Use of Long-Term Anticoagulation is Associated With Traumatic Intracranial Hemorrhage and Subsequent Mortality in Elderly Patients Hospitalized After Falls: Analysis of the New York State Administrative Database

Abstract

Previous studies addressing the relationship between anticoagulation and risk of traumatic intracranial hemorrhage (ICH) have provided conflicting results, and have examined infrequently elderly patients after falls. We used a statewide hospital discharge database to test the hypothesis that long-term anticoagulation (LTA) increases the likelihood of traumatic ICH and subsequent mortality in this patient population. Patients aged 65 years or older and hospitalized as the result of a fall were extracted from the New York State Statewide Planning and Cooperative Systems Database for the year 2004. LTA, ICH, and additional injuries including skull fracture, vertebral fracture, rib fracture, lower extremity fracture, thoracic visceral injury, and abdominal visceral injury were defined using corresponding International Classification for Disease, Ninth Edition coding. Covariates included age, gender, and comorbidity. Additional outcomes included length of stay and mortality. Multivariable logistic regression was used to identify independent predictors of traumatic ICH and subsequent mortality. A total of 47,717 patients met the inclusion criteria. Falls were associated with a traumatic ICH in 2,517 patients (5.1%), and the mortality rate of patients with a fall-related, traumatic ICH was 15.5% (n = 394). A total of 1,511 (3.2%) patients hospitalized after a fall used LTA. Based on univariate analysis, ICH was the only injury that occurred more commonly in patients who used LTA, when compared with those who did not (8.0% vs. 5.3%, respectively, p < 0.0001). Furthermore, although overall mortality did not differ by use of LTA, mortality after ICH was significantly higher in patients who used LTA when compared with those who did not (21.9% vs. 15.2%, respectively, p = 0.04). Controlling for age, gender, and comorbidity, patients on LTA were 50% more likely to sustain a traumatic ICH after a fall (odds ratio = 1.50; 95% confidence interval, 1.23-1.81; p < 0.0001). Furthermore, among patients who sustained an ICH, mortality was 1.57-fold greater in patients on LTA (odds ratio = 1.57; 95% confidence interval, 1.02-2.45; p = 0.04). These data indicate that use of LTA is independently associated with traumatic ICH and subsequent mortality in elderly patients hospitalized after a fall.