Oral anticoagulants have been demonstrated to reduce the incidence of, and mortality secondary to, embolic strokes associated with atrial fibrillation.  Despite this, oral anticoagulants are underprescribed with some estimates suggesting as few as 40% of eligible patients receive therapy.  The risk of falls is the most commonly cited reason for not providing oral anticoagulation, although the risk of bleeding associated with falls on oral anticoagulants is still debated.  In this study Donzé et al evaluated a prospective cohort of elderly individuals requiring oral anticoagulation at a single European centre.

A total of 515 patients were enrolled with a mean age of 71.  Falls risk was assessed with the use of 2 validated questionnaires with nearly 60% of the population deemed to be at high risk.  Follow-up was for 12 months with the primary outcome being the time to a first major bleed. A total of 35 patients had a first major bleed during follow-up (incidence rate: 7.5 per 100 patient-years). Comparing patients at high risk of falls with patients at low risk, there was no significant difference in major bleeding (8.0 vs 6.8 per 100 patient-years, P=0.64).  Similarly, using multivariate analysis a high falls risk was not associated with the risk of a major bleed (HR, 1.09; 95% CI, 0.54-2.21).  Overall, only 3 major bleeds occurred directly after a fall (incidence rate: 0.6 per 100 patient-years).

Conclusions

In this prospective cohort study, patients on oral anticoagulants at high risk of falls did not have a significantly increased risk of major bleeding. These findings suggest that being at risk of falls is not a valid reason to avoid anticoagulation therapy.

• Donzé J, Clair C, Hug B, Rodondi N, Waeber G, Cornuz J and Aujesky D. Risk of Falls and Major Bleeds in Patients on Oral Anticoagulation Therapy.  The American Journal of Medicine (2012) 125, 773-778