History of anticoagulant and antiplatelet therapy as a predictive factor for transfusion requirement in elderly trauma patients in intensive care: A retrospective registry–based cohort analysis

Abstract

Introduction: With increased life expectancy, the proportion of elderly trauma admissions has increased. Elderly patients frequently have underlying diseases necessitating anticoagulant/antiplatelet medication, which worsens coagulopathy. We ascertained the relationship between preinjury anticoagulants/antiplatelet medication use and transfusion requirements in patients older than 65 years. Methods: This retrospective study enrolled patients admitted to the trauma intensive care unit of Chungbuk National University Hospital during January 2016 to June 2019. Data on medication history, clinical features, and component transfusions were analyzed with the chi-square test, independent t-test, one-way analysis of variance, and analysis of covariance. Results: Overall, 142 and 324 (overall 466) patients did and did not receive anticoagulant/antiplatelet medication, respectively. Falls were more frequent ( p < 0.001) in the medicated group ( n = 36; 25.4% vs n = 25; 7.7%). Head and neck injuries were more frequent among patients in the medicated group (58.5% vs 46.6%, p = 0.02), and they had a lower Injury Severity Score (ISS; 18.2 vs 20.2, p = 0.03), with no difference in serum hemoglobin level and coagulation function. The non-medicated group received more red blood cell transfusions within 4 h of arrival (2.24 vs 1.42 units, p = 0.03). Post hoc analysis revealed differences in red blood cell transfusions within 4 h of arrival between the non-medicated and warfarin groups (2.24 vs 0.33 units). Patients with head and neck injuries received less red blood cells than patients with other injuries (head and neck 1.07; chest and abdomen 2.73; pelvic and extremity 3.34 units, p < 0.001). On linear regression analysis, the Injury Severity Score and Glasgow Coma Scale score influenced the transfusion volume. Multivariate analysis controlled for Injury Severity Score, Glasgow Coma Scale score, and main injury site showed no intergroup differences in transfusion requirements. Conclusion: Preinjury anticoagulant/antiplatelet medication use was not significantly associated with transfusion amounts in patients older than 65 years.