Physical activity and risk of bleeding in elderly patients taking anticoagulants

J Thromb Haemost. 2015 Feb;13(2):197-205. doi: 10.1111/jth.12793. Epub 2014 Dec 30.


Background: Although the possibility of bleeding during anticoagulant treatment may limit patients from taking part in physical activity, the association between physical activity and anticoagulation-related bleeding is uncertain.

Objectives: To determine whether physical activity is associated with bleeding in elderly patients taking anticoagulants.

Patients/methods: In a prospective multicenter cohort study of 988 patients aged ≥ 65 years receiving anticoagulants for venous thromboembolism, we assessed patients' self-reported physical activity level. The primary outcome was the time to a first major bleeding, defined as fatal bleeding, symptomatic bleeding in a critical site, or bleeding causing a fall in hemoglobin or leading to transfusions. The secondary outcome was the time to a first clinically relevant non-major bleeding. We examined the association between physical activity level and time to a first bleeding by using competing risk regression, accounting for death as a competing event. We adjusted for known bleeding risk factors and anticoagulation as a time-varying covariate.

Results: During a mean follow-up of 22 months, patients with a low, moderate, and high physical activity level had an incidence of major bleeding of 11.6, 6.3, and 3.1 events per 100 patient-years and an incidence of clinically relevant non-major bleeding of 14.0, 10.3, and 7.7 events per 100 patient-years, respectively. A high physical activity level was significantly associated with a lower risk of major bleeding (adjusted sub-hazard ratio 0.40, 95% confidence interval 0.22-0.72). There was no association between physical activity and non-major bleeding.

Conclusions: A high level of physical activity is associated with a decreased risk of major bleeding in elderly patients receiving anticoagulant therapy.

Trial registration: NCT00973596.

Keywords: anticoagulants; elderly; hemorrhage; physical activity; risk factors.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anticoagulants / adverse effects*
  • Female
  • Hemorrhage / blood
  • Hemorrhage / chemically induced*
  • Hemorrhage / diagnosis
  • Hemorrhage / mortality
  • Hemorrhage / prevention & control*
  • Humans
  • Incidence
  • Male
  • Motor Activity*
  • Prospective Studies
  • Protective Factors
  • Risk Assessment
  • Risk Factors
  • Switzerland / epidemiology
  • Time Factors
  • Treatment Outcome
  • Venous Thromboembolism / blood
  • Venous Thromboembolism / diagnosis
  • Venous Thromboembolism / drug therapy*


  • Anticoagulants

Associated data