An increased risk of falling is often cited asa reason for not using anticoagulation in frailor elderly patients. A recent review of theevidence related to falls and major bleedingepisodes in anticoagulated patients foundthat, in the average patient taking warfarinfor atrial fibrillation (AF), the risk of intracranialhemorrhage from a fall is much smallerthan the risk of a stroke related to AF.
The largest study reviewed 2633 falls in1861 hospitalized patients. The rate ofmajor hemorrhage was 6.2% for patientson warfarin and 11.3% for control patients.As expected, bleeding was more commonin patients with an elevated internationalnormalized ratio. The authors concludedthat withholding anticoagulation shouldnot be made based solely on the patient'srisk of falling.
Dr. Garrett is a clinical pharmacist practitionerat Cornerstone Health Care in HighPoint, NC.