How does a history of falls impact the decision to initiate antiplatelet therapy (Antiplatelet agents) in patients?

From the Guidelines

A history of falls is a critical consideration in deciding on antiplatelet therapy, and for patients with a significant fall history, the benefits of antiplatelet therapy should be carefully weighed against the heightened bleeding risk, with a preference for single antiplatelet therapy with aspirin (75-100 mg daily) over dual antiplatelet therapy. For patients with a history of falls, the risk of bleeding complications, particularly intracranial hemorrhage, is increased, and this risk should be carefully considered when deciding on antiplatelet therapy 1.

Key Considerations

• The risk of delayed intracranial hemorrhage (ICH) after blunt head trauma in patients on anticoagulant or antiplatelet therapy is rare, and most studies suggest that patients with a normal initial head CT can be safely discharged 1.
• However, patients with a history of falls may require more frequent monitoring and individualized assessment of their fall risk and antiplatelet therapy appropriateness 1.
• The decision to use antiplatelet therapy in patients with a history of falls should be based on the frequency and severity of falls, the indication for antiplatelet therapy (primary vs. secondary prevention), and other bleeding risk factors such as age, renal function, and concomitant medications 1.
• Single antiplatelet therapy with aspirin (75-100 mg daily) may be preferred over dual antiplatelet therapy (such as aspirin plus clopidogrel 75 mg daily) in patients with recurrent falls, and for those with both high cardiovascular risk and high fall risk, consider using the lowest effective dose of aspirin alone and implementing fall prevention strategies 1.

Recommendations

• For patients with a significant fall history, consider using single antiplatelet therapy with aspirin (75-100 mg daily) over dual antiplatelet therapy 1.
• Implement fall prevention strategies and conduct more frequent monitoring in patients with a history of falls who are on antiplatelet therapy 1.
• Regularly reassess fall risk and antiplatelet therapy appropriateness at follow-up visits, particularly in elderly patients where both fall risk and cardiovascular disease prevalence are higher 1.

From the Research

History of Falls and Antiplatelet Therapy

• A history of falls in older adults is a significant concern, with more than 27% of adults 65 years and older experiencing falls each year 2.
• The decision to prescribe antiplatelet therapy, such as clopidogrel, must consider the risk of falls and potential interactions with other medications.
• There is no direct evidence in the provided studies that links a history of falls to the decision for antiplatelet therapy.
• However, studies suggest that patients with a history of falls may be at higher risk for bleeding events, which could impact the decision to prescribe antiplatelet therapy 3, 4, 5.

Considerations for Antiplatelet Therapy

• Dual antiplatelet therapy with aspirin and clopidogrel is effective in reducing cardiovascular events, but increases the risk of gastrointestinal bleeding 3, 4, 5.
• Proton pump inhibitors (PPIs) may be prescribed to reduce the risk of gastrointestinal bleeding, but their interaction with clopidogrel is controversial 3, 4, 5.
• The decision to prescribe antiplatelet therapy must weigh the benefits of reducing cardiovascular events against the risks of bleeding and potential interactions with other medications.

Fall Prevention Strategies

• Fall prevention strategies, such as regular physical activity, balance disorders treatment, and home safety assessments, can reduce the risk of falls in older adults 2, 6.
• These strategies may be particularly important for patients prescribed antiplatelet therapy, as they may be at higher risk for bleeding events.