1
|
Naito K, Funakoshi H, Takahashi J. Association of antiplatelet or anticoagulant agents with in-hospital mortality among blunt torso trauma patients without severe traumatic brain injury: A retrospective analysis of the Japanese nationwide trauma registry. Injury 2023; 54:70-74. [PMID: 35934568 DOI: 10.1016/j.injury.2022.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 02/02/2023]
Abstract
AIM Patients with head trauma who take antiplatelet or anticoagulant (APAC) agents have a higher rate of mortality. However, the association between these agents and mortality among blunt torso trauma patients without severe traumatic brain injury remains unclear. METHODS Using the Japanese nationwide trauma registry, we conducted a retrospective cohort study including adult patients with blunt torso trauma without severe head trauma between January 2019 and December 2020. Eligible patients were divided into two groups based on whether or not they took any APAC agents. The primary outcome was in-hospital mortality. To adjust for potential confounding factors, we conducted random effects logistic regression to account for patients clustering within the hospitals. The model was adjusted for potential confounders, including age, mechanism of injury, Charlson comorbidity index, systolic blood pressure, and injury severity scale on arrival as potentially confounding factors. RESULTS During the study period, 16,201 patients were eligible for the analysis. A total of 832 patients (5.1%) were taking antiplatelet or anticoagulant agents. Overall in-hospital mortality was 774 patients (4.8%). APAC group had a higher risk of in-hospital mortality compared with the non-APAC group (6.9% vs. 4.7%; unadjusted OR, 1.51; 95% CI, 1.12-2.00; P < 0.01). After adjusting for potential confounder, there were no significant intergroup difference in a higher in-hospital mortality compared to with the non-APAC group (OR, 1.07; 95%CI, 0.65-1.77; P = 0.79). CONCLUSION The use of APAC agents before the injury was not associated with higher in-hospital mortality among blunt torso trauma patients without severe traumatic brain injury.
Collapse
Affiliation(s)
- Keiko Naito
- Department of Emergency and Critical Care Medicine, Tokyobay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba 279-0001, Japan.
| | - Hiraku Funakoshi
- Department of Emergency and Critical Care Medicine, Tokyobay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba 279-0001, Japan
| | - Jin Takahashi
- Department of Emergency and Critical Care Medicine, Tokyobay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba 279-0001, Japan
| |
Collapse
|
2
|
O'Brien T, Mitra B, Le Sage N, Tardif PA, Emond M, D'Astous M, Mercier E. Clinically significant traumatic intracranial hemorrhage following minor head trauma in older adults: a retrospective cohort study. Brain Inj 2020; 34:834-839. [PMID: 32286890 DOI: 10.1080/02699052.2020.1753242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The primary objective of this study was to determine the incidence of clinically significant traumatic intracranial hemorrhage (T-ICH) following minor head trauma in older adults. Secondary objective was to investigate the impact of anticoagulant and antiplatelet therapies on T-ICH incidence. METHODS This retrospective cohort study extracted data from electronic patient records. The cohort consisted of patients presenting after a fall and/or head injury and presented to one of five ED between 1st March 2010 and 31st July 2017. Inclusion criteria were age ≥ 65 years old and a minor head trauma defined as an impact to the head without fulfilling criteria for traumatic brain injury. RESULTS From the 1,000 electronic medical records evaluated, 311 cases were included. The mean age was 80.1 (SD 7.9) years. One hundred and eighty-nine (189) patients (60.8%) were on an anticoagulant (n = 69), antiplatelet (n = 130) or both (n = 16). Twenty patients (6.4%) developed a clinically significant T-ICH. Anticoagulation and/or antiplatelets therapies were not associated with an increased risk of clinically significant T-ICH in this cohort (Odds ratio (OR) 2.7, 95% CI 0.9-8.3). CONCLUSIONS In this cohort of older adults presenting to the ED following minor head trauma, the incidence of clinically significant T-ICH was 6.4%.
