Impact of anticoagulation and antiplatelet drugs on surgery rates and mortality in trauma patients

Felix M Bläsius,Hagen Andruszkow,Frank Hildebrand,Klemens Horst,Cavan Lübke,Markus Laubach,Rolf Lefering,Philipp Lichte

doi:10.1038/s41598-021-94675-7

Felix M Bläsius, Hagen Andruszkow + Show 6 more

Open Access

https://doi.org/10.1038/s41598-021-94675-7

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Abstract

Preinjury anticoagulation therapy (AT) is associated with a higher risk for major bleeding. We aimed to evaluated the influence of preinjury anticoagulant medication on the clinical course after moderate and severe trauma. Patients in the TraumaRegister DGU ≥ 55 years who received AT were matched with patients not receiving AT. Pairs were grouped according to the drug used: Antiplatelet drugs (APD), vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC). The primary end points were early (< 24 h) and total in-hospital mortality. Secondary endpoints included emergency surgical procedure rates and surgery rates. The APD group matched 1759 pairs, the VKA group 677 pairs, and the DOAC group 437 pairs. Surgery rates were statistically significant higher in the AT groups compared to controls (APD group: 51.8% vs. 47.8%, p = 0.015; VKA group: 52.4% vs. 44.8%, p = 0.005; DOAC group: 52.6% vs. 41.0%, p = 0.001). Patients on VKA had higher total in-hospital mortality (23.9% vs. 19.5%, p = 0.026), whereas APD patients showed a significantly higher early mortality compared to controls (5.3% vs. 3.5%, p = 0.011). Standard operating procedures should be developed to avoid lethal under-triage. Further studies should focus on detailed information about complications, secondary surgical procedures and preventable risk factors in relation to mortality.

Highlights

Preinjury anticoagulation therapy (AT) is associated with a higher risk for major bleeding
The matched-pair analyses were performed with 5,746 patients (2,873 pairs), resulting in 1,759, 677 and 437 pairs with Antiplatelet drugs (APD), vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC) pre-medication, respectively
Length of stay (LOS), intensive care unit (ICU) length of stay and intubation rates showed no differences within the three matchedpair analyses (Table 2)

Summary

Introduction

Preinjury anticoagulation therapy (AT) is associated with a higher risk for major bleeding. Pairs were grouped according to the drug used: Antiplatelet drugs (APD), vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC). Abbreviations AT Anticoagulant therapy AIS Abbreviated injury scale APD Antiplatelet drugs ASA American Society of Anesthesiologists AUC AUC—Academy for Trauma Surgery DGU German Trauma Society DOAC Direct oral anticoagulant ESP Emergency surgical procedures ICU Intensive Care Unit ISS Injury Severity Score LOS Length of stay PCC Prothrombin complex concentrates PRBC Packed red blood cells RISC II Revised Injury Severity Classification Score II SD Standard deviation TR-DGU TraumaRegister DGU TTS Tertiary Trauma Survery VKA Vitamin K antagonist. In up to 20% of geriatric trauma patients, occult hypoperfusion has been described[14] These risk factors may lead to under-triage, which is associated with a four-fold higher mortality in the geriatric trauma population compared to accurately triaged trauma p atients[15]. We evaluated the impact of preinjury AT treatment on surgery, thromboembolic events and mortality

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