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

Détails

ID Serval
serval:BIB_3C2EE8138E87
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Risk of falls and bleeding in elderly patients with acute venous thromboembolism.
Périodique
Journal of internal medicine
Auteur(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.
ISSN
1365-2796 (Electronic)
ISSN-L
0954-6820
Statut éditorial
Publié
Date de publication
10/2014
Peer-reviewed
Oui
Volume
276
Numéro
4
Pages
378-386
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
Whether or not a high risk of falls increases the risk of bleeding in patients receiving anticoagulants remains a matter of debate.
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.
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).
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.
Mots-clé
Accidental Falls, Aged, Aged, 80 and over, Anticoagulants/adverse effects, Anticoagulants/therapeutic use, Female, Hemorrhage/epidemiology, Hemorrhage/etiology, Humans, Male, Prospective Studies, Risk Factors, Venous Thromboembolism/drug therapy, bleeding, elderly, falls, venous thromboembolism
Pubmed
Web of science
Création de la notice
30/10/2014 17:26
Dernière modification de la notice
22/10/2019 5:11
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