Abstract
BackgroundFalls 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).MethodsOur 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.ResultsIn 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.ConclusionsAmong 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.
Highlights
Falls are a leading cause of trauma in elderly patients presenting at the emergency department (ED) [1, 2]
We aim to analyse our series of elderly, anticoagulated ED patients admitted after a fall and compare patients on direct oral anticoagulants (DOAC) with those on vitamin K antagonists (VKA) with regards to bleeding complications
Abbreviation: DOAC Direct oral anticoagulant, VKA Vitamin K antagonist the Charlson Comorbidity Index and the HAS-BLED score and iii) restricting the analysis to the n = 1177 patient with falls from their own height revealed similar odds ratios (OR) of i) 0.7, 95% CI: 0.5–0.9, p = 0.016, ii) 0.7, 95% CI: 0.5–0.9, p = 0.005, iii) 0.7, 95% CI: 0.5–1.0, p = 0.039
Summary
In up to 50% of the patients with an indication for anticoagulation for stroke prevention, anticoagulation is not prescribed, as the perceived greater risk of bleeding – especially after falls – outweighs the perceived risk of stroke [15, 16] and a prior history of a fall is a clinically useful risk factor for poor outcome in anticoagulated elderly patients [17]. This underlines the need for trials on the interaction between falls and anticoagulation. We have compared the proportional incidence of bleeding complications in patients on either direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
