ratio 1.09; 95% confidence interval, 0.54-2.21). Overall, only 3 major bleeds occurred directly after a fall (incidence rate: 0.6 per 100 patient-years). CONCLUSIONS: In this prospective cohort, patients on oral anticoagulants at high risk of falls did not have a significantly increased risk of major bleeds. These findings suggest that being at risk of falls is not a valid reason to avoid oral anticoagulants in medical patients.
Authors: Tim A Holt; Andrew Rh Dalton; Susan Kirkpatrick; Jenny Hislop; Tom Marshall; Matthew Fay; Nadeem Qureshi; Daniel S Lasserson; Karen Kearley; Jill Mollison; Ly-Mee Yu; David Fitzmaurice; Fd Richard Hobbs Journal: Br J Gen Pract Date: 2018-11-05 Impact factor: 5.386
Authors: Waltraud Leiss; Marie Méan; Andreas Limacher; Marc Righini; Kurt Jaeger; Hans-Jürg Beer; Joseph Osterwalder; Beat Frauchiger; Christian M Matter; Nils Kucher; Anne Angelillo-Scherrer; Jacques Cornuz; Martin Banyai; Bernhard Lämmle; Marc Husmann; Michael Egloff; Markus Aschwanden; Nicolas Rodondi; Drahomir Aujesky Journal: J Gen Intern Med Date: 2014-08-21 Impact factor: 5.128
Authors: Jane S Saczynski; Saket R Sanghai; Catarina I Kiefe; Darleen Lessard; Francesca Marino; Molly E Waring; David Parish; Robert Helm; Felix Sogade; Robert Goldberg; Jerry Gurwitz; Weijia Wang; Tanya Mailhot; Benita Bamgbade; Bruce Barton; David D McManus Journal: J Am Geriatr Soc Date: 2019-10-01 Impact factor: 5.562