PMID- 32627046
OWN - NLM
STAT- MEDLINE
DCOM- 20220210
LR  - 20220210
IS  - 1863-9941 (Electronic)
IS  - 1863-9933 (Linking)
VI  - 48
IP  - 1
DP  - 2022 Feb
TI  - Mortality in relation to presence and type of oral antithrombotic agent among 
      adult trauma patients: a single-center retrospective cohort study.
PG  - 497-505
LID - 10.1007/s00068-020-01429-7 [doi]
AB  - 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.
CI  - (c) 2020. Springer-Verlag GmbH Germany, part of Springer Nature.
FAU - Yuval, Jonathan B
AU  - Yuval JB
AD  - Trauma and Acute Care Surgery, Department of Surgery, Hadassah-Hebrew University 
      Medical Center, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel.
FAU - Felix, Karry J
AU  - Felix KJ
AD  - The Joseph H. and Belle R. Braun School of Public Health and Community Medicine, 
      Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
FAU - Demma, Jonathan
AU  - Demma J
AD  - Trauma and Acute Care Surgery, Department of Surgery, Hadassah-Hebrew University 
      Medical Center, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel.
FAU - Awissat, Haytem
AU  - Awissat H
AD  - Trauma and Acute Care Surgery, Department of Surgery, Hadassah-Hebrew University 
      Medical Center, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel.
FAU - Kedar, Asaf
AU  - Kedar A
AD  - Trauma and Acute Care Surgery, Department of Surgery, Hadassah-Hebrew University 
      Medical Center, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel.
FAU - Weiss, Daniel J
AU  - Weiss DJ
AD  - Trauma and Acute Care Surgery, Department of Surgery, Hadassah-Hebrew University 
      Medical Center, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel.
FAU - Pikarsky, Alon J
AU  - Pikarsky AJ
AD  - Trauma and Acute Care Surgery, Department of Surgery, Hadassah-Hebrew University 
      Medical Center, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel.
FAU - Paltiel, Ora
AU  - Paltiel O
AD  - The Joseph H. and Belle R. Braun School of Public Health and Community Medicine, 
      Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
FAU - Hamdi-Levi, Irena
AU  - Hamdi-Levi I
AD  - Trauma and Acute Care Surgery, Department of Surgery, Hadassah-Hebrew University 
      Medical Center, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel.
FAU - Kalish, Yosef
AU  - Kalish Y
AD  - Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, 
      Israel.
FAU - Bala, Miklosh
AU  - Bala M
AUID- ORCID: 0000-0002-1504-6162
AD  - Trauma and Acute Care Surgery, Department of Surgery, Hadassah-Hebrew University 
      Medical Center, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel. 
      Rbalam@hadassah.org.il.
LA  - eng
PT  - Journal Article
DEP - 20200705
PL  - Germany
TA  - Eur J Trauma Emerg Surg
JT  - European journal of trauma and emergency surgery : official publication of the 
      European Trauma Society
JID - 101313350
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 5Q7ZVV76EI (Warfarin)
SB  - IM
MH  - Adult
MH  - Anticoagulants/therapeutic use
MH  - *Fibrinolytic Agents/therapeutic use
MH  - Humans
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Retrospective Studies
MH  - *Warfarin/therapeutic use
OTO - NOTNLM
OT  - Anticoagulants
OT  - Antithrombotic
OT  - Injury
OT  - Mortality
OT  - Trauma
EDAT- 2020/07/07 06:00
MHDA- 2022/02/11 06:00
CRDT- 2020/07/07 06:00
PHST- 2020/01/04 00:00 [received]
PHST- 2020/06/28 00:00 [accepted]
PHST- 2020/07/07 06:00 [pubmed]
PHST- 2022/02/11 06:00 [medline]
PHST- 2020/07/07 06:00 [entrez]
AID - 10.1007/s00068-020-01429-7 [pii]
AID - 10.1007/s00068-020-01429-7 [doi]
PST - ppublish
SO  - Eur J Trauma Emerg Surg. 2022 Feb;48(1):497-505. doi: 10.1007/s00068-020-01429-7. 
      Epub 2020 Jul 5.