PMID- 33522831
OWN - NLM
STAT- MEDLINE
DCOM- 20220526
LR  - 20220526
IS  - 1555-9823 (Electronic)
IS  - 0003-1348 (Linking)
VI  - 88
IP  - 6
DP  - 2022 Jun
TI  - The Effect of Anticoagulation and Antiplatelet Use in Trauma Patients on 
      Mortality and Length of Stay.
PG  - 1137-1145
LID - 10.1177/0003134821989043 [doi]
AB  - BACKGROUND: Though many trauma patients are on anticoagulation or antiplatelet 
      therapy (AAT), there are few generalizable data on the risks for these patients. 
      The purpose of this study was to analyze the impact of anticoagulation (AC) and 
      antiplatelet (AP) therapy on mortality and length of stay (LOS) in general trauma 
      patients. METHODS: A retrospective review was performed of patients in the 
      institutional trauma registry during 2019 to determine AAT use on admission and 
      discharge. Outcomes were compared using standard statistics. RESULTS: Of 2261 
      patients who met the inclusion criteria, 2 were excluded due to an incomplete 
      medication reconciliation, resulting in 2259 patients. Patients on AAT had a 
      higher mortality (4.5% vs 2.1%). On multivariable analysis, preadmission AC (odds 
      ratio OR, 3.325, P = .001), age (OR 1.040, P < .001), and injury severity score 
      ((ISS) 1.094, P < .001) were associated with mortality. Anticoagulation use was 
      also associated with longer LOS on multivariable analysis (OR: 1.626, P = .005). 
      Antiplatelet use was not associated with higher mortality or longer LOS. More 
      patients on AAT were unable to be discharged home. However, patients on AAT did 
      not have a greater blood transfusion requirement or need more hemorrhage control 
      procedures. Lastly, 23.7% of patients on preadmission AAT were not discharged on 
      any AAT. DISCUSSION: These data demonstrate that patients on AC, but not AP, have 
      greater mortality and longer hospital LOS. This may provide guidance for those 
      being newly started on AAT. Further work to determine which patients benefit most 
      from restarting AAT would lead to improvement in the care of trauma patients.
FAU - Narula, Nisha
AU  - Narula N
AD  - Department of Surgery, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA.
FAU - Tsikis, Savas
AU  - Tsikis S
AD  - Department of Surgery, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA.
FAU - Jinadasa, Sayuri P
AU  - Jinadasa SP
AD  - Department of Surgery, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA.
FAU - Parsons, Charles S
AU  - Parsons CS
AD  - Department of Surgery, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA.
FAU - Cook, Charles H
AU  - Cook CH
AD  - Department of Surgery, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA.
FAU - Butt, Bonnie
AU  - Butt B
AD  - Department of Surgery, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA.
FAU - Odom, Stephen R
AU  - Odom SR
AD  - Department of Surgery, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA.
LA  - eng
PT  - Journal Article
DEP - 20210201
PL  - United States
TA  - Am Surg
JT  - The American surgeon
JID - 0370522
RN  - 0 (Anticoagulants)
SB  - IM
MH  - *Anticoagulants/therapeutic use
MH  - *Hemorrhage/chemically induced
MH  - Humans
MH  - Injury Severity Score
MH  - Length of Stay
MH  - Retrospective Studies
OTO - NOTNLM
OT  - aspirin
OT  - direct oral anticoagulation
OT  - novel oral anticoagulation
OT  - traumatic injury
OT  - warfarin
EDAT- 2021/02/02 06:00
MHDA- 2022/05/27 06:00
CRDT- 2021/02/01 12:15
PHST- 2021/02/02 06:00 [pubmed]
PHST- 2022/05/27 06:00 [medline]
PHST- 2021/02/01 12:15 [entrez]
AID - 10.1177/0003134821989043 [doi]
PST - ppublish
SO  - Am Surg. 2022 Jun;88(6):1137-1145. doi: 10.1177/0003134821989043. Epub 2021 Feb 
      1.