An increased risk of falling is often cited as a reason for not using anticoagulation in frail or elderly patients. A recent review of the evidence related to falls and major bleeding episodes in anticoagulated patients found that, in the average patient taking warfarin for atrial fibrillation (AF), the risk of intracranial hemorrhage from a fall is much smaller than the risk of a stroke related to AF.

The largest study reviewed 2633 falls in 1861 hospitalized patients. The rate of major hemorrhage was 6.2% for patients on warfarin and 11.3% for control patients. As expected, bleeding was more common in patients with an elevated international normalized ratio. The authors concluded that withholding anticoagulation should not be made based solely on the patient's risk of falling.

Dr. Garrett is a clinical pharmacist practitioner at Cornerstone Health Care in High Point, NC.