ArticleDrugs & aging2021
Impact of Fall Risk and Direct Oral Anticoagulant Treatment on Quality-Adjusted Life-Years in Older Adults with Atrial Fibrillation: A Markov Decision Analysis.
Article in Drugs & aging, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.
- Direct Oral Anticoagulants vs. Vitamin K Antagonists in Atrial Fibrillation Patients at Risk of Falling: A Meta-Analysis.Frontiers in cardiovascular medicine · 2022Pooled it
- Clinical characteristics and outcomes of intracranial hemorrhage in geriatric patients receiving non-vitamin K antagonist oral anticoagulants: a multicenter observational study.Irish journal of medical science · 2026Article
- Article
- Association between poor blood pressure control and intracranial haemorrhage-related mortality in patients with atrial fibrillation receiving oral anticoagulation: a retrospective observational cohort study.Frontiers in stroke · 2026Article
- To anticoagulate or not to anticoagulate-that is the question in patients with fall risks.Research and practice in thrombosis and haemostasis · 2025Article
- The Use of Direct Oral Anticoagulants (DOACs) in the Geriatric Population-How to Overcome the Challenges of Geriatric Syndromes.Journal of clinical medicine · 2025Review
- Investigating Falls Risk Awareness in Hospitals Using the Self-Awareness of Falls Risk Measure (SAFRM): Empirical Research Quantitative.Nursing open · 2025Article
- [Drug therapy for arterial hypertension and atrial fibrillation in frail patients : Are there any new insights and recommendations?]Innere Medizin (Heidelberg, Germany) · 2024Review
- Anticoagulant use in older persons at risk for falls: therapeutic dilemmas-a clinical review.European geriatric medicine · 2023Review
- Clinical outcomes in patients with atrial fibrillation and a history of falls using non-vitamin K antagonist oral anticoagulants: A nationwide cohort study.International journal of cardiology. Heart & vasculature · 2023Article
- Anticoagulation Holiday: Resumption of Direct Oral Anticoagulants for Atrial Fibrillation in Patients with Index Traumatic Intracranial Hemorrhage.World neurosurgery: X · 2023Article
- Challenging clinical scenarios for therapeutic anticoagulation: A practical approach.Thrombosis research · 2022Review
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
objectiveThe decision to initiate anticoagulation in older adults with atrial fibrillation is complicated by the benefit of ischemic stroke prevention vs the risk of falls resulting in major bleeds. The objective of this study was to assess the impact of different treatments including direct oral anticoagulants on quality-adjusted life-years (QALYs) in patients aged 75 years and older with atrial fibrillation in the context of falls.
methodsA Markov decision process was constructed for older patients with atrial fibrillation taking no anti-thrombotic, aspirin, warfarin, rivaroxaban, and apixaban. Input probabilities for clinical events were estimated from the available literature. One-way and two-way sensitivity analyses were performed by measuring the impact of varying input probabilities of clinical events on QALY outcomes.
resultsThe base-case scenario estimated that older adults treated with no anti-thrombotic, aspirin, warfarin, rivaroxaban, and apixaban had QALYs of 8.03, 8.69, 10.38, 11.02, and 11.56, respectively. The sensitivity analysis estimated that an older adult would need to fall over 45 (rivaroxaban) and 458 (apixaban) times per year for the QALY of a direct oral anticoagulant to be lower than that of aspirin.
conclusionsOlder adults with atrial fibrillation benefit from stroke protection of anticoagulants, especially direct oral anticoagulants, even if they are at high risk of falls. Clinicians should not consider fall risk as a deciding factor for withholding anticoagulation in this population of patients.
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Registered trials
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