Risk of major bleeding in recurrent fallers receiving anticoagulation for atrial fibrillation: a prospective cohort study. Journal Articles uri icon

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abstract

  • 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.

authors

  • Regina, Jean
  • Girod, Fiona
  • Marques-Vidal, Pedro
  • Porretta, Alessandra Pia
  • Vaucher, Julien
  • Samim, Daryoush
  • Rodondi, Nicolas
  • Moutzouri, Elisavet
  • Beer, Jürg H
  • Schwenkglenks, Matthias
  • Ammann, Peter
  • Kühne, Michael
  • Conen, David
  • Méan, Marie
  • Swiss-AF investigators

publication date

  • May 2025