What question did this study set out to answer?

To determine whether increasing age is associated with an increased risk and severity of bleeding complications during warfarin treatment.

June 1, 1996Annals of Internal Medicine

The Risk for and Severity of Bleeding Complications in Elderly Patients Treated with Warfarin

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Why the study?

Does increasing age increase the risk of bleeding complications in patients treated with warfarin?

Population

2376 patients receiving warfarin for various indications at 6 anticoagulation clinics

Comparison

Warfarin treatment in older age groups vs Warfarin treatment in younger age groups

Design

Cohort

Follow-up

3702 patient-years (total)

Authors

SFStephan D. FihnGeneral Cardiology

Discussion

Member takes

Implication

Supports warfarin across ages except ≥80 years; leaves open whether closer monitoring mitigates life-threatening bleeding.

Key Points

To determine whether increasing age is associated with an increased risk and severity of bleeding complications during warfarin treatment.
Combined retrospective and prospective cohort study of N=2,376 patients receiving warfarin across 6 anticoagulation clinics over 3,702 patient-years.
Categorized bleeding events as minor, serious, life-threatening, or fatal, and assessed risk using Cox and Poisson regression adjusted for anticoagulation intensity and prothrombin time ratio deviation.
Unadjusted minor bleeding ranged from 16.3 to 24.0 per 100 patient-years and serious bleeding from 4.4 to 9.3 per 100 patient-years, with neither varying significantly by age group.
Unadjusted life-threatening or fatal bleeding was elevated in patients aged ≥80 years (3.38 per 100 patient-years vs 0.75 for <50 years; unadjusted RR 4.5, 95% CI, 1.3 to 15.6; adjusted RR 4.6, 95% CI, 1.2 to 18.1).
Overall bleeding was not associated with age after adjustment for anticoagulation intensity and prothrombin time ratio deviation (RR 0.99 to 1.03 per year of age; lower-bound 95% CI, 0.97 to 1.01; upper-bound 95% CI, 1.00 to 1.09).

Structured PICO

Does increasing age increase the risk of bleeding complications in patients treated with warfarin?

Population

2376 patients receiving warfarin for various indications at 6 anticoagulation clinics

Intervention

Warfarin treatment in older age groups (specifically 80 years of age and older)

Comparator

Warfarin treatment in younger age groups (specifically younger than 50 years of age)

Outcome

Bleeding events categorized as minor, serious, life-threatening, or fatalsafety

Age is generally not an independent predictor of bleeding risk in patients on warfarin, except for a significantly increased risk of life-threatening and fatal bleeding in those aged 80 years or older.

Cite This Study

Stephan D. Fihn (1996) studied this question.

synapsesocial.com/papers/6a7c92e30dd979f2a48ce0d0 https://doi.org/10.7326/0003-4819-124-11-199606010-00004

Topics

Anticoagulation in AF

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The Risk for and Severity of Bleeding Complications in Elderly Patients Treated with Warfarin

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

The Risk for and Severity of Bleeding Complications in Elderly Patients Treated with Warfarin

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider