Indiana University School of Medicine, Department of Surgery, 720 Eskenazi Ave., EZ 2-431 SURG, Indianapolis, IN 46202, USA.
Indiana University School of Medicine, Department of Surgery, 720 Eskenazi Ave., EZ 2-431 SURG, Indianapolis, IN 46202, USA.
Am J Emerg Med. 2022 Jan;51:119-123. doi: 10.1016/j.ajem.2021.10.008. Epub 2021 Oct 9.
Falls are the leading cause of morbidity and mortality in the elderly. Non-valvular Atrial fibrillation (AF) is present in up to 9% of this group and often requires oral anticoagulation (OAC). The CHADS-VASc and HAS-BLED scores are validated tools assessing risk of ischemic stroke from AF and major bleeding (MB) from OAC. It is unclear if these predictions remain accurate in post-fall patients. This study seeks to determine the stroke and major bleeding rate in atrial fibrillation patients after a ground level fall and identify if validated risk scoring systems accurately stratify risk in this cohort.
Retrospective review of patients with AF presented to the emergency department after a fall. CHADS-VASc and HAS-BLED scores were calculated. Follow up information was reviewed to 1 year. Patients were grouped according to discharge thromboprophylaxis plan (DTP): no treatment, Anti-platelet (AP), OAC, and AP + OAC. Outcomes were ischemic stroke, MB, or death at 1 year. Ischemic stroke and MB rates were calculated. Kruskal-Wallis, Χ, Fisher's exact, and multivariable logistic regression were used to evaluate for clinical associations.
192 patients were included. MB rate was 14.5 bleeds/100 person-years, and ischemic stroke rate was 10.9/100 person-years. There were no observed differences between DTPs. Overall, one-year mortality was 22.1%. On unadjusted analysis, CHADS-VASc did associate with ischemic stroke (p = 0.03); HAS-BLED did not associate with MB (p = 0.17). After logistic regression accounting for known risk factors, neither system associated with ischemic stroke or MB.
Fall patients are at higher risk for both ischemic stroke and MB compared to previously published reports. Current risk assessment tools should be used with caution. Further study of risk factors is warranted to guide medication decisions in these patients.
跌倒 是老年人发病率和死亡率的主要原因。该人群中有高达 9%的人患有非瓣膜性心房颤动（AF），且常需要口服抗凝剂（OAC）治疗。CHA2DS2-VASc 和 HAS-BLED 评分是评估 AF 所致缺血性脑卒中风险和 OAC 相关大出血（MB）风险的有效工具。目前尚不清楚这些预测在跌倒后患者中是否仍然准确。本研究旨在确定地面水平跌倒后心房颤动患者的脑卒中发生率和大出血发生率，并确定经验证的风险评分系统是否能准确分层该队列的风险。
回顾性分析因跌倒而就诊于急诊科的 AF 患者。计算 CHA2DS2-VASc 和 HAS-BLED 评分。回顾随访信息至 1 年。根据出院时的血栓预防计划（DTP）将患者分组：无治疗、抗血小板（AP）、OAC 和 AP+OAC。终点事件为 1 年内的缺血性脑卒中、MB 或死亡。计算缺血性脑卒中发生率和 MB 发生率。采用 Kruskal-Wallis、Χ2、Fisher 确切概率法和多变量逻辑回归评估临床关联。
共纳入 192 例患者。MB 发生率为 14.5 例/100 人年，缺血性脑卒中发生率为 10.9 例/100 人年。不同 DTP 之间无差异。总体而言，1 年死亡率为 22.1%。未经校正分析，CHADS2-VASc 与缺血性脑卒中相关（p=0.03）；HAS-BLED 与 MB 无相关性（p=0.17）。经多变量逻辑回归校正已知危险因素后，两个评分系统均与缺血性脑卒中或 MB 无相关性。
与之前发表的报告相比，跌倒患者发生缺血性脑卒中或 MB 的风险更高。目前的风险评估工具应谨慎使用。有必要进一步研究危险因素，以指导这些患者的药物治疗决策。
