Effect of pre‐injury anticoagulant and antiplatelet agents on blood loss in elderly patients with severe trauma

Ohmori, Takao; Kitamura, Taisuke; Onishi, Hirokazu; Ishihara, Junko; Nojima, Tsuyoshi; Yamamoto, Katsunobu

doi:10.1002/ams2.152

Cited by 15 publications

(11 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients with ongoing antithrombotic treatment admitted for any bleeding event to the emergency department [ 760 ], as well as general trauma patients without brain injury [ 761 ], did not show a significant increase in mortality risk. In elderly patients (≥ 65 years of age) with severe trauma and pre-injury anticoagulants and APA, only the warfarin group had a significantly higher risk of bleeding [ 762 ], but in other studies pre-injury APA usage was significantly associated with massive transfusion [ 763 ] and haemostatic treatments within 24 h [ 764 ], but without an impact on survival. Prior use of APA was also a risk factor for the development of complications in blunt chest trauma [ 765 ].…”

Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

et al. 2019

View full text Add to dashboard Cite

Background: Severe traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources. Methods: The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004, and the current author group included representatives of six relevant European professional societies. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reexamined and revised based on scientific evidence that has emerged since the previous edition and observed shifts in clinical practice. New recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. Results: Advances in our understanding of the pathophysiology of post-traumatic coagulopathy have supported improved management strategies, including evidence that early, individualised goal-directed treatment improves the outcome of severely injured patients. The overall organisation of the current guideline has been designed to reflect the clinical decision-making process along the patient pathway in an approximate temporal sequence. Recommendations are grouped behind the rationale for key decision points, which are patient-or problem-oriented rather than related to specific treatment modalities. While these recommendations provide guidance for the diagnosis and treatment of major bleeding and coagulopathy, emerging evidence supports the author group's belief that the greatest outcome improvement can be achieved through education and the establishment of and adherence to local clinical management algorithms. Conclusions: A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. If incorporated into local practice, these clinical practice guidelines have the potential to ensure a uniform standard of care across Europe and beyond and better outcomes for the severely bleeding trauma patient.

show abstract

Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Studies have shown that for patients taking aspirin, severe trauma and even brain injury do not increase mortality but will require significantly more transfused blood [162]. For patients taking clopidogrel, severe trauma will significantly increase mortality [163,164]. Therefore, for patients undergoing antiplatelet therapy, platelet transfusion is recommended in cases of persistent bleeding with platelet dysfunction or even thrombocytopenia [165].…”

Section: Alternative Treatment Recommendation 22: Platelet Transfusiomentioning

confidence: 99%

Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China

Song¹,

Liu

Zhu

et al. 2020

Military Med Res

View full text Add to dashboard Cite

Thrombocytopenia is a common complication of critical care patients. The rates of bleeding events and mortality are also significantly increased in critical care patients with thrombocytopenia. Therefore, the Critical Care Medicine Committee of Chinese People's Liberation Army (PLA) worked with Chinese Society of Laboratory Medicine, Chinese Medical Association to develop this consensus to provide guidance for clinical practice. The consensus includes five sections and 27 items: the definition of thrombocytopenia, etiology and pathophysiology, diagnosis and differential diagnosis, treatment and prevention.

show abstract

“…Ferraris et al also reported that preinjury antiplatelet medication does not affect bleeding following an injury [13]. However, other studies have reported that elderly trauma patients on warfarin are at an increased risk of needing a massive transfusion [19,20]. Ohmori et al reported that patients taking anticoagulants had a 4.91-fold or antiplatelets 3.67-fold increased risk of needing a massive transfusion following a trauma, however, this study was conducted with a small sample [20].…”

Section: Discussionmentioning

confidence: 80%

Are Preinjury Anticoagulant and Antiplatelet Medications a Pitfall in the Bleeding Tendencies of Elderly Trauma Patients in Intensive Care?

Kim¹,

Sul²,

Lee³

et al. 2020

Preprint

View full text Add to dashboard Cite

Purpose: The elderly are more likely to be on anticoagulant or antiplatelet medications, which increase bleeding. We aimed to determine the effect of preinjury anticoagulant or antiplatelet medications on required blood transfusions and the trauma outcomes of elderly patients.Methods: We retrospectively reviewed the medical records of all elderly trauma patients admitted to Chungbuk National University Hospital from January 2016 to June 2019. We compared the required number of blood transfusion units, complications, and mortality rate between those on anticoagulant or antiplatelet medications and those that were not, using the chi-squared test, independent t-test, liner regression analysis, and logistic regression analysis.Results: Out of 466 patients, 142 were on anticoagulant or antiplatelet medications while 324 were not. There was a significant statistical difference in the unit amount of red blood cells transfused within 4 hours of arriving at the hospital between the medicated and non-medicated groups (0.89 vs 1.43 units, respectively, p = 0.02); however, multivariate analysis showed no statistical difference (p = 0.28). The medication group showed a higher rate of complications compared to the non-medicated group (47.9% vs. 29.6%, respectively, p = 0.001), bleeding (17.6% vs 2.8%, respectively, p = 0.001), and pneumonia (24.4% vs 14.2%, respectively, p =0.01). There was no statistical difference in the mortality rate (16.9% vs. 22.2%, respectively, p = 0.21). Conclusion: Preinjury anticoagulant or antiplatelet medications in elderly trauma patients increased bleeding and complications such as pneumonia but did not affect transfusion requirement, or mortality rate.

show abstract

Effect of pre‐injury anticoagulant and antiplatelet agents on blood loss in elderly patients with severe trauma

Cited by 15 publications

References 21 publications

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China

Are Preinjury Anticoagulant and Antiplatelet Medications a Pitfall in the Bleeding Tendencies of Elderly Trauma Patients in Intensive Care?

Contact Info

Product

Resources

About