Bridging the gap: Addressing anticoagulation underutilization in elderly atrial fibrillation patients post-fall

Abstract

Introduction and objectives

The choice to start or stop anticoagulation therapy in elderly patients post-fall is a major clinical challenge because falls increase the risk of bleeding. However, anticoagulation is essential in patients with atrial fibrillation (AF) to prevent thromboembolic events, and concerns about bleeding and bias may result in the prescription of anticoagulants. This study, conducted from September 2019 to October 2023, examined patients aged > 50 years with AF who fell in-hospital, with the aim of identifying influencing anticoagulant prescriptions.

Methods

All the patients included in the study experienced falls during hospitalization. It is important to note that these falls were not a reason for admission.

Results

Out of the 327 patients in the study, 210 (64.2%) were discharged on anticoagulation therapy, and 79.5% received non-vitamin K antagonist oral anticoagulants. Significant associations were found between cardiology consultations and male participants (P < .001), those aged 65–74 (P < .001), and those with health insurance (P = .001). Patients aged 65–74 years (P < .001), rural residence (P = .03), independent ambulation (P < .001), and health insurance (P < .001) were significantly associated with anticoagulation discharge.

Conclusions

Contrary to expectations, the decision to initiate oral anticoagulation in hospitalized patients with AF and a history of accidental falls was not primarily based on risk scales such as CHA₂DS₂-VASc but rather on other clinical, social, and medical coverage conditions. This underscores the need for a more nuanced understanding of the factors influencing anticoagulation decisions in this vulnerable population.