RT Journal Article
SR Electronic
T1 The effect of preinjury warfarin use on mortality rates in trauma patients: a European multicentre study
JF Emergency Medicine Journal
JO Emerg Med J
FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine
SP 916
OP 920
DO 10.1136/emermed-2014-203959
VO 32
IS 12
A1 Fiona E Lecky
A1 Mahad Omar
A1 Omar Bouamra
A1 Tom Jenks
A1 Antoinette Edwards
A1 Ceri E Battle
A1 Phillip A Evans
YR 2015
UL http://emj.bmj.com/content/32/12/916.abstract
AB Objective To define the relationship between preinjury warfarin use and mortality in a large European sample of trauma patients.Methods A multicentred study was conducted using data collated from European (predominately English and Welsh) trauma receiving hospitals. Patient data from the Trauma Audit and Research Network database from 2009 to 2013 were analysed. Univariate and multivariate logistic regression was used to estimate OR for mortality associated with preinjury warfarin use in the whole adult trauma cohort and a matched sample of patients comparable in terms of age, gender, GCS, pre-existing medical conditions and injury severity.Results A total of 136 617 adult trauma patients (2009–2013) were included, with 499 patients reported to be using warfarin therapy at the time of trauma. Preinjury warfarin use was associated with a significantly higher mortality rate at 30 days postinjury compared with the non-users. Following adjustment of age, injury severity and GCS, preinjury warfarin use was associated with increased mortality in trauma patients (adjusted OR 2.14; 95% CI 1.66 to 2.76; p<0.001). In the matched subset, 22% of warfarinised trauma patients died compared with 16.3% of non-warfarinised trauma patients with comparable age, injury severity and GCS (adjusted OR 1.94; 95% CI 1.25 to 3.01; p=0.003).Conclusions Preinjury warfarin use has been demonstrated to be an independent predictor of mortality in trauma patients. Clinicians managing major trauma patients on warfarin need to be aware of the vulnerability of this group.