Clinical research study
Risk of Falls and Major Bleeds in Patients on Oral Anticoagulation Therapy

https://doi.org/10.1016/j.amjmed.2012.01.033Get rights and content

Abstract

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.

Section snippets

Materials and Methods

We used data from a prospective cohort study that was conducted in the Internal Medicine inpatient and outpatient services of a Swiss university hospital.12 From January 1, 2008 to March 31, 2009, all consecutive adult inpatients and outpatients treated with a vitamin K antagonist (such as acenocoumarol or phenprocoumon, which are comparable with warfarin13) were identified using either the hospital's computerized physician order-entry system for inpatients or based on physician notification of

Results

We identified 650 consecutive patients on oral anticoagulants. Of these, 132 (20.8%) were excluded because of refusal or inability to give informed consent, and 3 (0.5%) because they withdrew consent during follow-up. Thus, the final sample included 515 patients with a total of 467.5 patient-years. The median age was 71.2 years (interquartile range 17.8), and 329 (63.9%) were men. Overall, 330 of 515 patients (64%) had started oral anticoagulant therapy ≥3 months before enrollment. Based on our

Discussion

In this prospective cohort of adult medical patients who received oral anticoagulants, we found that patients on oral anticoagulants at high risk of falls did not have a higher risk of major bleeds than patients at low risk of falls. Overall, only 0.6 fall-related major bleeds per 100 patient-years (3 nonfatal subdural hemorrhages) occurred during follow-up, indicating that oral anticoagulants in medical patients who have a high risk of falls may be safe. The clinical implication of our

Conclusion

In summary, patients on oral anticoagulants who were identified by 2 validated questions to be at high risk of falls did not have a higher risk of major bleeds compared with low falls risk patients. Our findings suggest that being at risk of falls is not a valid reason to avoid oral anticoagulants in medical patients.

Acknowledgment

We thank Dr Vera Sistenich for the careful review of the paper.

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    Funding: This study was financially supported by an intramural grant (CardioMet) from the University Hospital Lausanne, Switzerland and the Swiss Science National Foundation (PBLAP3-131814).

    Conflict of Interest: None.

    Authorship: All authors had access to the data and had a role in writing the manuscript.

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