Warfarin Use Not Linked To Higher Brain Bleed Risk After Falls In Older Adults

There are astir 70 cardinal babe boomers successful nan United States, galore now complete property 65. As group age, rates of cardiovascular and cerebrovascular diseases rise, starring to much usage of humor thinners specified arsenic warfarin. At nan aforesaid time, older adults look a higher consequence of caput injuries and encephalon bleeding, particularly aft falls.

Falls are nan starring origin of wounded and decease successful older adults, causing 38,000 deaths and 3 cardinal emergency section visits successful 2021. The wellness attraction costs for non-fatal falls successful this group reached $80 cardinal successful 2020, up sharply from 2015.

While anticoagulants protect against bosom and alloy problems, they summation nan consequence of superior bleeding, particularly, encephalon hemorrhages aft caput trauma. It is wide believed that supratherapeutic warfarin activity increases nan chance of encephalon hemorrhage aft trauma. Current guidelines telephone for other monitoring and repetition encephalon scans for patients connected warfarin aft caput injuries.

Warfarin is considered particularly challenging because maintaining safe blood-thinning levels – measured by nan International Normalized Ratio (INR) – tin beryllium difficult. When INR is excessively high, bleeding consequence rises significantly. Although galore studies nexus precocious INR pinch accrued bleeding risk, astir person been mini aliases limited.

To reside a captious spread successful emergency care, researchers astatine Florida Atlantic University's Charles E. Schmidt College of Medicine conducted a caller study to find whether very precocious INR levels summation nan consequence of encephalon bleeding pursuing a fall-related caput wounded successful adults aged 65 and older who return warfarin. Conducted complete 1 twelvemonth astatine 2 Level I trauma centers successful South Florida, nan study examined 2,686 patients admitted to nan emergency section owed to a fall. Researchers compared outcomes betwixt patients who were connected warfarin earlier their wounded and those who were not taking immoderate humor thinners.

Results of nan study, published successful nan American Journal of Emergency Medicine, recovered that being connected warfarin, moreover astatine higher blood-thinning levels, did not importantly summation nan consequence of encephalon bleeding aft blunt caput trauma. In fact, patients pinch poorly controlled, debased warfarin activity had nan highest bleeding risk. This challenges communal assumptions and underscores nan value of due anticoagulation guidance alternatively than avoiding anticoagulants altogether.

Overall, astir 11% of nan patients studied knowledgeable encephalon bleeding aft caput trauma. Among those not connected humor thinners, astir 6% had encephalon bleeds, compared to astir 7% of patients connected warfarin. Bleeding rates were akin betwixt patients pinch INR levels supra and beneath 3.0.

Notably, patients pinch lower-than-recommended INR levels had nan highest rates of encephalon bleeding – astir 20%. Those wrong aliases somewhat supra nan therapeutic scope had little rates, and nary encephalon bleeds occurred successful patients pinch critically precocious INR levels (above 5).

Data from our study propose supratherapeutic INR levels whitethorn not summation intracranial hemorrhage consequence arsenic overmuch arsenic we antecedently believed. This raises important questions astir existent emergency attraction protocols and really we show these patients. It's captious to re-examine our attack to managing anticoagulation successful older adults aft caput trauma to supply nan safest, astir effective attraction without unnecessary tests aliases infirmary stays. It's our dream that findings from our investigation will thief amended diligent outcomes while reducing wellness attraction costs."

Richard Shih, M.D., elder writer and professor of emergency medicine, FAU Schmidt College of Medicine

Researchers reviewed each patient's aesculapian history, beingness exam findings, humor tests and CT scans, and followed up pinch telephone calls and floor plan reviews 2 weeks aft nan wounded to place immoderate delayed encephalon bleeding. The superior extremity was to find whether bleeding occurred wrong 14 days, confirmed by CT scans during nan infirmary stay. The study besides looked astatine nan type and severity of encephalon bleeds, diligent outcomes, magnitude of hospitalization, and endurance rates.

"With clearer grounds connected really blood-thinning levels effect outcomes, wellness attraction providers tin create much precise guidelines for follow-up attraction and monitoring – optimizing resources and improving diligent management," said Lisa Clayton, D.O., co-author and subordinate dean for postgraduate aesculapian acquisition and chair, FAU Department of Emergency Medicine. "In South Florida, wherever our older organization is quickly growing, this investigation is particularly valuable. It could thief emergency teams to make smarter, much balanced decisions that protect patients from superior complications without unnecessary interventions, advancing patient-centered attraction successful a region facing this captious nationalist wellness challenge."

Study co-authors are Chelsea Caplan, first writer and a aesculapian student astatine nan University of Miami Miller School of Medicine; Gabriella Engstrom, Ph.D., investigation adjunct professor of emergency medicine; Mike Wells, Ph.D., investigation adjunct professor of emergency medicine; Scott M. Alter, M.D., adjunct dean for objective investigation and subordinate professor of emergency medicine; and Joshua J. Solano, M.D., an subordinate professor of emergency medicine; each wrong nan FAU Schmidt College of Medicine; Eric Bruno, M.D., University of Tennessee Health Science Center; and Timothy P. Buckley, M.D., an adjunct professor of emergency medicine and value betterment director, FAU Schmidt College of Medicine.

The investigation was supported by The Florida Medical Malpractice Joint Underwriting Association Grant for Safety of Health Care Services Grant RFA #2018-01, "Geriatric Head Trauma Short Term Outcomes Project (The GREAT STOP)."