Atrial Fibrillation, Anticoagulation, and Major Bleeding Episodes in Geriatric Patients at the Risk of Falling

Abstract

Background: Geriatric patients are at risk for atrial fibrillation (AF), stroke, and the risk of anticoagulation (OAC) related bleeding is presumed to be higher. Detailed knowledge about the prevalence of AF and bleeding pattern in this population is scarce. This study sought to assess the prevalence of AF, use of OAC and rate of major bleeding in geriatric patients who frequently fall. Methods: Observational cohort study at a Fall and Syncope Clinic. Patients of 65 years and older, that underwent both an electrocardiogram (ECG) and holter registration were included. Use and reasons to withhold OAC, and rate of major bleeding were retrieved from the medical files. Results: n=428, mean age 79.8 years. Mean CHA2DS2VASc and HAS-BLED score was 4.0 and 2.9 respectively. AF was known in 98 (23%) patients, first diagnosed in 10 (2%). First diagnosed AF was identified on all Holters, and on the ECG in half of the new cases. AF was paroxysmal in 45 patients (45%). 84% of patients known with AF used OAC. The rate of major bleeding was 1.1 per 100 treatment years. Major bleeding was not different between patients using antiplatelet agents (APA), OAC or no antithrombotic medication. Conclusions: The rate of AF in geriatric patients is high and almost 50% is paroxysmal. Compared to previous studies the use of OAC has substantially increased to 84% and in this geriatric cohort no differences were found in the rate of major bleeding between those with APA, OAC or without antithrombotic medication.