Recurrent Falls Among Elderly Patients and the Impact of Anticoagulation Therapy

Chiu, Alexander S.; Jean, Raymond; Fleming, Matthew R; Pei, Kevin Y.

doi:10.1007/s00268-018-4728-1

Cited by 24 publications

(26 citation statements)

References 30 publications

(25 reference statements)

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“…In our patient, appropriate anticoagulation might have prevented the event of CCI. Risk-benefit profile of oral anticoagulation for patients with tendency to fall should be elucidated further [15].…”

Section: Discussionmentioning

confidence: 99%

Simultaneous cardio-cerebral embolization associated with atrial fibrillation: a case report

et al. 2019

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Background Simultaneous cerebral and myocardial infarction is called cardiocerebral infarction (CCI), and is rarely encountered. Because of the narrow time window and complex pathophysiology, CCI is challenging to immediately diagnose and treat. Case presentation A 73-year-old woman suddenly developed right hemiplegia and severe aphasia. Twelve-lead electrocardiography showed tachycardic atrial fibrillation without any significant ST-T change. Magnetic resonance imaging revealed a proximal middle cerebral artery occlusion. She was immediately treated with alteplase at the dosage approved for ischemic stroke followed by mechanical thrombectomy as bridging therapy, and complete recanalization was achieved. Aphasia improved and she began to complain of chest pain, and reported that she had experienced chest discomfort just prior to right limb weakness. Coronary angiography showed a partial filling defect in the right coronary artery with rapid and adequate distal flow, for which percutaneous coronary intervention was not required. Alteplase was suggested to have effectively resolved the coronary emboli. The occlusions of the cerebral and coronary arteries were assumed to have occurred nearly simultaneously and cardiogenic embolism due to atrial fibrillation was considered as the most likely etiology. Conclusions As seen in the present case, CCI may benefit from immediate treatment with intravenous tissue plasminogen activator (IV-tPA). Although which of percutaneous coronary intervention or cerebral thrombectomy should be performed first remains unclear, we must decide whether to rescue the brain or heart first in each patient within a limited window of time. This dilemma has recently become evident in this era with mechanical thrombectomy strongly established as an effective intervention for acute ischemic stroke. Close cooperation between stroke physicians and cardiologists is becoming more important.

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Section: Discussionmentioning

confidence: 99%

Simultaneous cardio-cerebral embolization associated with atrial fibrillation: a case report

et al. 2019

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“…Fall risk is a common reason clinicians withhold anticoagulation, [23][24][25] but there is little evidence that it should preclude treatment. 12 25 While approximately 5% of fall cases were readmitted for the same reason within 6 months, anticoagulation treatment was not associated with likelihood of a second fall or hemorrhage related to the fall in a nationally representative readmission registry 26 as well as a Medicare database. 27 However, anticoagulation was associated with disproportionate mortality in those who bled from secondary fall events (21.5% vs 6.9%).…”

Section: Risk Of Recurrent Icrhmentioning

confidence: 98%

“…27 However, anticoagulation was associated with disproportionate mortality in those who bled from secondary fall events (21.5% vs 6.9%). 26 Secondary analysis of the ARISTOTLE trial (n=16 491) of apixaban and warfarin revealed that prior history of falls resulted in elevated risk of major hemorrhage, including ICrH, and death (adjusted HR (aHR) (95% CI)=1.39 (1.05 to 1.84), 1.87 (1.02 to 3.43), 1.70 (1.36 to 2.14), respectively) in anticoagulated subjects. 28 Fall risk assessed during the ENGAGE-AF-TIMI48 trial of edoxaban and warfarin was associated with major bleeding, life-threatening bleeding and allcause mortality (aHR (95% CI)=1.30 (1.04 to 1.64), 1.67 (1.11 to 2.50), 1.45 (1.23 to 1.70), respectively).…”

Section: Risk Of Recurrent Icrhmentioning

confidence: 99%

Restarting and timing of oral anticoagulation after traumatic intracranial hemorrhage: a review and summary of ongoing and planned prospective randomized clinical trials

King

Milling²,

Gajewski

et al. 2020

Trauma Surg Acute Care Open

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Anticoagulant-associated traumatic intracranial hemorrhage (tICrH) is a devastating injury with high morbidity and mortality. For survivors, treating clinicians face the dilemma of restarting oral anticoagulation with scarce evidence to guide them. Thromboembolic risk is high from the bleeding event, patients’ high baseline risks, that is, the pre-existing indication for anticoagulation, and the risk of immobility after the bleeding episode. This must be balanced with potentially devastating hematoma expansion or new hemorrhagic lesions. Retrospective evidence and expert opinion support restarting oral anticoagulants in most patients with tICrH, but timing is uncertain. Researchers have failed to make clear distinctions between tICrH and spontaneous intracranial hemorrhage (sICrH), which have differing natural histories. While both appear to benefit from restarting, sICrH has a higher rebleeding risk and similar or lower thrombotic risk. Clinical equipoise on restarting is also divergent. In sICrH, equipoise is centered on whether to restart. In tICrH, it is centered on when. Several prospective randomized clinical trials are ongoing or about to start to examine the risk–benefit of restarting. Most of them are restricted to patients with sICrH, with antiplatelet control groups. Most are also restricted to direct oral anticoagulants (DOACs), as they are associated with a lower overall risk of ICrH. There is some overlap with tICrH via subdural hematoma, and one trial is specific to restart timing with DOACs in only traumatic cases. This is a narrative review of the current evidence for restarting anticoagulation and restart timing after tICrH along with a summary of the ongoing and planned clinical trials.

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“…A anticoagulants did not have a significantly increased risk of major bleeding as compared to low fall risk patients, suggesting that a heightened fall risk alone should not discourage usage of oral anticoagulants in patients with AF [44]. Others have similarly concluded that anticoagulant usage does not increase the risk of significant bleeding injury [45,46], but may increase mortality due to a bleeding injury [45]. Another study concluded that older direct anticoagulant users with traumatic head injury following low-level falls did not have increased morbidity or mortality as compared with warfarin or non-anticoagulant users [47].…”

Section: Atrial Fibrillation Therapymentioning

confidence: 98%

Link between cardiovascular disease and the risk of falling: A comprehensive review of the evidence

Mikoś

Winnicki

Henry

et al. 2021

Polish Archives of Internal Medicine

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This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA 4.0), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited, distributed under the same license, and used for noncommercial purposes only.

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Recurrent Falls Among Elderly Patients and the Impact of Anticoagulation Therapy

Cited by 24 publications

References 30 publications

Simultaneous cardio-cerebral embolization associated with atrial fibrillation: a case report

Simultaneous cardio-cerebral embolization associated with atrial fibrillation: a case report

Restarting and timing of oral anticoagulation after traumatic intracranial hemorrhage: a review and summary of ongoing and planned prospective randomized clinical trials

Link between cardiovascular disease and the risk of falling: A comprehensive review of the evidence

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