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Falls in ED patients: do elderly patients on direct oral anticoagulants bleed less than those on vitamin K antagonists?
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 c...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022425/ https://www.ncbi.nlm.nih.gov/pubmed/33823884 http://dx.doi.org/10.1186/s13049-021-00866-6 |
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author | Müller, Martin Chanias, Ioannis Nagler, Michael Exadaktylos, Aristomenis K. Sauter, Thomas C. |
author_facet | Müller, Martin Chanias, Ioannis Nagler, Michael Exadaktylos, Aristomenis K. Sauter, Thomas C. |
author_sort | Müller, Martin |
collection | PubMed |
description | 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13049-021-00866-6. |
format | Online Article Text |
id | pubmed-8022425 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-80224252021-04-07 Falls in ED patients: do elderly patients on direct oral anticoagulants bleed less than those on vitamin K antagonists? Müller, Martin Chanias, Ioannis Nagler, Michael Exadaktylos, Aristomenis K. Sauter, Thomas C. Scand J Trauma Resusc Emerg Med Original Research 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13049-021-00866-6. BioMed Central 2021-04-06 /pmc/articles/PMC8022425/ /pubmed/33823884 http://dx.doi.org/10.1186/s13049-021-00866-6 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Original Research Müller, Martin Chanias, Ioannis Nagler, Michael Exadaktylos, Aristomenis K. Sauter, Thomas C. Falls in ED patients: do elderly patients on direct oral anticoagulants bleed less than those on vitamin K antagonists? |
title | Falls in ED patients: do elderly patients on direct oral anticoagulants bleed less than those on vitamin K antagonists? |
title_full | Falls in ED patients: do elderly patients on direct oral anticoagulants bleed less than those on vitamin K antagonists? |
title_fullStr | Falls in ED patients: do elderly patients on direct oral anticoagulants bleed less than those on vitamin K antagonists? |
title_full_unstemmed | Falls in ED patients: do elderly patients on direct oral anticoagulants bleed less than those on vitamin K antagonists? |
title_short | Falls in ED patients: do elderly patients on direct oral anticoagulants bleed less than those on vitamin K antagonists? |
title_sort | falls in ed patients: do elderly patients on direct oral anticoagulants bleed less than those on vitamin k antagonists? |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022425/ https://www.ncbi.nlm.nih.gov/pubmed/33823884 http://dx.doi.org/10.1186/s13049-021-00866-6 |
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