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Association between anticoagulants and mortality and functional outcomes in older patients with major trauma

Nobuhiro Sato, Peter Cameron, Susan Mclellan, Ben Beck, Belinda Gabbe Orcid Logo

Emergency Medicine Journal, Volume: 39, Issue: 10, Pages: emermed - 2019

Swansea University Author: Belinda Gabbe Orcid Logo

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DOI (Published version): 10.1136/emermed-2019-209368

Abstract

The number of trauma patients taking anticoagulants and antiplatelet agents is increasing as society ages. However, there have been limited and inconsistent reports of the association between anticoagulants and mortality and functional outcomes. This study aimed to quantify the association between a...

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Published in: Emergency Medicine Journal
ISSN: 1472-0205 1472-0213
Published: BMJ 2021
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URI: https://cronfa.swan.ac.uk/Record/cronfa58430
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first_indexed 2021-10-20T11:27:46Z
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spelling 2023-01-04T15:37:42.0399323 v2 58430 2021-10-20 Association between anticoagulants and mortality and functional outcomes in older patients with major trauma 4bdcc94332b2bd10530c5e71ceb04f14 0000-0001-7096-7688 Belinda Gabbe Belinda Gabbe true false 2021-10-20 FGMHL The number of trauma patients taking anticoagulants and antiplatelet agents is increasing as society ages. However, there have been limited and inconsistent reports of the association between anticoagulants and mortality and functional outcomes. This study aimed to quantify the association between anticoagulant/antiplatelet medication at the time of injury and both short-term and longer-term outcomes in older major trauma patients. This was a population-based registry study using data from the Victorian State Trauma Registry from July 2017 to June 2018. We included patients with major trauma aged 65 years and older. The outcomes of interest were in-hospital mortality, hospital length of stay, intensive care unit length of stay and the Extended Glasgow Outcome Scale (GOS-E) at 6 months after injury. We examined the association between the outcomes and anticoagulants/antiplatelet agents at the time of injury and used multivariable logistic regression models to account for known confounders. There were 1323 older adults eligible for inclusion in the study, of which 249 (18.8%) were taking anticoagulants (n=8 were taking both anticoagulants and antiplatelet agents), 380 (28.7%) were taking antiplatelet agents and 694 (52.5%) were not using either. Any anticoagulant use was associated with higher odds of in-hospital mortality (adjusted OR (AOR), 2.38; 95% CI 1.58 to 3.59) compared with not using anticoagulants. No differences were observed in the GOS-E at 6 months after injury between any anticoagulants use, antiplatelet use and no anticoagulant use (anticoagulant AOR, 0.71; 95% CI 0.48 to 1.05, antiplatelet AOR, 1.02; 95% CI 0.73 to 1.42). Anticoagulant use at the time of injury was associated with higher odds of in-hospital mortality but did not adversely impact functional outcomes at 6 months after injury. These findings demonstrate the importance of seeking an accurate history of anticoagulant use and its indication, as well as the immediate initiation of reversal therapies. [Abstract copyright: © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.] Journal Article Emergency Medicine Journal 39 10 emermed 2019 BMJ 1472-0205 1472-0213 death/mortality, trauma, major trauma management, geriatrics, research 5 10 2021 2021-10-05 10.1136/emermed-2019-209368 COLLEGE NANME Medicine, Health and Life Science - Faculty COLLEGE CODE FGMHL Swansea University 2023-01-04T15:37:42.0399323 2021-10-20T12:24:49.7749235 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Nobuhiro Sato 1 Peter Cameron 2 Susan Mclellan 3 Ben Beck 4 Belinda Gabbe 0000-0001-7096-7688 5
title Association between anticoagulants and mortality and functional outcomes in older patients with major trauma
spellingShingle Association between anticoagulants and mortality and functional outcomes in older patients with major trauma
Belinda Gabbe
title_short Association between anticoagulants and mortality and functional outcomes in older patients with major trauma
title_full Association between anticoagulants and mortality and functional outcomes in older patients with major trauma
title_fullStr Association between anticoagulants and mortality and functional outcomes in older patients with major trauma
title_full_unstemmed Association between anticoagulants and mortality and functional outcomes in older patients with major trauma
title_sort Association between anticoagulants and mortality and functional outcomes in older patients with major trauma
author_id_str_mv 4bdcc94332b2bd10530c5e71ceb04f14
author_id_fullname_str_mv 4bdcc94332b2bd10530c5e71ceb04f14_***_Belinda Gabbe
author Belinda Gabbe
author2 Nobuhiro Sato
Peter Cameron
Susan Mclellan
Ben Beck
Belinda Gabbe
format Journal article
container_title Emergency Medicine Journal
container_volume 39
container_issue 10
container_start_page emermed
publishDate 2021
institution Swansea University
issn 1472-0205
1472-0213
doi_str_mv 10.1136/emermed-2019-209368
publisher BMJ
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 0
active_str 0
description The number of trauma patients taking anticoagulants and antiplatelet agents is increasing as society ages. However, there have been limited and inconsistent reports of the association between anticoagulants and mortality and functional outcomes. This study aimed to quantify the association between anticoagulant/antiplatelet medication at the time of injury and both short-term and longer-term outcomes in older major trauma patients. This was a population-based registry study using data from the Victorian State Trauma Registry from July 2017 to June 2018. We included patients with major trauma aged 65 years and older. The outcomes of interest were in-hospital mortality, hospital length of stay, intensive care unit length of stay and the Extended Glasgow Outcome Scale (GOS-E) at 6 months after injury. We examined the association between the outcomes and anticoagulants/antiplatelet agents at the time of injury and used multivariable logistic regression models to account for known confounders. There were 1323 older adults eligible for inclusion in the study, of which 249 (18.8%) were taking anticoagulants (n=8 were taking both anticoagulants and antiplatelet agents), 380 (28.7%) were taking antiplatelet agents and 694 (52.5%) were not using either. Any anticoagulant use was associated with higher odds of in-hospital mortality (adjusted OR (AOR), 2.38; 95% CI 1.58 to 3.59) compared with not using anticoagulants. No differences were observed in the GOS-E at 6 months after injury between any anticoagulants use, antiplatelet use and no anticoagulant use (anticoagulant AOR, 0.71; 95% CI 0.48 to 1.05, antiplatelet AOR, 1.02; 95% CI 0.73 to 1.42). Anticoagulant use at the time of injury was associated with higher odds of in-hospital mortality but did not adversely impact functional outcomes at 6 months after injury. These findings demonstrate the importance of seeking an accurate history of anticoagulant use and its indication, as well as the immediate initiation of reversal therapies. [Abstract copyright: © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.]
published_date 2021-10-05T04:14:57Z
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