The impact of preinjury antithrombotic medication on hemostatic interventions in trauma patients

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• 作者：Daisuke Kudo ; MD ; PhD^a ; ^{kudodaisuke@med.tohoku.ac.jp} ; Shigeki Kushimoto ; MD ; PhD^a ; ^{kussie@emergency-medicine.med.tohoku.ac.jp} ; Atsushi Shiraishi ; MD ; PhD^b ; ^c ; ^{siris.accm@tmd.ac.jp} ; Hiroshi Ogura ; MD ; PhD^d ; ^{ogura@hp-emerg.med.osaka-u.ac.jp} ; Akiyoshi Hagiwara ; MD ; PhD^e ; ^{kudodaisuke@med.tohoku.ac.jp} ; Daizoh Saitoh ; MD ; PhD^f ; ^{ds0711@ndmc.ac.jp} ; J-OCTET Investigators
• 刊名：The American Journal of Emergency Medicine
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：35
• 期：1
• 页码：62-65
• 全文大小：265 K
• 卷排序：35

文摘

The purpose of this study was to determine whether preinjury medication with antithrombotic agents was related to an increase in hemostatic interventions in patients with severe trauma without traumatic brain injury.MethodsConsecutive trauma patients who were admitted to the emergency departments of the study hospitals with an injury severity score ≥16 were enrolled in this retrospective, observational, multicenter study of coagulation in the acute phase of severe trauma. Patients without a traumatic brain injury with an abbreviated injury scale ≥3 were evaluated. Patients were divided into those with and those without preinjury medication with antithrombotic agents. The impact of preinjury antithrombotic medication on the composite primary outcome, defined as administration of fresh frozen plasma ≥10 U and/or hemostatic treatment (surgery and/or interventional radiology) within 24 hours, was analyzed.ResultsThe preinjury medication group consisted of 20 (6.4%) of the total 312 patients. Preinjury medication was one of the independent risk factors for the composite outcome (odds ratio, 3.16; 95% confidence interval, 1.08-9.10; P < .05) adjusting for age, sex, and injury severity score on multivariate analysis. Preinjury antithrombotic therapy was also associated with hemostatic treatments within 24 hours (odds ratio, 3.40; 95% confidence interval, 1.16-9.85; P = .026). Survival time was not different between the 2 groups on Cox regression analysis.ConclusionsPreinjury antithrombotic medication in severe trauma patients without traumatic brain injury may be associated with a higher risk of hemostatic interventions.