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

Kämpfen, P; Méan, M; Limacher, A; Righini, M; Jaeger, K; Beer, H-J; Osterwalder, J; Frauchiger, B; Matter, C M; Kucher, N; Cornuz, J; Banyai, M; Egloff, M; Aschwanden, M; Bounameaux, H; Rodondi, N; Aujesky, D (2014). Risk of falls and bleeding in elderly patients with acute venous thromboembolism. Journal of internal medicine, 276(4), pp. 378-386. Blackwell Scientific Publications 10.1111/joim.12236

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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.

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