Abstract
BackgroundBleeding represents the most well-known and the most feared complications caused by the use of antithrombotic agents. There is, however, limited documentation whether pre-injury use of antithrombotic agents affects outcome after head trauma. The aim of this study was to define the relationship between the use of preinjury antithrombotic agents and mortality among elderly people sustaining blunt head trauma.MethodsA retrospective cohort analysis was performed on the hospital based trauma registry at Oslo University Hospital. Patients aged 55 years or older sustaining blunt head trauma between 2004 and 2006 were included. Multivariable logistic regression analyses were used to identify independent predictors of 30-day mortality. Separate analyses were performed for warfarin use and platelet inhibitor use.ResultsOf the 418 patients admitted with a diagnosis of head trauma, 137 (32.8 %) used pre-injury antithrombotic agents (53 warfarin, 80 platelet inhibitors, and 4 both). Seventy patients died (16.7 %); 15 (28.3 %) of the warfarin users, 12 (15.0 %) of the platelet inhibitor users, and two (50 %) with combined use of warfarin and platelet inhibitors, compared to 41 (14.6 %) of the non-users. There was a significant interaction effect between warfarin use and the Triage Revised Trauma Score collected upon the patients’ arrival at the hospital. After adjusting for potential confounders, warfarin use was associated with increased 30-day mortality among patients with normal physiology (adjusted OR 8,3; 95 % CI, 2.0 to 34.8) on admission, but not among patients with physiological derangement on admission. Use of platelet inhibitors was not associated with increased mortality.ConclusionsThe use of warfarin before trauma was associated with increased 30-day mortality among a subset of patients. Use of platelet inhibitors before trauma was not associated with increased mortality. These results indicate that patients on preinjury warfarin may need closer monitoring and follow up after trauma despite normal physiology on admission to the emergency department.
Highlights
Bleeding represents the most well-known and the most feared complications caused by the use of antithrombotic agents
In 326 patients (78.0 %), anatomic injury was defined as major trauma (NISS ≥ 15), whereas physiological derangement (T-RTS ≤ 11) was present in 162 patients (38.8 %)
It seems like the negative impact of preinjury warfarin use on mortality is most pronounced in a subpopulation of patients with severe trauma and with normal physiology on admission
Summary
Bleeding represents the most well-known and the most feared complications caused by the use of antithrombotic agents. There is, limited documentation whether pre-injury use of antithrombotic agents affects outcome after head trauma. Intracranial bleeding, represents the most well-known and the most feared complications with use of antithrombotic agents, and is associated with a high morbidity and mortality. There is, limited documentation whether pre-injury use of antithrombotic agents affects mortality after blunt head trauma. A number of studies have described an increased risk of mortality in head trauma patients on preinjury warfarin [1,2,3,4,5], while other studies report no difference in outcome [6,7,8,9]. Larger studies from administrative- and trauma databases have shown an increased risk of mortality in trauma patients on preinjury warfarin [10,11,12]. The therapeutic anticoagulation, not the warfarin use itself, has been shown to be important [4, 13,14,15], indicating that anticoagulants may play a mechanistic role in the adverse outcomes and not serve as markers for co-morbidity that leads to worse outcome
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