Mortality in relation to presence and type of oral antithrombotic agent among adult trauma patients: a single-center retrospective cohort study

Yuval, Jonathan B.; Felix, Karry J; Demma, Jonathan Abraham; Awissat, Haytem; Kedar, Asaf; Weiss, Daniel J.; Pikarsky, Alon J.; Paltiel, Ora; Hamdi-Levi, Irena; Kalish, Yosef; Bala, Miklosh

doi:10.1007/s00068-020-01429-7

Cited by 3 publications

(3 citation statements)

References 18 publications

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“…Therefore, there may be justification for discontinuing anticoagulant drug administration when patients who are administered ACT suffer major trauma. In contrast, Yuval et al reported that antithrombotic drugs such as anticoagulants and antiplatelet drugs did not significantly increase mortality or blood transfusion requirements among patients with major trauma, including patients with head trauma (28). Thus, the efficacy of APT before the injury and continued administration of antiplatelet drugs after injury remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Retrospective cohort study to determine the effect of preinjury antiplatelet or anticoagulant therapy on mortality in patients with major trauma

et al. 2023

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ObjectiveThis study aimed to compare outcomes among patients who sustained major trauma from injury with and without receiving antiplatelet therapy (APT) or anticoagulant therapy (ACT) to test the hypothesis that APT does not increase the risk of mortality. However, ACT increases the mortality risk in the acute phase of trauma.MethodsPatients registered in the Japanese Observational body for Coagulation and Thrombolysis in Early Trauma 2 between April 2017 and March 2018 who had sustained a severe injury in any anatomic region of the body, as determined using an injury severity score (ISS) ≥ 16 were included in this retrospective cohort study. We analyzed the mortality within 24 h from the arrival using a multivariable linear regression analysis adjusted for several confounding variables.ResultsWe identified 1,186 eligible participants who met the inclusion criteria for this study: 105 in the APT (cases), 1,081 in the non-antiplatelet therapy (nAPT) group (controls), 65 in the ACT (cases), and 1,121 in the non-anticoagulant therapy (nACT) group (controls). The mortality within 24 h in the ACT group was significantly higher than in the nACT group (odds ratio 4.5; 95%CI: 1.2–16.79; p = 0.025); however, there was no significant difference between the two groups with or without the antiplatelet drug (odds ratio 0.32; 95%CI: 0.04–2.79; p = 0.3) administration. Other outcomes, like the 28-day mortality, mortality at discharge, and surgery for hemostasis, were not significantly different between regular users and non-users of either antiplatelet or anticoagulant drugs.ConclusionRegular antiplatelet medications did not increase mortality within 24 h, 28 days, or at discharge in patients with major trauma, suggesting that standard treatment, including surgery, is sufficient.

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Section: Discussionmentioning

confidence: 99%

Retrospective cohort study to determine the effect of preinjury antiplatelet or anticoagulant therapy on mortality in patients with major trauma

et al. 2023

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“…In the multivariate analysis, ISS was found to be a signi cant determinant of in-hospital mortality and 30-day mortality, which correlates with previous study results. [57,58] Despite the strengths of the present study, some limitations should be considered. Documentation bias cannot be excluded entirely in any retrospective study despite carefully reviewing all included data.…”

Section: Discussionmentioning

confidence: 98%

Epidemiology of maxillofacial trauma in elderly patients receiving oral anticoagulant or antithrombotic medication; a Swiss retrospective study

Bettschen,

Tsichlaki,

Chatzimichail

et al. 2024

Preprint

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Background: The percentage of elderly trauma patients under anticoagulation and antiplatelet agents has been rising lately. With time, newer agents have been introduced with certain advantages and precautions. We aimed to investigate the demographic data, causes, and type of maxillofacial trauma, concomitant injuries, hospitalization time, haemorrhagic complications, and total costs of emergency department (ED) care in elderly patients admitted to the ED with maxillofacial trauma while receiving anticoagulation (AC) or antiplatelet therapy (APT). Methods: Data were gathered from the ED of Bern University Hospital. In this retrospective analysis, patients older than 65 years with maxillofacial trauma presenting to our ED between 2013 and 2019 with therapeutic AC/APT were included. Results: A total of 196 patients were included. The median age was 81 years (interquartile range [IQR]: 74-87), and 111 (56.6%) were men. 54.1% (n=106) were 80 years or older. One hundred thirty-seven of the patients (69.9%) suffered from a cardiovascular disease. Previous thromboembolic events (n=82, 41.8%) and atrial fibrillation (n=50, 25.5%) were the most reported indications for oral anticoagulation or antithrombotic therapy intake. Falls (n=162, 82.7%) were the leading cause of facial injury, followed by road traffic injuries (n=26, 13.2%). The most reported primary injuries were orbital fracture (n=46, 23,5%) along with a fracture of the zygomatic bone (n=38, 19,4%) and fracture of the midface (Le Fort I, II, III) (n=35, 17,9%) followed by zygomatic bone fracture (n=38, 19.4%) and mandible fracture (n=20, 10.2%). Epistaxis was noted in 23 cases (11.7%) and oral bleeding in 10 (5.1%). In 120 patients (61.2%), haematomas involved the middle third of the face, which were operated on most frequently in absolute terms. Fourteen patients suffered an intracerebral haemorrhage (n=14, 7.1%), whereas retrobulbar bleeding was observed in 20 patients (10.2%). The overall in-hospital mortality rate was 2.6% (n=5). Conclusions: This study reaffirms the link between falls and the prevalence of maxillofacial trauma in older individuals. Additionally, it underscores the substantial occurrence of mid-face haematomas in geriatric patients undergoing AC/APT. Considering the increasing growth of the geriatric population, enhancing prevention strategies and refining safety guidelines are urgently necessary.

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“…Other studies have found similar findings among trauma patients, with a 2020 study of trauma anticoagulated and non-anticoagulated patients finding no increased risk of mortality among patients taking DOACs compared with controls. 6 A 2021 study utilizing the international TraumaRegister DGU found that DOAC therapy did not affect in-hospital mortality, increased mortality in the VKA group, no difference in length of stay among anticoagulated patients and controls and that anticoagulated patients had a higher incidence of surgeries. 7 There appear to exist differences in outcomes among patients taking different anticoagulants, with patients on DOACs having lower mortality than those on warfarin, although outcomes may be worse in DOACs compared with warfarin after traumatic brain injury.…”

Section: Discussionmentioning

confidence: 99%

The anticoagulated trauma patient in the wilderness

DeLoughery,

DeLoughery

2024

Br J Haematol

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Mortality in relation to presence and type of oral antithrombotic agent among adult trauma patients: a single-center retrospective cohort study

Cited by 3 publications

References 18 publications

Retrospective cohort study to determine the effect of preinjury antiplatelet or anticoagulant therapy on mortality in patients with major trauma

Retrospective cohort study to determine the effect of preinjury antiplatelet or anticoagulant therapy on mortality in patients with major trauma

Epidemiology of maxillofacial trauma in elderly patients receiving oral anticoagulant or antithrombotic medication; a Swiss retrospective study

The anticoagulated trauma patient in the wilderness

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