The Effect of Anticoagulation and Antiplatelet Use in Trauma Patients on Mortality and Length of Stay

Abstract

Background Though many trauma patients are on anticoagulation or antiplatelet therapy (AAT), there are few generalizable data on the risks for these patients. The purpose of this study was to analyze the impact of anticoagulation (AC) and antiplatelet (AP) therapy on mortality and length of stay (LOS) in general trauma patients. Methods A retrospective review was performed of patients in the institutional trauma registry during 2019 to determine AAT use on admission and discharge. Outcomes were compared using standard statistics. Results Of 2261 patients who met the inclusion criteria, 2 were excluded due to an incomplete medication reconciliation, resulting in 2259 patients. Patients on AAT had a higher mortality (4.5% vs 2.1%). On multivariable analysis, preadmission AC (odds ratio OR, 3.325, P = .001), age (OR 1.040, P < .001), and injury severity score ((ISS) 1.094, P < .001) were associated with mortality. Anticoagulation use was also associated with longer LOS on multivariable analysis (OR: 1.626, P = .005). Antiplatelet use was not associated with higher mortality or longer LOS. More patients on AAT were unable to be discharged home. However, patients on AAT did not have a greater blood transfusion requirement or need more hemorrhage control procedures. Lastly, 23.7% of patients on preadmission AAT were not discharged on any AAT. Discussion These data demonstrate that patients on AC, but not AP, have greater mortality and longer hospital LOS. This may provide guidance for those being newly started on AAT. Further work to determine which patients benefit most from restarting AAT would lead to improvement in the care of trauma patients.

Clinical outcomes for patients on antiplatelet and anticoagulants in thoracoabdominal trauma

“…In contrast to Narula's study [ 1 ] which demonstrated higher rates of mortality in patients taking warfarin and DOACs, we found that use of preinjury clopidogrel increased mortality and platelet use in the first 24 h while warfarin and DOAC use trended toward higher mortality ( Table 2 ). Warfarin was significantly associated with higher risk of serious in-hospital complications, as well as increased hospital and ICU length of stay.…”

“…Many studies, including those by Narula and Reina et al [ 1 , 2 ] have investigated outcomes in trauma patients taking clopidogrel, warfarin, or DOACs prior to injury. However, there remains a paucity of literature on patient outcomes in those taking AP/AC who sustain thoracoabdominal trauma requiring surgical intervention in the first 24 h, allowing this to be the first study of its kind.…”

“…One such study in 2022 by Narula et al [ 1 ] investigated how antiplatelets and anticoagulants affect trauma patients as a whole in regards to mortality and length of stay by retrospectively investigating over 2200 patients in their trauma registry. They concluded that patients on anticoagulants have a higher mortality rate and longer hospital length of stay, while those on antiplatelets did not.…”

Supervised Learning Algorithm Comparison in Discharge Status Prediction of Trauma Patients: Empirical Evaluation

“…Conversely, the discharge outcomes of trauma patients involve various factors, including the length of hospitalization, rates of mortality, rates of readmission, and the distinction between discharge to home and discharge to healthcare facilities [5][6][7][8].…”