1303: IMPACT OF ANTIPLATELET AND ANTICOAGULANT AGENTS ON EMERGENT SURGERY FOR ORTHOPEDIC TRAUMAS

Abstract

Introduction: Traumatic injuries bring about an increasing and significant challenge to healthcare systems worldwide. Most traumatic injuries are orthopedic in nature commonly caused by falls and road traffic accidents. A large concern relates to older patients taking anticoagulants and/or antiplatelets (AP/AC) prior to an injury due to the increased risk of hemorrhagic complications. This study utilized the Michigan Trauma Quality Improvement Program (MTQIP) database to determine the effect that AP/AC have on outcomes following emergent surgery for orthopedic traumas. Methods: Patients were included with age >18 years, Maximum Extremity or Pelvic Girdle severity value of abbreviated injury score (AIS) >2, injury severity score (ISS) >5, underwent extremity-related operation (based on the MTQIP Hospital Procedures ICD-10 codes), and underwent a procedure within 24 hours of ED admission. Patients were excluded if they had an AIS >3 in other body region, or no signs of life at initial evaluation. Results: Within the 4,030 patients analyzed, 97 were in the warfarin with or without (+/-) aspirin cohort, 146 in the direct oral anticoagulants (DOAC) +/- aspirin cohort, 140 in the clopidogrel +/- aspirin cohort, and 2,981 in the no AP/AC cohort (control group). After controlling for demographic, comorbid, and clinical characteristics, no significant difference in mortality rates was observed in the treatment groups (p>0.05). However, our subgroup analysis did reveal a significantly higher mortality rate within the warfarin and aspirin subgroup as compared to the control group (odds ratio [OR], 5.849; confidence interval [CI], 1.557-21.975, p=0.009). With regards to hospital complications, there was a significant increase in this outcome within all treatment groups, DOAC +/- aspirin (OR, 1.898; CI, 1.252-2.879, p=0.003), warfarin +/- aspirin (OR, 3.06; CI, 1924-4.868, p< 0.001), clopidogrel +/- aspirin (OR, 2.345; CI, 1.56-3.526, p< 0.001) groups. Conclusions: Patients on AP/AC who experience an orthopedic trauma requiring an emergent operation do not have an increased risk of mortality compared to patients not on AP/AC except for patients on warfarin and aspirin prior to admission.