title: Risk of falls and bleeding in elderly patients with acute venous thromboembolism.
abstract: OBJECTIVE
  Whether or not a high risk of falls increases the risk of bleeding in patients receiving anticoagulants remains a matter of debate.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Kämpfen
authors.forename: M
authors.initials: M
authors.lastname: Méan
authors.forename: A
authors.initials: A
authors.lastname: Limacher
authors.forename: M
authors.initials: M
authors.lastname: Righini
authors.forename: K
authors.initials: K
authors.lastname: Jaeger
authors.forename: H-J
authors.initials: HJ
authors.lastname: Beer
authors.forename: J
authors.initials: J
authors.lastname: Osterwalder
authors.forename: B
authors.initials: B
authors.lastname: Frauchiger
authors.forename: C M
authors.initials: CM
authors.lastname: Matter
authors.forename: N
authors.initials: N
authors.lastname: Kucher
authors.forename: J
authors.initials: J
authors.lastname: Cornuz
authors.forename: M
authors.initials: M
authors.lastname: Banyai
authors.forename: M
authors.initials: M
authors.lastname: Egloff
authors.forename: M
authors.initials: M
authors.lastname: Aschwanden
authors.forename: H
authors.initials: H
authors.lastname: Bounameaux
authors.forename: N
authors.initials: N
authors.lastname: Rodondi
authors.forename: D
authors.initials: D
authors.lastname: Aujesky
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants
keywords: bleeding; elderly; falls; venous thromboembolism