Risk of falls and bleeding in elderly patients with acute venous thromboembolism

Publication

Risk of falls and bleeding in elderly patients with acute venous thromboembolism

Journal Paper/Review - Apr 16, 2014

Kämpfen P, Rodondi N, Bounameaux H, Aschwanden M, Egloff M, Banyai M, Cornuz J, Kucher N, Matter C M, Frauchiger B, Osterwalder Joseph, Beer H-J, Jaeger K, Righini M, Limacher A, Méan M, Aujesky D

Citation

Kämpfen P, Rodondi N, Bounameaux H, Aschwanden M, Egloff M, Banyai M, Cornuz J, Kucher N, Matter C, Frauchiger B, Osterwalder J, Beer H, Jaeger K, Righini M, Limacher A, Méan M, Aujesky D. Risk of falls and bleeding in elderly patients with acute venous thromboembolism. J Intern Med 2014; 276:378-86.

Type

Journal Paper/Review (English)

Journal

J Intern Med 2014; 276

Publication Date

Apr 16, 2014

Issn Electronic

1365-2796

Pages

378-86

Brief description/objective

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 nine 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 nonmajor 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 nonmajor 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 nonmajor bleeding [subhazard 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 nonmajor 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.