A significant number of elderly patients are prescribed blood thinners to offset the risk for blood clots. Blood-thinning medications serve a definite purpose among some seniors. But, in combination with a high risk for falls, the symptom of severe bleeding that may accompany blood-thinning medications is cause for concern.
In this article, we’ll review the risk factors relating to blood thinners and falls in the elderly. Seniors, caregivers and loved ones need to be conscientious in the aging treatment plan to ensure optimal health in later life. Awareness of medications like blood thinners and their risks is an essential component of this process.
What are blood thinners?
Blood thinners are also called anticoagulants. This type of medication is often prescribed to the elderly to prevent the formation of blood clots, which is also called thrombosis. Seniors with atrial fibrillation, among other conditions, are at higher risk for blood clots and will likely be prescribed this form of medicine.
Blood thinners may also refer to anti-platelet medications, such as aspirin and clopidogrel. These medications counteract overactive platelets, which may cause blood clots.
Falls and the elderly
Falls are a serious risk among the elderly population. In fact, falls are the main reason for fatal and non-fatal injuries among seniors in the United States. Serious falls can lead to injury, disability and even death in severe cases. The risk for falls among older adults may prevent them from living independently into their later years.
Generally, the risk of falls rises with age, along with the physical and cognitive decline that naturally occurs with aging. Falls can range in seriousness, from a minor bump to an injury that requires hospitalization. As such, the severity of a fall in an elderly adult relies on a number of factors. If an object is in the way of the fall, the senior may hit it with force. It’s often in these instances that concern over bleeding is high.
The connection between blood thinners, falls and bleeding
Blood thinners can prolong the amount of time that a person bleeds for, as well as increase the volume of blood loss. Bleeding has implications for multiple body systems and can impact breathing, pulse and blood pressure. These facts underline the concern over serious health complications for seniors at risk of both falls and blood clots who are taking blood thinners.
Blood thinners have been linked to an increased risk of bleeding among patients who experience a fall. However, considering the results of a study measuring the risk for intracranial hemorrhage in relation to the risk for falls in elderly patients, the connection between blood thinners, hemorrhage, and falls isn’t remarkable. The patients with nonvalvular atrial fibrillation had approximately the same chance for intracranial hemorrhage as those taking aspirin or warfarin. In fact, the risk was even the same for elderly patients not being treated with antithrombotic therapy.
Further supporting this idea, a study from the Association for the Publication of the Journal of Internal Medicine analyzed elderly patients with acute venous thromboembolism to measure their risk for falls in relation to their risk for bleeding. The results revealed that a large risk of falls in these senior patients is connected to non-major bleeding. However, their risk of falls was not linked to major bleeding. This study concluded that the choice to not administer anticoagulants to senior patients because of fall risk should be based upon patient priorities and their risk for repeated acute venous thromboembolism.
The benefits of blood thinners vs. the risk for bleeding
Patients with a high risk for stroke, namely those with atrial fibrillation and related conditions, are often prescribed blood thinners. These medications prevent thrombosis or the formation of blood clots. Blood clots can form in the heart and may travel to the brain, at which the chance for stroke is significant. When blood clots disrupt blood flow to the heart, a heart attack may occur.
The generally accepted idea among modern medical professionals is that the benefits that blood thinners provide to elderly patients outweighs the risk for bleeding. That being said, the risk for falls must be considered in relation to this point, given that a fall could initiate bleeding. A few key factors that should be considered in the decision of whether or not to take blood thinners are:
- The degree of day-to-day care received by the patient (do they have a live-in caregiver or live in a residential facility?)
- The senior’s medical history
- The senior’s risk and history of falls
Concern over anticoagulant-related bleeding among seniors in their nineties is widespread in geriatrics. But, information from the thrombosis service professionals at the University Medical Center Groningen further underlines the point that anticoagulant benefits eclipse bleeding risks for elderly patients taking these medications. The thrombosis service at the center tracks the conditions of senior patients taking vitamin K antagonist, which is one of many commonly prescribed blood thinners. According to their observations, there’s no gap between the risk for bleeding in patients in their seventies and patients in their eighties. Patients in their nineties have a somewhat higher risk, but the rise isn’t as momentous as previous assumptions suggested. The center’s data also shows that the risk for thrombosis in these patients is far larger than the chance for bleeding.
The risk for bleeding among seniors taking blood thinners is significant. But, this risk is as it relates to the chance of falls for elderly patients generally doesn’t merit an end to blood thinner administration. The benefits that blood thinners provide to seniors at risk for a blood clot and stroke typically exceed the danger of bleeding after a fall.
That being said, every patient is different. The decision of whether or not to take blood thinners for seniors at risk for falls is individual. Depending on the patient’s main concerns and treatment preferences, medications may be adjusted.
More from Seasons.com:
“Blood Thinners Safe for People in Their Nineties.” UMCG, University Medical Center Groningen, 6 July 2016, www.umcg.nl/EN/corporate/News/Paginas/blood-thinners-safe.aspx.
“Blood Thinners: Risk Factors Associated with Falling and What to Do When You Fall.” Hospital Improvement Innovation Network, American Hospital Association, 8 Jan. 2016, www.hret-hiin.org/resources/display/blood-thinners-risk-factors-associated-with-falling-and-what-to-do-when-you-fall.
“Blood Thinners: Risk Factors Associated with Falling and What to Do When You Fall.” Minnesota Hospital Association, Minnesota Hospital Association, www.mnhospitals.org/Portals/0/Documents/ptsafety/falls/blood-thinners-education.pdf.
Coleman, Julia, et al. “The Effect Anticoagulation Status on Geriatric Fall Trauma Patients.” American Journal of Surgery, U.S. National Library of Medicine, Dec. 2016, www.ncbi.nlm.nih.gov/pubmed/27889266.
“Fall Prevention Facts.” NCOA, National Council on Aging, www.ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts/.
Kampfen, P, et al. “Risk of Falls and Bleeding in Elderly Patients with Acute Venous Thromboembolism.” Journal of Internal Medicine, U.S. National Library of Medicine, Oct. 2014, www.ncbi.nlm.nih.gov/pubmed/24645727.
Quinn, Gene R., et al. “Fall Risk and Anticoagulation for Atrial Fibrillation in the Elderly: A Delicate Balance.” Cleveland Clinic Journal of Medicine, Cleveland Clinic Journal of Medicine, 30 Aug. 2017, www.mdedge.com/ccjm/article/121320/cardiology/fall-risk-and-anticoagulation-atrial-fibrillation-elderly-delicate/page/0/1.