Outcomes of trauma patients on chronic antithrombotic therapies in a trauma center in a rural state

Abstract

Objective: The number of trauma patients presenting with chronic antithrombotic therapy is on the rise. The risk of hemorrhage, the leading cause of death in trauma patients, increases for those on such therapy. This study sought to compare the clinical outcomes of patients on warfarin, direct oral anticoagulants (DOAC), or antiplatelet agents. Methods: A retrospective cohort analysis was conducted on adult patients admitted to a Level 1 trauma center with pre-admission antithrombotic therapy. Patients were divided into those on warfarin, DOACs, and antiplatelet agents. The primary outcomes measured were hospital mortality, total blood products received, hospital length of stay (LOS), and ICU LOS. Results: 738 patients were included in the study: 191 (26 %) warfarin, 260 (35 %) DOACs, and 287 (39 %) antiplatelet. There were no differences in the demographic variables between study groups. The Injury Severity Score (ISS) was similar across the three groups as well as blood product usage, reversal agent usage, and mean hospital stay. Multivariable regression showed patients with pre-admission antiplatelet usage were more likely to have a shorter ICU LOS than those on warfarin (p = 0.048). Conclusion: Blood product and reversal agent use was similar between patients on warfarin, DOACs, or antiplatelet agents. Patients on antiplatelet agents had a shorter ICU stay than the warfarin group, the only significant difference observed. Our results indicate similar safety profiles of antithrombotic medications in a generic trauma population, likely due to institutional protocols to increase responsiveness and immediate availability of resources when the patient has known anticoagulation.

Keywords

• Traumatic injury
• Anticoagulation
• Antithrombotic medication
• Clinical outcomes
• Retrospective review