Falls in ED patients: do elderly patients on direct oral anticoagulants bleed less than those on vitamin K antagonists? - Muller, M.; Chanias, I.; Nagler, M.; Exadaktylos, A. K.; Sauter, T. C. (Scand J Trauma Resusc Emerg Med, 2021)
BACKGROUND: Falls from standing are common in the elderly and are associated with a significant risk of bleeding. We have compared the proportional incidence of bleeding complications in patients on either direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA). METHODS: Our retrospective cohort study compared elderly patients (>/=65 years) on DOAC or VKA oral anticoagulation who presented at the study site - a Swiss university emergency department (ED) - between 01.06.2012 and 01.07.2017 after a fall. The outcomes were the proportional incidence of any bleeding complication and its components (e.g. intracranial haemorrhage), as well as procedural and clinical parameters (length of hospital stay, admission to intensive care unit, in-hospital-mortality). Uni- and multivariable analyses were used to compare the studied outcomes. RESULTS: In total, 1447 anticoagulated patients were included - on either VKA (n = 1021) or DOAC (n = 426). There were relatively more bleeding complications in the VKA group (n = 237, 23.2%) than in the DOAC group (n = 69, 16.2%, p = 0.003). The difference persisted in multivariable analysis with 0.7-fold (95% CI: 0.5-0.9, p = 0.014) lower odds for patients under DOAC than under VKA for presenting with any bleeding complications, and 0.6-fold (95% 0.4-0.9, p = 0.013) lower odds for presenting with intracranial haemorrhage. There were no significant differences in the other studied outcomes. CONCLUSIONS: Among elderly, anticoagulated patients who had fallen from standing, those under DOACs had a lower proportional incidence of bleeding complications in general and an even lower incidence of intracranial haemorrhage than in patients under VKAs.
Keywords: journalArticle; AKE is member of the advisory boards of all registered DOACs. IC reports no; Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Anticoagulants/*administration & dosage; Bleeding; Daiichi-Sankyo. TCS and MM have received research grants from the Gottfried and; Direct oral anticoagulants; Emergency Service, Hospital/*statistics & numerical data; Fall; Female; Fibrinolytic Agents/*administration & dosage; Hemorrhage/*epidemiology/prevention & control; Hospital Mortality/trends; Humans; Incidence; Intra cranial bleeding; Julia Bangerter Rhyner Foundation. MN has received research grants or lecture; Length of Stay; Male; Retrospective Studies; Switzerland/epidemiology; Syncope; Vitamin K antagonist; Vitamin K/*antagonists & inhibitors; conflict of interest; fees from Bayer, CSL Behring, Roche Diagnostics, and Instrumentation Laboratory