Risk of traumatic intracranial haemorrhage is increased in older people exposed to oral anticoagulation with phenprocoumon

Abstract

Background

Hospital admissions resulting from traumatic intracranial haemorrhages (TIH) in older people are increasing. There are concerns regarding an increased risk of a TIH in people taking oral anticoagulants (OAC) like phenprocoumon.

Aims

The aim of this study was to estimate the incremental risk of a TIH associated with OAC in older people. Furthermore, this study explored differences in risk according to functional status.

Methods

The study took data from a large German health insurance provider and combined hospital diagnoses with data regarding drug dispensing to estimate rates of a TIH in people with and without exposure to phenprocoumon. Analyses were stratified by sex and by severe functional impairment as disclosed by the long-term care insurance provider.

Results

Overall, exposure to OAC resulted in 2.7 times higher rates of TIH. People with severe functional impairment had a higher baseline risk of TIH than people without severe functional impairment. However, the incremental risk in those exposed to OAC was similar among people with and without severe functional impairment (standardised incidence rate difference 15.73 (95% CI 7.84; 23.61) and 12.10 (95% CI 9.63; 14.57) per 10,000 person-years, respectively).

Conclusions

OAC increases the risk of TIH considerably. The incremental risk of TIH in those exposed to OAC is comparable between people with and without severe functional impairment. The presence of severe functional impairment per se should not exclude such patients from the potential benefits of OAC. For now, the prescription should be personalized based on individual fall risk factors and risk-taking behaviour.

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Acknowledgements

We would like to thank Marianna Hanke-Ebersoll from the Allgemeine Ortskrankenkasse (AOK) for her support of our analyses.

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Correspondence to Petra Benzinger.

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The study was approved by the Ethics Committee of Ulm University.

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Conduction of the study was in accordance with the ethical standards of the institutional ethical committee and with the 1964 Helsinki declaration and its later amendments. This article does not contain any studies animals performed by any of the authors.

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Büchele, G., Rapp, K., Bauer, J. et al. Risk of traumatic intracranial haemorrhage is increased in older people exposed to oral anticoagulation with phenprocoumon. Aging Clin Exp Res 32, 441–447 (2020). https://doi.org/10.1007/s40520-019-01215-5

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Keywords

  • Elderly
  • Anticoagulation
  • Head injury
  • Intracranial haemorrhage
  • Trauma