Direct oral anticoagulants compared with warfarin in patients with severe blunt trauma

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• 作者：James M. Feeney^a ; ^c ; ^{feeneymd@yahoo.com} (MD ; FACS) ; Matthew Neulander ; MD^b ; ^c ; Monica DiFiori^d ; Lilla Kis^d ; David S. Shapiro^a ; ^c (MD ; FACS ; FCCM) ; Vijay Jayaraman ; MD^a ; ^c ; William T. Marshall III^a ; ^c (DO ; FACOS) ; Stephanie C. Montgomery^a ; ^c (MD ; FACS)
• 关键词：Severe trauma ; Direct oral anticoagulants ; Warfarin ; Acquired coagulopathy
• 刊名：Injury
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：48
• 期：1
• 页码：47-50
• 全文大小：256 K
• 卷排序：48

文摘

We queried our Trauma Quality Improvement Program registry for patients who presented between 6/1/2011 and 9/1/2015 with severe (injury severity score (ISS) > 15) blunt traumatic injury during anticoagulant use. Patients were then grouped into those prescribed warfarin and patients prescribed any of the available novel Direct Oral Anticoagulants (DOAC) medications. We excluded severe (AIS ≧ 4) head injuries.ResultsThere were no differences between DOAC and warfarin groups in terms of age, gender mean ISS, median hospital or intensive care unit lengths of stay, complication proportions, numbers of complications per patient, or the proportion of patients requiring transfusion. Finally, excluding patients who died, the observed proportion of discharge to skilled nursing facility was similar.In our sample of trauma patients, DOAC use was associated with significantly lower mortality (DOAC group 8.3% vs. warfarin group 29.5%, p < 0.015). The ratio of units transfused per patient was also lower in the DOAC group (2.8 ± 1.8 units/patient in the DOAC group vs. 6.7 ± 6.4 units per patient in the warfarin group; p = 0.001).ConclusionIn conclusion, we report an association with decrease in mortality and a decrease in transfused blood products in severely injured trauma patients with likely minimal or no head injury taking novel DOACs over those anticoagulated with warfarin for outpatient anticoagulation.