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Being housebound greatly increases the risk of a warfarin-associated bleed, but old age has no independent effect, according to a GP-led study.

The authors said many GPs had assumed the elderly were automatically at increased risk of suffering a bleed, which had led to underuse of warfarin in older patients.

But they said the focus should be on patients who are housebound, after finding they were 14 times more likely than normal to suffer a bleed.

The study was published in September's British Journal of General Practice and looked at 344 patients with an average age of 71 who were taking warfarin.

Study leader Dr Barclay Goudie, a GP in Dundee, said: 'The data suggests the management of patients who need domiciliary monitoring should differ from that of patients who are still mobile enough to attend the surgery.

'It may be necessary to apply more restrictive criteria for initiating treatment and to adopt a lower target INR in dependent patients.'

He said multiple morbidity, polypharmacy, cognitive impairment and frequent hospital visits might contribute to the increased risk of bleeding.

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