(O-C4) Presence of Delirium in Emergency Department Fall Patients on Antithrombotic Agents

Objectives: In this study, we sought to explore the association between delirium and antithrombotic medications on clinical outcomes in the geriatric population presenting post-fall injury.

Background: In the United States, prescription of antithrombotic medications is extremely common in the geriatric population. In addition, this demographic is also at risk for falls that can result in significant post-injury bleeding. Therefore, when assessing falls, antithrombotic medications can significantly complicate emergency department (ED) evaluations. Incidence of delirium can also impact clinical and functional outcomes in older patients.

Methods: This was a prospective observational study at two large, level 1 trauma centers in Southeast Michigan. Patients were eligible for analysis if they had falls while they were on any antithrombotic medications. We excluded patients < 55 years. Research assistants prospectively collected data at two institutions from September 2018 to February 2020. Antithrombotic medications were divided into antiplatelet and anticoagulant medications. Data on the presence of delirium was ascertained from treating clinicians. Outcomes included intracranial hemorrhage (ICH) and hospital admission. Analysis included univariate statistics and multivariable logistic regression.

Results: A total of 573 patients were included in the study of whom 206 (36.0%) were 80 years or greater and 334 (58.3%) were female. African Americans accounted for 274 (48.1%) of the patients, and 242 (42.5%) were Caucasian. Nearly half of the patients were admitted to the hospital (279, 48.7%). Delirium was present in 66 (11.1%) patients. Delirium was more common in those 80 years or older (16.0% versus 8.3%, p=0.014) as well as those with known dementia (28.9% versus 8.1%, p< 0.001). Patients with delirium have higher odds of intracranial hemorrhage (odds ratio [OR] 3.36, 95% confidence interval [CI] 1.15 – 9.87). Most patients with delirium required hospital admission (68.2%). The use of anticoagulant as opposed to antiplatelet medications alone had higher odds of intracranial hemorrhage (OR 2.04, 95% CI 0.66 – 6.35), though this did not reach statistical significance.

Conclusions: Rates of delirium were low in this geriatric fall analysis but strongly associated with intracranial hemorrhage in patients with falls on antithrombotic medications. Given the increased risk for ICH in patients with delirium, caution should be used when prescribing anticoagulation and antiplatelet medications. Further studies are needed to evaluate the link between dementia delirium and falls on blood thinners.

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Funding (Optional): N/A