The impact of pre-injury direct oral anticoagulants compared to warfarin in geriatric G-60 trauma patients

European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society
J F BarlettaA J Mangram

Abstract

Pre-injury oral anticoagulants are associated with worse outcomes in geriatric (G-60) trauma patients, but there are limited data comparing warfarin with direct oral anticoagulants (DOAC). We sought to compare outcomes in G-60 trauma patients taking pre-injury DOACs vs. warfarin. All trauma patients, age ≥60 who were admitted to the hospital and taking an oral anticoagulant pre-injury were retrospectively identified. Patients were excluded if their reason for admission was a suicide attempt or penetrating extremity injury. Outcome measures included blood transfusions, hospital LOS, and mortality. A second analysis was performed, whereby patients were matched using ISS and age. There were 3,941 patients identified; 331 had documentation of anticoagulant use, pre-injury (warfarin, n = 237; DOAC, n = 94). Demographics were similar, but ISS [9 (4-13) vs. 8 (4-9), p = .027], initial INR [2.2 (1.8-2.9) vs. 1.2 (1.1-1.5), p < .001], and the use of pharmacologic reversal agents (48 vs. 14%, p < .001) were higher in the warfarin group. There was no difference in the use of blood transfusions (24 vs. 17%, p = .164) or mortality (5.9 vs. 4.3%, p = .789) between warfarin and DOAC groups, respectively. However, LOS was longer in the warfari...Continue Reading

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Citations

Jun 22, 2017·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·M Maegele, T Lustenberger
Mar 28, 2018·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Oliver PrexlHerbert Schöchl
Jun 17, 2020·The Journal of Trauma and Acute Care Surgery·Takeshi NishimuraClifton W Callaway
Jul 7, 2020·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·Jonathan B YuvalMiklosh Bala
Oct 3, 2018·Journal of Orthopaedic Trauma·Martin BruckbauerHerbert Schöchl
Oct 18, 2020·The Journal of Emergency Medicine·Juliette A L SantingKorné Jellema

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