Falls, anticoagulation, and the elderly: Are we inappropriately treating atrial fibrillation in this high-risk population?
Watson JN, Karamanos E, Silverman ME, Kandalaft N, Gupta AH, and Thomas C. Falls, anticoagulation, and the elderly: Are we inappropriately treating atrial fibrillation in this high-risk population? J Am Coll Surg 2017; 225(4):S53.
J Am Coll Surg
INTRODUCTION: There are approximately 2.3 million people with atrial fibrillation in the US. The incidence is rising as the elderly population expands. Anticoagulation is a critical decision because the incidence of stroke is increased 5-fold in patients with atrial fibrillation. From a geriatric trauma perspective, this creates a unique patient population, as 50% of people over the age of 80 years will fall at least once per year. A common concern for physicians dealing with geriatric trauma victims is whether anticoagulation is appropriate in this high fall-risk group. METHODS: We performed a retrospective, comprehensive chart review of all patients admitted to a level I trauma center with atrial fibrillation, who fell while taking anticoagulation from May 2013 to April 2016. The patients were captured by the hospital trauma database. The CHA2DS2-VASc and HAS-BLED scores were calculated for each patient. Statistical analysis of the demographics, comorbidities, and severity of injuries was completed. RESULTS: A total of 242 patients were identified. Fifty-eight percent of the patient population was female, and average age was 78 years old. The average CHA2DS2-VASc and HAS-BLED scores were 5.25 and 3.05, respectively. We identified a 1.6% incidence of CHA2DS2-VASc equal to 0 or 1. Overall mortality was 32% at the time of review. Of the patient population, 8.6% were deceased within 30 days of the fall. CONCLUSIONS: There is a very low incidence of inappropriate anticoagulation for atrial fibrillation. After a fall, the risk of morbidity and mortality is very high. The mortality rate is independent of age and comorbidities.