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

In this prospective cohort, patients, who were on oral anticoagulants and who had a high risk of falling, did not have a significantly increased risk of major bleeds. These findings suggest that falling risk is not a valid reason to avoid oral anticoagulants.

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.

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— Jacques Donzé, MD, MSc, Carole Clair, MSc, MD, Balthasar Hug, MD, MBA, MPH, Nicolas Rodondi, MD, MAS, Gérard Waeber, MD, Jacques Cornuz, MD, MPH, Drahomir Aujesky, MD, MSc

This article originally appeared in the August 2012 issue of the The American Journal of Medicine.