Risk of major bleeding in recurrent fallers receiving anticoagulation for atrial fibrillation: a prospective cohort study.

Background
The risk of fall-related bleeding is a frequent reason for not following recommendations on anticoagulation in patients with atrial fibrillation (AF).Objectives
To assess whether patients on anticoagulation therapy with recurrent falls are at an increased risk of bleeding.Methods
We used data from the Swiss-AF multicenter cohort study, including patients aged ≥65 years with documented AF and oral anticoagulant treatment. Recurrent fallers were defined as those reporting > 1 fall/y. The primary outcome was first major bleeding as defined by the International Society on Thrombosis and Haemostasis. To account for death as a competing event, we used the Fine-Gray competing risk regression model to examine the association between a history of recurrent falls and time to a first major bleeding event. The results were expressed as subdistribution hazard ratios with 95% CIs.Results
We included 2154 patients (mean age, 73.4 years; 27.5% female), 180 (8.3%) of whom reported recurrent falls. During a median follow-up of 36 months, 368 (17.1%) patients died, and 218 (10.1%) had a first major bleeding event. Recurrent fallers were more likely to experience trauma-related bleeding episodes than nonfallers (16.7% vs 9.2%). The adjusted subdistribution hazard ratio for major bleeding in recurrent fallers was 1.16 (95% CI, 0.74-1.82). In subgroup analyses of patients receiving direct oral anticoagulants or vitamin K antagonists, the risk of major bleeding was not increased for recurrent fallers.Conclusion
We found no association between recurrent falls and risk of major bleeding in AF patients receiving direct oral anticoagulants or vitamin K antagonists.