Safety and differences between direct oral anticoagulants and vitamin K antagonists in the risk of post-traumatic intrathoracic bleeding after rib fractures in elderly patients

Abstract

Closed chest traumas are frequent consequences of falls in the elderly. The presence of concomitant oral anticoagulant therapy can increase the risk of post-traumatic bleeding even in cases of trauma with non-severe dynamics. There is limited information about the differences between vitamin K antagonists and direct oral anticoagulants in the risk of post-traumatic bleeding. To assess differences in the risk of developing intra-thoracic hemorrhages after chest trauma with at least one rib fracture caused by an accidental fall in patients over 75 years of age taking oral anticoagulant therapy. This study involved data from four emergency departments over two years. All patients on oral anticoagulant therapy and over 75 years of age who reported a closed thoracic trauma with at least one rib fracture were retrospectively evaluated. Patients were divided into two study groups according their anticoagulant therapy. Of the 342 patients included in the study, 38.9% (133/342) were treated with direct oral anticoagulants and 61.1% (209/342) were treated with vitamin K antagonist. A total of 7% (24/342) of patients presented intrathoracic bleeding, while 5% (17/342) required surgery or died as a result for the trauma. Posttraumatic intrathoracic bleeding occurred in 4.5% (6/133) of patients receiving direct oral anticoagulants and 8.6% (18/209) of patients receiving vitamin K antagonist. Logistic regression analysis, revealed no difference in the risk of intrathoracic haemorrhages between the two studied groups. Direct oral anticoagulants therapy presents a risk of post-traumatic intrathoracic haemorrhage comparable to that of vitamin K antagonist therapy.

Health care utilization outcomes in patients with blunt chest wall trauma following discharge from the emergency department: A retrospective, observational data-linkage study

“…In this study, COPD was also a predictor of increased health care resource utilization in patients discharged directly home from the ED. The use of preinjury anticoagulants has been similarly reported as a predictor of poor outcomes, 36–38 which is also supported by our study findings.…”

Risk factors that predict mortality in patients with blunt chest wall trauma: an updated systematic review and meta-analysis

“…A number of other risk factors were investigated in either one or two studies and included time after injury,66 lateral rib fractures,20 vital capacity21 and predicted forced vital capacity,22 83 pulmonary contusion,39 73 surgical emphysema,68 early hyperoxaemia,84 lactate80 and base excess,16prehospital anticoagulants or antiplatelets,19 85 and alcohol use disorder75 (full results are reported in online supplemental file 3, table 8).…”