Physical Activity and Risk of Bleeding in Elderly Patients Taking Anticoagulants.

Frey, P M; Méan, M; Limacher, A; Jaeger, Kurt; Beer, Hans-Jürg; Frauchiger, Beat; Aschwanden, Markus; Rodondi, N; Righini, Marc; Egloff, Michael; Osterwalder, Joseph; Kucher, N; Angelillo, Anne; Husmann, Marc; Banyai, Martin; Matter, Christian M; Aujesky, D (2015). Physical Activity and Risk of Bleeding in Elderly Patients Taking Anticoagulants. Journal of thrombosis and haemostasis, 13(2), pp. 197-205. Wiley-Blackwell 10.1111/jth.12793

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BACKGROUND

Although the possibility of bleeding during anticoagulant treatment may limit patients from taking part in physical activity, the association between physical activity and anticoagulation-related bleeding is uncertain.

OBJECTIVES

To determine whether physical activity is associated with bleeding in elderly patients taking anticoagulants.

PATIENTS/METHODS

In a prospective multicenter cohort study of 988 patients aged ≥65 years receiving anticoagulants for venous thromboembolism, we assessed patients' self-reported physical activity level. The primary outcome was the time to a first major bleeding, defined as fatal bleeding, symptomatic bleeding in a critical site, or bleeding causing a fall in hemoglobin or leading to transfusions. The secondary outcome was the time to a first clinically-relevant non-major bleeding. We examined the association between physical activity level and time to a first 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

During a mean follow-up of 22 months, patients with a low, moderate, and high physical activity level had an incidence of major bleeding of 11.6, 6.3, and 3.1 events per 100 patient-years, and an incidence of clinically relevant non-major bleeding of 14.0, 10.3, and 7.7 events per 100 patient-years, respectively. A high physical activity level was significantly associated with a lower risk of major bleeding (adjusted sub-hazard ratio 0.40, 95%-CI 0.22-0.72). There was no association between physical activity and non-major bleeding.

CONCLUSIONS

A high level of physical activity is associated with a decreased risk of major bleeding in elderly patients receiving anticoagulant therapy. This article is protected by copyright. All rights reserved.

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