Clinical research studyRisk of Falls and Major Bleeds in Patients on Oral Anticoagulation Therapy
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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Cited by (0)
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.