Outcomes of Older Adults on Anticoagulation Sustaining Ground-Level Falls: A Retrospective Analysis

Ground-level falls (GLFs) are a leading cause of morbidity and mortality in older adults, a population frequently prescribed anticoagulants. While effective for thromboembolic prevention, the association between anticoagulation and fall-related complications, including traumatic brain injury (TBI), remains mixed, with prior studies reporting inconsistent findings. This study utilized a large national database to evaluate whether preinjury anticoagulation is associated with worse outcomes following GLFs, hypothesizing increased mortality and severe TBI in anticoagulated versus nonanticoagulated older adults.

The 2017-2022 Trauma Quality Improvement Program database was queried for older adult trauma patients (OATPs) (≥65 y) presenting after GLFs. Patients were stratified by anticoagulant use. Bivariate analyses and multivariable logistic regression assessed associations with TBI severity and inhospital mortality.

Among 1,062,072 OATPs, 300,623 (28.3%) were on anticoagulation. Anticoagulated patients had higher rates of mild (21.1% versus 14.0%, P < 0.001), moderate (13.2% versus 11.9%, P < 0.001), and severe TBI (4.9% versus 2.8%, P < 0.001). They more frequently required the highest-level trauma activation (2.4% versus 1.5%, P < 0.001) and had higher complication (6.4% versus 4.5%, P < 0.001) and mortality rates (4.3% versus 2.5%, P < 0.001). Anticoagulation was independently associated with mortality (OR 1.34, CI 1.31-1.37, P < 0.001) and TBI severity, from mild (OR 1.64, CI 1.62-1.65, P < 0.001) to severe TBI (OR 1.80, CI 1.76-1.84, P < 0.001).

Preinjury anticoagulation in OATPs was independently associated with severe TBI and mortality. While anticoagulation remains important for thromboembolic prevention, these findings highlight substantial risk in a fall-prone aging population. Re-evaluation of geriatric anticoagulation guidelines to better balance thromboembolic protection with trauma-related risk appears warranted.