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European Journal of Trauma and Emergency Surgery

Erschienen in:

05.07.2020 | Original Article

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

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

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 1/2022

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Abstract

Purpose

Oral anticoagulants (AC) and antiplatelet (AP) agents are increasingly prescribed to prevent and treat acute and chronic thrombotic conditions. The direct oral anticoagulants (DOAC), a newer class of AC, raise concerns in the trauma setting. Our study aims to compare the mortality rates and other outcomes among adult trauma patients based on pre-admission AC/AP status.

Methods

We conducted a retrospective cohort study of a prospectively collected database of trauma patients previously on DOAC, warfarin, aspirin or clopidogrel. A matched control group of trauma patients not receiving AC/AP was used for comparison. Our primary endpoint was in-hospital mortality according to antithrombotic medication class. Secondary endpoints included length of stay (LOS), intensive care unit (ICU) admission, need for blood transfusion, and discharge to a dependent setting. Univariate and multivariate analyses were conducted.

Results

There were 996 exposed patients and 234 controls, with no major clinically significant difference among study groups in terms of gender, injury site, injury severity, mechanism, and comorbidities. The mortality rates were 2.14% (control, 5/234), 2.88% (DOAC, 3/104), 3.34% (aspirin, 17/509), 7.63% (warfarin, 18/236), 9% (clopidogrel, 8/89), and 13.79% (aspirin + clopidogrel, 8/58) (p < 0.001). In multivariate analyses, there was no difference regarding mortality between DOAC and reference groups. Blood transfusion was more likely in patients receiving warfarin or AP than those prescribed DOAC.

Conclusion

There was no evidence of increased mortality or blood transfusion requirement among trauma patients on DOAC, including head trauma patients. Further studies on head trauma and specific subgroups of DOAC are recommended.

Nur mit Berechtigung zugänglich

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Titel: Mortality in relation to presence and type of oral antithrombotic agent among adult trauma patients: a single-center retrospective cohort study
verfasst von: Jonathan B. Yuval
Karry J. Felix
Jonathan Demma
Haytem Awissat
Asaf Kedar
Daniel J. Weiss
Alon J. Pikarsky
Ora Paltiel
Irena Hamdi-Levi
Yosef Kalish
Miklosh Bala
Publikationsdatum: 05.07.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Trauma and Emergency Surgery / Ausgabe 1/2022
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-020-01429-7

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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