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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

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

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.

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Acknowledgements

The study formed part of a master’s thesis of Karry J Felix at the Braun School of Public Health and Community Medicine, Hadassah-Hebrew University. Ellen Sieh provided English language copy editing.

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Authors and Affiliations

  1. Trauma and Acute Care Surgery, Department of Surgery, Hadassah-Hebrew University Medical Center, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel

    Jonathan B. Yuval, Jonathan Demma, Haytem Awissat, Asaf Kedar, Daniel J. Weiss, Alon J. Pikarsky, Irena Hamdi-Levi & Miklosh Bala

  2. Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Yosef Kalish

  3. The Joseph H. and Belle R. Braun School of Public Health and Community Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Karry J. Felix & Ora Paltiel

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  1. Jonathan B. Yuval
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Correspondence to Miklosh Bala.

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Yuval, J.B., Felix, K.J., Demma, J. et al. Mortality in relation to presence and type of oral antithrombotic agent among adult trauma patients: a single-center retrospective cohort study. Eur J Trauma Emerg Surg 48, 497–505 (2022). https://doi.org/10.1007/s00068-020-01429-7

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  • DOI: https://doi.org/10.1007/s00068-020-01429-7

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