Anticoagulants linked to high mortality in trauma patients

Older patients taking anticoagulants have higher mortality rates if admitted to hospital for major trauma, an Australian study has shown.

The findings, derived from the Victorian State Trauma Registry, highlight importance of seeking an accurate history of anticoagulant use, as well as the immediate initiation of reversal therapies, according to emergency medicine specialists in Melbourne.

Their study analysed mortality and functional outcome data from 1323 older adults (over 65) admitted to Victorian hospitals for major trauma injuries such as from falls or motor vehicle accidents in 2017-2018.

Almost one in five patients (19%) were taking anticoagulants, 29% were taking antiplatelet agents and 53% were not using either.

In-hospital mortality was 31.7% for patients who used anticoagulants, 18.4% for patients who used antiplatelet agents and 14.6% for patients who did not use anticoagulants.

Use of anticoagulants on admission was associated with higher odds of in-hospital mortality (adjusted Odds Ratio, 2.38; 95% CI 1.58 to 3.59) compared with not using anticoagulants.

Antiplatelet agents showed no evidence of association with mortality. There was also no evidence of any association between anticoagulant or antiplatelet use at the time of injury and length of hospital stay or on function at six months after injury.

The study investigators, from Monash University, said a link between anticoagulants and mortality had important clinical implications at a time when the number of trauma patients taking anticoagulants was increasing in line with an ageing population.

They noted that subdural haematoma was the most common serious injury in patients who died in hospital, and the proportion of head injuries increased with anticoagulant use.

“Consistent with our findings, previous studies have described preinjury warfarin use associated with higher risk of traumatic intracranial haemorrhage and mortality,” they wrote.

“Our findings highlight the importance of seeking an accurate history of anticoagulant use and its indication, as well as the immediate initiation of reversal therapies,” they said.

“In addition, emergency physicians might be better able to predict the prognosis of the patients with a history of anticoagulant use.”

The findings are published in the Emergency Medicine Journal.

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