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Injury. 2017 Jan;48(1):47-50. doi: 10.1016/j.injury.2016.08.016. Epub 2016 Aug 27.

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

Author information

1
Saint Francis Hospital and Medical Center, Department of Surgery, 114 Woodland St. Hartford, CT 06103, USA; University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT 06030, USA. Electronic address: feeneymd@yahoo.com.
2
Saint Francis Hospital and Medical Center, Department of Emergency Medicine, 114 Woodland St. Hartford, CT 06103, USA; University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT 06030, USA.
3
Trinity College, 300 Summit Street, Hartford, CT 06106, USA.
4
Saint Francis Hospital and Medical Center, Department of Surgery, 114 Woodland St. Hartford, CT 06103, USA; University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT 06030, USA.

Abstract

METHODS:

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.

RESULTS:

There 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).

CONCLUSION:

In 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.

KEYWORDS:

Acquired coagulopathy; Direct oral anticoagulants; Severe trauma; Warfarin

PMID:
27582383
DOI:
10.1016/j.injury.2016.08.016
[Indexed for MEDLINE]

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