Elsevier

Surgery

Volume 150, Issue 4, October 2011, Pages 861-868
Surgery

Central Surgical Association
Impact of preinjury warfarin and antiplatelet agents on outcomes of trauma patients

Presented at the 67th Annual Meeting of the Central Surgical Society, Detroit, Michigan, March 17-19, 2011.
https://doi.org/10.1016/j.surg.2011.07.070Get rights and content

Background

Warfarin and antiplatelet agents (WAA) are prevalent among trauma patients, but the impact of these agents on patient outcomes has not been clearly defined. In this study, we examined the impact of preinjury WAA on outcomes in trauma patients.

Methods

A 40-month (September 2004 to December 2007) retrospective review of data in the trauma registry at a New York State level 1 trauma center was performed. Patients on WAA were compared to those not on these medications. The primary outcome of interest was mortality, and the secondary outcomes of interest were as length of stay (LOS) and disposition on discharge. A separate analysis was done for patients with intracranial hemorrhage (ICH). The chi-square test, the Student t test, and the modified Poisson regression analysis were used to estimate the incident risk ratios for the outcomes.

Results

A total of 3,436 trauma patients were identified, of whom 456 were taking anticoagulants (warfarin, n = 91 patients; aspirin, n = 228; clopidogrel, n = 43; and various combinations, n = 94). Patients on warfarin were 3.1 times more likely to die (relative risk [RR], 3.2; 95% confidence interval [CI], 1.6–6.6), after adjusting for potential confounders. Aspirin and clopidogrel were not associated with increased mortality, but WAA were associated with increased risk of ICH (49.8% vs 30.5%; RR, −1.6; 95% CI, 1.4–1.9). WAA did not affect LOS or disposition. Among patients with ICH, only warfarin increased mortality (28.9% vs 5.8%; RR, −3.1; 95% CI, 1.3–7.2).

Conclusion

Preinjury warfarin treatment was found to be an independent risk factor for mortality. WAA agents increased risk of ICH. Among those patients with ICH, only warfarin was associated with increased mortality. Antiplatelet agents did not affect mortality or LOS.

Section snippets

Methods

After approval by an institutional review board, data were obtained retrospectively from the trauma registry at a New York State level 1 trauma center over a 40-month period from September 2004 to December 2007. Eligible patients consisted of all trauma patients who met inclusion criteria of the New York State Trauma Registry. Patients were divided into groups: patients taking only warfarin or clopidogrel or aspirin or various combinations of these drugs or compared to a control group of

Patient demographics and study variables

For the 40-month period, 3,436 patients were identified in the trauma registry. Patient demographics and distribution of the study variables associated significantly with the risk of mortality on bivariate analysis are presented in Table I; this Table also lists the distribution of patients who took various combinations of the WAA medications before injury. Overall, greater than 50% patients had an ISS >15. Nearly 70% of patient with ICH had an ISS >15.

Of the 3,436 patients in this study, 456

Discussion

This study supports other studies reporting that preinjury use of medications that alter bleeding time and coagulation were associated with a greater overall mortality and a greater rate of traumatic brain injury. All-cause mortality was associated independently with warfarin use but not with the use of aspirin or clopidogrel. Lack of differences in ICU stay and hospital LOS may be because of some early deaths in the WAA group. Increased early deaths in the WAA group also could explain why

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