%0 Journal Article
%T Clinical outcomes and history of fall in patients with atrial fibrillation treated with oral anticoagulation: insights from the ARISTOTLE Trial
%J American journal of medicine
%D 2018
%A Rao, Meena P.
%A Vinereanu, Dragos
%A Wojdyla, Daniel M.
%A Alexander, John H.
%A Atar, Dan
%A Hylek, Elaine M.
%A Hanna, Michael
%A Wallentin, Lars
%A Lopes, Renato D.
%A Gersh, Bernard J.
%A Granger, Christopher B.
%V 131
%N 3
%P 269-275.e2
%X PURPOSE: We assessed outcomes among anticoagulated patients with atrial fibrillation (AF) and a history of falling, and whether the benefits of apixaban versus warfarin are consistent in this population. <br><br>METHODS: Of the 18,201 patients in ARISTOTLE, 16,491 had information about history of falling - 753 with history of falling and 15,738 without history of falling. The primary efficacy outcome was stroke or systemic embolism; the primary safety outcome was major bleeding. <br><br>RESULTS: When compared with patients without a history of falling, patients with a history of falling were older, more likely to be female and have dementia, cerebrovascular disease, depression, diabetes, heart failure, osteoporosis, fractures, and higher CHA2DS2-VASc and HAS-BLED scores. Patients with a history of falling had higher rates of major bleeding (adjusted HR 1.39; 95% CI 1.05-1.84; p=0.020), including intracranial bleeding (adjusted HR 1.87, 95% CI 1.02-3.43; p=0.044), and death (adjusted HR 1.70; 95% CI 1.36-2.14; p<0.0001), but similar rates of stroke or systemic embolism and hemorrhagic stroke. There was no evidence of a differential effect of apixaban compared with warfarin on any outcome, regardless of history of falling. Among those with a history of falling, subdural bleeding occurred in 5 of 367 patients treated with warfarin and 0 of 386 treated with apixaban. <br><br>CONCLUSIONS: Patients with AF and a history of falling receiving anticoagulation have a higher risk of major bleeding, including intracranial, and death. The efficacy and safety of apixaban compared with warfarin were consistent, irrespective of history of falling.<br><br>Copyright © 2017. Published by Elsevier Inc.<p /> <p>Language: en</p>
%G en
%I Elsevier Publishing
%@ 0002-9343
%U http://dx.doi.org/10.1016/j.amjmed.2017.10.036