The Use of Oral Anticoagulation Is Not Independently Associated with Mortality in Frail Older Patients with Repeated Falls.

Autor: Zwart LAR; Department of Geriatric Medicine, Northwest Clinics, 1815 JD Alkmaar, The Netherlands.; Department of Geriatric Medicine, Dijklander Hospital, 1624 NP Hoorn, The Netherlands., Walgers JJ; Department of Geriatric Medicine, Northwest Clinics, 1815 JD Alkmaar, The Netherlands., Hemels MEW; Department of Cardiology, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands.; Department of Cardiology, Radboud UMC, 6525 GA Nijmegen, The Netherlands., Germans T; Department of Cardiology, Northwest Clinics, 1815 JD Alkmaar, The Netherlands., de Groot JR; Department of Cardiology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands., Jansen RWMM; Department of Geriatric Medicine, Northwest Clinics, 1815 JD Alkmaar, The Netherlands.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2023 Nov 29; Vol. 12 (23). Date of Electronic Publication: 2023 Nov 29.
DOI: 10.3390/jcm12237388
Abstrakt: Background: Particularly in frail patients, anticoagulation may be underused because of the fear of bleeding.
Objective: To determine whether the use of antithrombotic medication is an independent risk factor for mortality in frail elderly with repeated falls.
Methods: All patients aged 65 years or older at the Fall and Syncope Clinic were eligible. Frailty was calculated with a Frailty Index (FI) based on the accumulation of deficits model. Risks were calculated with a cox regression analysis, adjusted for age, sex, and Frailty Index.
Results: 663 patients were included in this analysis. The median age was 80 years, 438 were women (66%), 73% had polypharmacy, and 380 patients (57%) had cognitive impairment. The mean FI was 0.23 (sd 0.09), 182 patients were moderately frail (27.5%), and 259 (39.1%) were severely frail. A total of 140 (21%) used oral anticoagulation and 223 (34%) used antiplatelet agents. A total of 196 patients (29.6%) died during follow-up. In the adjusted cox regression model, the use of neither antiplatelets nor anticoagulation was associated with mortality. A strong association was found with frailty (HR 74.0, 95% CI 13.1-417.3) and a weak association with age (HR 1.05, 95% CI 1.03-1.08). A lower risk of mortality was seen in women (HR 0.5, 95% CI 0.3-0.6).
Conclusions: In this cohort of frail older patients, there was no independent association between the use of antithrombotic medication and mortality. A strong association with mortality was found with frailty, a weak association was found with age, and a lower mortality risk was found in women. Our data indicate that the fear of bleeding or increased mortality in frail patients with an indication for oral anticoagulation may be unjustified.
Databáze: MEDLINE
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