Collapse
Affiliation(s)
- Toby O'Brien
- Axe Santé Des Populations Et Pratiques Optimales En Santé, Unité De Recherche En Traumatologie - Urgence - Soins Intensifs, Centre De Recherche Du CHU De Québec, Université Laval , Québec, Canada.,National Trauma Research Institute, Alfred Hospital , Melbourne, Australia
| | - Biswadev Mitra
- National Trauma Research Institute, Alfred Hospital , Melbourne, Australia.,Canada Département De Médecine Familiale Et Médecine d'Urgence, Faculté De Médecine, Université Laval , Québec, Canada
| | - Natalie Le Sage
- Axe Santé Des Populations Et Pratiques Optimales En Santé, Unité De Recherche En Traumatologie - Urgence - Soins Intensifs, Centre De Recherche Du CHU De Québec, Université Laval , Québec, Canada.,School of Public Health and Preventive Medicine, Monash University , Melbourne, Australia
| | - Pier-Alexandre Tardif
- Axe Santé Des Populations Et Pratiques Optimales En Santé, Unité De Recherche En Traumatologie - Urgence - Soins Intensifs, Centre De Recherche Du CHU De Québec, Université Laval , Québec, Canada
| | - Marcel Emond
- Axe Santé Des Populations Et Pratiques Optimales En Santé, Unité De Recherche En Traumatologie - Urgence - Soins Intensifs, Centre De Recherche Du CHU De Québec, Université Laval , Québec, Canada.,School of Public Health and Preventive Medicine, Monash University , Melbourne, Australia.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval , Quebec, Canada
| | - Myreille D'Astous
- Service of Neurosurgery, Department of Surgery, CHU De Québec, Université Laval , Québec, Canada
| | - Eric Mercier
- Axe Santé Des Populations Et Pratiques Optimales En Santé, Unité De Recherche En Traumatologie - Urgence - Soins Intensifs, Centre De Recherche Du CHU De Québec, Université Laval , Québec, Canada.,School of Public Health and Preventive Medicine, Monash University , Melbourne, Australia.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval , Quebec, Canada
| |
Collapse
|
3
|
Fernando SM, Mok G, Castellucci LA, Dowlatshahi D, Rochwerg B, McIsaac DI, Carrier M, Wells PS, Bagshaw SM, Fergusson DA, Tanuseputro P, Kyeremanteng K. Impact of Anticoagulation on Mortality and Resource Utilization Among Critically Ill Patients With Major Bleeding. Crit Care Med 2020; 48:515-524. [PMID: 32205598 DOI: 10.1097/ccm.0000000000004206] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Patients with major bleeding are commonly admitted to the ICU. A growing number are on either oral or parenteral anticoagulation, but the impact of anticoagulation on patient outcomes is unknown. We sought to examine this association between anticoagulation therapy and mortality, as well as the independent effects of warfarin compared to direct oral anticoagulants. DESIGN Analysis of a prospectively collected registry (2011-2017) of consecutive ICU patients admitted with major bleeding (as defined by International Society on Thrombosis and Haemostasis clinical criteria). SETTING Two hospitals within a single tertiary care level hospital system. PATIENTS We analyzed 1,598 patients identified with major bleeding, of which 245 (15.3%) had been using anticoagulation at the time of ICU admission. Of patients on anticoagulation, 149 were using warfarin, and 60 were using a direct oral anticoagulant. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome, in-hospital mortality, was analyzed using a multivariable logistic regression model. Patients with anticoagulation-associated major bleeding had higher in-hospital mortality (adjusted odds ratio, 1.49; 95% CI, 1.16-1.92). Among survivors, anticoagulation use was associated with longer median hospital length of stay, and higher mean costs. No differences in hospital mortality were seen between warfarin- and direct oral anticoagulant-associated major bleeding. Patients with warfarin-associated major bleeding had longer median length of stay (11 vs 6 d; p = 0.02), and higher total costs than patients with direct oral anticoagulant-associated major bleeding. CONCLUSIONS Among ICU patients admitted with major bleeding, pre-admission anticoagulation use was associated with increased hospital mortality, prolonged length of stay, and higher costs among survivors. As compared to direct oral anticoagulants, patients with warfarin-associated major bleeding had increased length of stay and costs. These findings have important implications in the care of ICU patients with major bleeding.
