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Oral Anticoagulant Use and Post-Fall Mortality in Long-Term Care Home Residents.
Yin, Christina Y; Scott, Mary M; Kimura, Maren; Hakimjavadi, Ramtin; Girard, Céline I; Clarke, Anna; Sood, Manish M; Siegal, Deborah M; Tanuseputro, Peter; Fung, Celeste; Sobala, Monica; de Wit, Kerstin; Hsu, Amy T; Backman, Chantal; Kobewka, Daniel.
Afiliación
  • Yin CY; Bruyère Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Electronic address: cyin@ohri.ca.
  • Scott MM; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; The Public Health Agency of Canada, Ottawa, Ontario, Canada.
  • Kimura M; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
  • Hakimjavadi R; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
  • Girard CI; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES uOttawa, Ottawa, Ontario, Canada.
  • Clarke A; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES uOttawa, Ottawa, Ontario, Canada.
  • Sood MM; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
  • Siegal DM; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
  • Tanuseputro P; ICES uOttawa, Ottawa, Ontario, Canada; Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.
  • Fung C; St. Patrick's Home of Ottawa, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
  • Sobala M; St. Patrick's Home of Ottawa, Ottawa, Ontario, Canada.
  • de Wit K; Department of Emergency Medicine and Medicine, Queen's University, Kingston, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
  • Hsu AT; Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
  • Backman C; Bruyère Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
  • Kobewka D; Bruyère Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES uOttawa, Ottawa, Ontario, Canada.
J Am Med Dir Assoc ; 25(12): 105233, 2024 Aug 31.
Article en En | MEDLINE | ID: mdl-39222662
ABSTRACT

OBJECTIVES:

Long-term care (LTC) residents are susceptible to falling and the risk of subsequent morbidity and mortality may be compounded with concurrent anticoagulation use. Uncertainty exists around the benefit and harm of anticoagulation use for residents with a high risk for falls because of concerns of major bleeding complications. We aimed to examine if anticoagulant use increases mortality risk among LTC residents who fall.

DESIGN:

A retrospective cohort study. SETTING AND

PARTICIPANTS:

Older adults (≥65 years) admitted to a LTC facility in Ontario, Canada between January 1, 2010, and December 1, 2019, who were transferred to emergency departments for fall-related injuries.

METHODS:

The exposure was the use of an oral anticoagulant (OAC). The primary outcome was mortality within 30 days of transfer. Secondary outcomes were major hemorrhage and care utilization. We used hierarchical logistic regression models to examine the association between the use of OAC and 30-day mortality.

RESULTS:

There were 56,419 residents transferred to the hospital for a fall, of whom 9611 (17.0%) were on an OAC. At 30 days, 5794 (10.3%) of the cohort had died 12.0% (1151) on an OAC and 9.90% (4643) not on an OAC [risk difference (RD), 2.1%; 95% CI, 1.40%-2.82%]. There were 485 major hemorrhage cases 1.3% (125) on an OAC and 0.8% (360) not on an OAC (RD, 0.5%; 95% CI, 0.26%-0.74%). Multivariable analysis found no significant association between OAC use and 30-day mortality [odds ratio (OR), 0.98; 95% CI, 0.90-1.06], but an increased risk of major hemorrhage (OR, 1.31; 95% CI, 1.04-1.66). Both groups had similar health system and neurosurgical care utilization. CONCLUSIONS AND IMPLICATIONS Among LTC residents transferred to the emergency department for fall-related injuries, OACs did not increase the risk of post-fall mortality. OAC prescribing for frail older adults who experience falls should consider their individual risk profile.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Am Med Dir Assoc Asunto de la revista: HISTORIA DA MEDICINA / MEDICINA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Am Med Dir Assoc Asunto de la revista: HISTORIA DA MEDICINA / MEDICINA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos