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Original research
Association between anticoagulants and mortality and functional outcomes in older patients with major trauma
  1. Nobuhiro Sato1,
  2. Peter Cameron1,2,
  3. Susan Mclellan1,
  4. Ben Beck1,3,
  5. Belinda Gabbe1,4
  1. 1 School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  2. 2 Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia
  3. 3 Faculty of Medicine, Laval University, Quebec, Québec, Canada
  4. 4 Health Data Research UK, Swansea University, Swansea, West Glamorgan, UK
  1. Correspondence to Dr Nobuhiro Sato, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; nobuhiro.sato{at}monash.edu

Abstract

Background 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.

Methods 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.

Results 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).

Conclusion 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.

  • trauma
  • research
  • geriatrics
  • major trauma management
  • death/mortality

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/emermed-2019-209368

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Handling editor Ellen J Weber

    • Twitter @Nobu_2Sato, @DrBenBeck

    • Contributors NS conceived the study. PC, BB, SM and BG supervised the conduct of the trial and data collection. NS and SM managed the data, including quality control. PC and BG provided statistical advice on the study design and analysed the data. NS and PC chaired the data oversight committee. NS, PC, BB and BG drafted the manuscript, and all authors contributed substantially to its revision. NS takes responsibility for the paper as a whole. All authors read and approved the final manuscript.

    • Funding BB was supported by an Australian Research Council Discovery Early Career Researcher Award Fellowship (DE180100825). PC was supported by a Medical Research Futures Fund (MRFF) Practitioner Fellowship. BG was supported by an Australian Research Council Future Fellowship (FT170100048). The Victorian State Trauma Registry is a Department of Health, State Government of Victoria and Transport Accident Commission funded project.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.