Collapse
Affiliation(s)
- Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Garrick Mok
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Daniel I McIsaac
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Dean A Fergusson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Peter Tanuseputro
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
4
|
Consideration of Anticoagulation: Surgical Care for the Elderly in Current Geriatrics Reports. CURRENT GERIATRICS REPORTS 2019. [DOI: 10.1007/s13670-019-00290-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
5
|
Open Repair of a Ruptured Abdominal Aortic Aneurysm on a Patient Under Rivaroxaban and Clopidogrel. Ann Vasc Surg 2019; 58:379.e5-379.e8. [PMID: 30684617 DOI: 10.1016/j.avsg.2018.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/23/2018] [Accepted: 09/24/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Direct oral anticoagulants are commonly used instead of vitamin K antagonists in patients needing long-term anticoagulant treatment. As their use has become more popular, there is an increase possibility to perform a major surgery on an urgent or emergency basis on patients under nonvitamin-K antagonist oral anticoagulants. CASE REPORT We report a case of a ruptured abdominal aortic aneurysm on a male patient under rivaroxaban and clopidogrel. Emergency open repair of the aneurysm was performed. No anti-Xa antidote was administered. The patient had an uneventful recovery. CONCLUSION An open repair of a ruptured abdominal aortic aneurysm under rivaroxaban is feasible. However, an antidote should be available in cases of uncontrolled diffused bleeding. To the best of our knowledge, this is the first reported case of successful open repair of a ruptured abdominal aortic aneurysm on a patient under rivaroxaban and clopidogrel.
Collapse
|
6
|
Dunn JA, Schroeppel TJ, Metzler M, Cribari C, Corey K, Boyd DR. History and significance of the trauma resuscitation flow sheet. Trauma Surg Acute Care Open 2018; 3:e000145. [PMID: 30402554 PMCID: PMC6203133 DOI: 10.1136/tsaco-2017-000145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 07/25/2018] [Accepted: 08/08/2018] [Indexed: 11/08/2022] Open
Abstract
There is little to no written information in the literature regarding the origin of the trauma flow sheet. This vital document allows programs to evaluate initial processes of trauma care. This information populates the trauma registry and is reviewed in nearly every Trauma Process Improvement and Patient Safety conference when discerning the course of patient care. It is so vital, a scribe is assigned to complete this documentation task for all trauma resuscitations, and there are continual process improvement efforts in trauma centers across the nation to ensure complete and accurate data collection. Indeed, it is the single most important document reviewed by the verification committee when evaluating processes of care at site visits. Trauma surgeons often overlook its importance during resuscitation, as recording remains the domain of the trauma scribe. Yet it is the first document scrutinized when the outcome is less than what is expected. The development of the flow sheet is not a result of any consensus statement, expert work group, or mandate, but a result of organic evolution due to the need for relevant and better data. The purpose of this review is to outline the origin, importance, and critical utility of the trauma flow sheet.
Collapse
Affiliation(s)
- Julie A Dunn
- Trauma and Acute Care Surgery, UC Health Medical Center of the Rockies, Loveland, Colorado, USA
| | - Thomas J Schroeppel
- Trauma and Acute Care Surgery, UC Health Memorial Hospital, Colorado Springs, Colorado, USA
| | - Michael Metzler
- Trauma and Acute Care Surgery, UC Health Medical Center of the Rockies, Loveland, Colorado, USA
| | - Chris Cribari
- Trauma and Acute Care Surgery, UC Health Medical Center of the Rockies, Loveland, Colorado, USA
- Trauma and Acute Care Surgery, UC Health Memorial Hospital, Colorado Springs, Colorado, USA
| | - Katherine Corey
- Trauma and Acute Care Surgery, UC Health Medical Center of the Rockies, Loveland, Colorado, USA
| | | |
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW The percentage of people over the age of 65 is growing rapidly and anesthesiologists must develop a medical understanding that is comprehensive to meet the unique medical needs of this population. The changing physiology of an elderly population makes them extremely vulnerable to trauma and the administration of blood products. Although most of these cases involve orthopedic attention, it is not less dangerous as a blunt trauma case. RECENT FINDINGS This article addresses some of the main concerns for the anesthesiologists of providing a hemostatic resuscitation in the geriatric population. Should blood that is new lead to better outcomes than blood that was collected more than 14 days from the injury? What role does patient frailty have in trauma and transfusion outcomes? Is the massive transfusion protocol safe for the geriatric population? As this subset of the population grows, the number of patients on anticoagulation therapy will grow. Knowledge of the bone marrow plays an important role in geriatric trauma. How does head trauma in the elderly differ from the younger patient? SUMMARY The information in this article is by no means comprehensive. Nongeriatric trauma protocols are far from being validated. Applying these protocols to the geriatric protocols must be investigated in terms of safety and benefits.
Collapse
Affiliation(s)
- Corey S Scher
- New York University School of Medicine, Bellevue Hospital, New York City, New York, USA
| |
Collapse
|