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Antithrombotics in the Fall Patient: Appropriateness and Risk-Benefit Analysis
A J Bethurum1, Kevin Zeng1, Thaddeus Puzdrakiewicz1
1Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA.
The American Surgeon
|March 27, 2024
Summary
Falls are a major cause of hospitalization in older adults. This study found that antithrombotic therapy risks may outweigh benefits in many fall patients, highlighting the need for careful medication review.
Area of Science:
- Geriatrics
- Trauma Surgery
- Cardiology
Background:
- Falls are the leading cause of trauma-related hospitalizations in the US, with over 3 million admissions in 2020.
- Elderly patients, a common demographic for falls, are frequently prescribed antithrombotic (AT) therapy.
Purpose of the Study:
- To analyze fall history in patients presenting after a ground-level fall (GLF).
- To assess the appropriateness of antithrombotic therapy regimens relative to individual fall risk.
Main Methods:
- Prospective study enrolling patients following a ground-level fall.
- Primary outcome: correlation between AT therapy necessity (CHA 2 DS 2 -VASc score) and fall risk (Morse Fall Risk score).
Main Results:
- The cohort comprised 30 patients with an average age of 77.
- A moderate positive correlation (r = 0.47; P = 0.012) was observed between CHA 2 DS 2 -VASc and Morse Fall Risk scores.
- Notably, 17% of high fall risk patients had a <5% 1-year risk of venous thromboembolism (VTE).
Conclusions:
- The risk of hemorrhage may exceed the benefits of thromboembolism prophylaxis in a significant number of patients presenting after a fall.
- The study underscores the substantial volume of falls in the elderly population and the critical need for reassessing AT therapy in this context.
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