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. Data are available upon reasonable request.

中文翻译：

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抗凝药物与患有重大创伤的老年患者的死亡率和功能结果之间的关联


背景随着社会老龄化，服用抗凝剂和抗血小板剂的创伤患者数量不断增加。然而，关于抗凝剂与死亡率和功能结果之间关系的报道有限且不一致。本研究旨在量化老年重大创伤患者受伤时的抗凝/抗血小板药物与短期和长期结果之间的关联。方法 这是一项基于人群的登记研究，使用了 2017 年 7 月至 2018 年 6 月维多利亚州创伤登记处的数据。我们纳入了 65 岁及以上患有严重创伤的患者。感兴趣的结果是伤后 6 个月的院内死亡率、住院时间、重症监护室住院时间和扩展格拉斯哥结果量表 (GOS-E)。我们检查了受伤时结果与抗凝剂/抗血小板剂之间的关联，并使用多变量逻辑回归模型来解释已知的混杂因素。结果 1323 名老年人符合纳入研究的条件，其中 249 名（18.8%）正在服用抗凝药物（n = 8 名同时服用抗凝剂和抗血小板药物），380 名（28.7%）正在服用抗血小板药物，694 名（52.5%）正在服用抗血小板药物。 ）也没有使用。与不使用抗凝剂相比，任何抗凝剂的使用都与较高的院内死亡率相关（调整后 OR (AOR)，2.38；95% CI 1.58 至 3.59）。受伤后 6 个月时，使用任何抗凝剂、使用抗血小板剂和不使用抗凝剂之间的 GOS-E 没有观察到差异（抗凝剂 AOR，0.71；95% CI 0.48 至 1.05，抗血小板剂 AOR，1.02；95% CI 0.73 至 1.42） 。 结论 受伤时使用抗凝药物与较高的​​院内死亡率相关，但不会对受伤后 6 个月的功能结果产生不利影响。这些发现证明了寻找准确的抗凝药物使用史及其适应症以及立即开始逆转治疗的重要性。数据可根据合理要求提供。