Study Finds Risk Factors for Intracranial Bleeds

Advanced age is not the only risk factor to consider when deciding whether a patient with atrial fibrillation should get anticoagulants.

Advanced age is known stroke risk factor for patients with atrial fibrillation (AF).

In a study of nearly 32,000 veterans age 75 or older with AF referred to care at Veterans Affairs facilities, a team from New York University School of Medicine teased out other risk factors in this group.

Oral anticoagulation reduces stroke risk by almost two-thirds, lead research John Dodson, MD MPH wrote in JAMA Cardiology.

But physicians hesitate to prescribe anticoagulants to older people who have AF.

The researchers found that the rate of traumatic intracranial bleeding among older adults with AF initiating warfarin therapy was higher than previously reported in clinical trials.

They also found that several factors placed patients at increased risk of these bleed, usually due to falls. Those are dementia, anemia, depression, anticonvulsant use, and unstable international normalized ratio.

“While we were unable to generate a clinical prediction tool to evaluate risk given poor model discrimination, we still believe that the individual factors we identified may potentially be used in patent- centered discussions about the benefits and harms of warfarin therapy in older adults,” the team wrote.

The potential shortcomings of the study included under-representation of women in the sample.