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Continuing from the previous Figure, this Figure considers some of the further misconceptions about the risks of anticoagulation therapy. One of the most common misconceptions is increased risk of bleeding. In general, patients with a history of gastrointestinal (GI) bleeding are only half as likely to receive warfarin. However it should be noted that those patients with a history of an ulcer-related GI bleed who have received appropriate therapy are no more likely to re-bleed than those without previous GI bleed.
The other principal misconception concerns risk of falling. Surveys again report that a majority of physicians report that they would not prescribe warfarin to patients with a high risk of falls. Again, however, the true risk of significant bleeding complications with falling is clearly overestimated. It is estimated that elderly individuals with a 5% yearly risk of stroke would need to fall 300 times for the risk of an intracranial bleed to outweigh the benefits of warfarin. In general, elderly individuals with a history of falls average 1.8 falls per year and are more likely to suffer a bone fracture than to experience a bleed. What physicians should ask themselves is whether many of their patients will be alive and active for the further 166 years (300 falls divided by 1.8 falls per year) that will be required for the risk of bleeding to outweigh the risk of stroke.
Rothman SA. Am J Med 2013; 126: 00-00.