Falls in ED patients: do elderly patients on direct oral anticoagulants bleed less than those on vitamin K antagonists?

Müller, Martin; Chanias, Ioannis; Nagler, Michael; Exadaktylos, Aristomenis K.; Sauter, Thomas C. (2021). Falls in ED patients: do elderly patients on direct oral anticoagulants bleed less than those on vitamin K antagonists? Scandinavian journal of trauma, resuscitation and emergency medicine, 29(1), p. 56. BioMed Central 10.1186/s13049-021-00866-6

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BACKGROUND

Falls from standing are common in the elderly and are associated with a significant risk of bleeding. We have compared the proportional incidence of bleeding complications in patients on either direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA).

METHODS

Our retrospective cohort study compared elderly patients (≥65 years) on DOAC or VKA oral anticoagulation who presented at the study site - a Swiss university emergency department (ED) - between 01.06.2012 and 01.07.2017 after a fall. The outcomes were the proportional incidence of any bleeding complication and its components (e.g. intracranial haemorrhage), as well as procedural and clinical parameters (length of hospital stay, admission to intensive care unit, in-hospital-mortality). Uni- and multivariable analyses were used to compare the studied outcomes.

RESULTS

In total, 1447 anticoagulated patients were included - on either VKA (n = 1021) or DOAC (n = 426). There were relatively more bleeding complications in the VKA group (n = 237, 23.2%) than in the DOAC group (n = 69, 16.2%, p = 0.003). The difference persisted in multivariable analysis with 0.7-fold (95% CI: 0.5-0.9, p = 0.014) lower odds for patients under DOAC than under VKA for presenting with any bleeding complications, and 0.6-fold (95% 0.4-0.9, p = 0.013) lower odds for presenting with intracranial haemorrhage. There were no significant differences in the other studied outcomes.

CONCLUSIONS

Among elderly, anticoagulated patients who had fallen from standing, those under DOACs had a lower proportional incidence of bleeding complications in general and an even lower incidence of intracranial haemorrhage than in patients under VKAs.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Institute of Clinical Chemistry
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center

UniBE Contributor:

Müller, Martin; Nagler, Michael; Exadaktylos, Aristomenis and Sauter, Thomas Christian

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1757-7241

Publisher:

BioMed Central

Language:

English

Submitter:

Pierrette Durand Lüthi

Date Deposited:

27 Apr 2021 15:16

Last Modified:

02 May 2021 03:06

Publisher DOI:

10.1186/s13049-021-00866-6

PubMed ID:

33823884

Uncontrolled Keywords:

Anticoagulants Bleeding Direct oral anticoagulants Fall Intra cranial bleeding Syncope Vitamin K antagonist

BORIS DOI:

10.48350/155867

URI:

https://boris.unibe.ch/id/eprint/155867

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