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Am J Surg. 2016 Dec;212(6):1237-1242. doi: 10.1016/j.amjsurg.2016.09.036. Epub 2016 Oct 1.

The effect anticoagulation status on geriatric fall trauma patients.

Author information

1
Department of Surgery, University of Toledo, 3000 Arlington Avenue, Toledo, OH 43614, USA. Electronic address: Julia.e.roberts@ucdenver.edu.
2
Department of Surgery, University of Toledo, 3000 Arlington Avenue, Toledo, OH 43614, USA.

Abstract

BACKGROUND:

This research study aims to identify the effect of anticoagulation status on hospital course, complications, and outcomes among geriatric fall trauma patients.

METHODS:

The study design is a retrospective cohort study, looking at fall trauma among patients aged 60 to 80 years from 2009 to 2013 at a university hospital in the United States. The statistical analysis, conducted with SPSS software with a threshold for statistical significance of P < .05, was stratified by anticoagulation status and then further by type of anticoagulation (aspirin, warfarin, clopidogrel, enoxaparin, and dipyridamole). Outcomes variables include mortality, length of stay (LOS), intensive care unit (ICU) admission, and complications.

RESULTS:

The total number of patients included in this study was 1,121. Compared with patients not on anticoagulation, there was a higher LOS among patients on anticoagulation (6.3 ± 6.2 vs 4.9 ± 5.2, P = .001). A higher LOS (7.2 ± 6.8 vs 5.0 ± 5.3, P = .001) and days in the ICU (2.1 ± 5.4 vs 1.1 ± 3.8, P = .010) was observed in patients on warfarin. A higher mortality (7.1% vs 2.8%, P = .013), LOS (6.3 ± 6.2 vs 5.1 ± 5.396, P = .036), and complication rate (49.1 vs 36.7, P = .010) was observed among patients on clopidogrel.

CONCLUSIONS:

In this study, a higher mortality and complication rate were seen among clopidogrel, and a greater LOS and number of days in the ICU were seen in patients on warfarin. These differences are important, as they can serve as a screening tool for triaging the severity of a geriatric trauma patient's condition and complication risk. For patients on clopidogrel, it is essential that these patients are recognized early as high-risk patients who will need to be monitored more closely. For patients on clopidogrel or warfarin, bridging a patient's anticoagulation should be initiated as soon as possible to prevent unnecessary increased LOS. At last, these data also provide support against prescribing patients clopidogrel when other anticoagulation options are available.

KEYWORDS:

Anticoagulation; Clopidogrel; Fall; Geriatric; Trauma; Warfarin

PMID:
27889266
DOI:
10.1016/j.amjsurg.2016.09.036
[Indexed for MEDLINE]

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