Risk of major bleeding in recurrent fallers receiving anticoagulation for atrial fibrillation: a prospective cohort study

Background: The risk of fall-related bleeding is a frequent reason for not following recommendations on anticoagulation in patients with atrial fibrillation (AF). Objectives: To assess whether patients on anticoagulation therapy with recurrent falls are at an increased risk of bleeding. Methods: We used data from the Swiss-AF multicenter cohort study, including patients aged ≥65 years with documented AF and oral anticoagulant treatment. Recurrent fallers were defined as those reporting > 1 fall/y. The primary outcome was first major bleeding as defined by the International Society on Thrombosis and Haemostasis. To account for death as a competing event, we used the Fine-Gray competing risk regression model to examine the association between a history of recurrent falls and time to a first major bleeding event. The results were expressed as subdistribution hazard ratios with 95% CIs. Results: We included 2154 patients (mean age, 73.4 years; 27.5% female), 180 (8.3%) of whom reported recurrent falls. During a median follow-up of 36 months, 368 (17.1%) patients died, and 218 (10.1%) had a first major bleeding event. Recurrent fallers were more likely to experience trauma-related bleeding episodes than nonfallers (16.7% vs 9.2%). The adjusted subdistribution hazard ratio for major bleeding in recurrent fallers was 1.16 (95% CI, 0.74-1.82). In subgroup analyses of patients receiving direct oral anticoagulants or vitamin K antagonists, the risk of major bleeding was not increased for recurrent fallers. Conclusion: We found no association between recurrent falls and risk of major bleeding in AF patients receiving direct oral anticoagulants or vitamin K antagonists.