Authors: Dadkhah Shahriar, Faramarzi Negar, Sohal Sumit, Al-Azzam Baha’a, Tsourkas Philippos, Pilla Sree Vidya.
Background: Aging is associated with increased prevalence of multiple pathologies including atrial fibrillation (AF), thrombophlebitis and predisposition to fall. Anticoagulation can decrease the burden of thrombophlebitis disorders and thromboembolic events. However, due to concerns associated with bleeding risk, possible fall related injuries, and the lack of reversing agents for Direct oral anticoagulants (DOACs), elderly patients have been undertreated with anticoagulation.
Methods: We performed a systematic search of electronic medical records of two teaching hospitals and selected elderly patients (≥ 65 years old) who presented to the emergency departments with the complaint of fall and had been treated with DOACs or warfarin prior to admission.
Results: 322 patients met inclusion criteria for the study (warfarin = 204 and DOACs = 118). Major bleeding, intracranial bleeding, ICU admission, bleeding related death/hospice and length of stay at the hospital was 21.5%, 4.9%, 16.7%, 2.5% and 4.7 ± 3.1 days in the warfarin group and 17.8%, 4.2%, 11%, 0% and 4.3 ± 3.9 days in the DOACs group, respectively (p-value = 0.46, 1, 0.19, 0.16 and 0.53). The length of stay in ICU was 2.5 ± 2.3 days in the warfarin group vs 1.7 ± 0.6 days in the DOACs group (p-value = 0.7). Anticoagulation was continued in 87.6% of patients upon discharge. Warfarin use, INR more than 3, major bleeding, intracranial bleeding and ICU admission were associated with stopping anticoagulation upon discharge from the hospital.
Conclusion: There were no statistically significant differences in health outcome between patients on warfarin and DOACs.
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