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


Autoria(s): 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.
Data(s)

2014

Resumo

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.

Identificador

http://serval.unil.ch/?id=serval:BIB_3C2EE8138E87

isbn:1365-2796 (Electronic)

pmid:24645727

doi:10.1111/joim.12236

isiid:000342722300005

Idioma(s)

en

Fonte

Journal of Internal Medicine, vol. 276, no. 4, pp. 378-386

Tipo

info:eu-repo/semantics/article

article