Citation

Kämpfen P, Méan M, Limacher A, Righini M, Jaeger K, Beer HJ, Osterwalder J, Frauchiger B, Matter CM, Kucher N, Cornuz J, Banyai M, Egloff M, Aschwanden M, Bounameaux H, Rodondi N, Aujesky D. J. Intern. Med. 2014; 276(4): 378-386.

Affiliation

Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland.

Copyright

(Copyright © 2014, John Wiley and Sons)

DOI

10.1111/joim.12236

PMID

24645727

Abstract

OBJECTIVE: Whether or not a high risk of falls increases the risk of bleeding in patients receiving anticoagulants remains a matter of debate.

METHODS: We conducted a prospective cohort study involving 991 patients ≥65 years of age who received anticoagulants for acute venous thromboembolism (VTE) at 9 Swiss hospitals between September 2009 and September 2012. The study outcomes were as follows: the time to a first major episode of bleeding; and clinically-relevant non-major bleeding. We determined the associations between the risk of falls and the time to a first episode of bleeding using competing risk regression, accounting for death as a competing event. We adjusted for known bleeding risk factors and anticoagulation as a time-varying covariate.

RESULTS: Four hundred fifty-eight of 991 patients (46%) were at high risk of falls. The mean duration of follow-up was 16.7 months. Patients at high risk of falls had a higher incidence of major bleeding (9.6 vs. 6.6 events/100 patient-years; P=0.05) and a significantly higher incidence of clinically relevant non-major bleeding (16.7 vs. 8.3 events/100 patient-years; P<0.001) than patients at low risk of falls. After adjustment, a high risk of falls was associated with clinically relevant non-major bleeding (sub-hazard ratio [SHR] = 1.74, 95% confidence interval [CI] = 1.23-2.46), but not with major bleeding (SHR = 1.24, 95% CI = 0.83-1.86).

CONCLUSION: In elderly patients who receive anticoagulants because of VTE, a high risk of falls is significantly associated with clinically-relevant non-major bleeding, but not with major bleeding. Whether or not a high risk of falls is a reason against providing anticoagulation beyond 3 months should be based on patient preferences and the risk of VTE recurrence. This article is protected by copyright. All rights reserved.

Language: en