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Halting anticoagulants in trauma patients may increase thrombosis risk

OCTOBER 23, 2017
Clinical Congress Daily Highlights, Monday First Edition

Trauma patients taking anticoagulants at the time of treatment may be at increased risk of deep vein thrombosis or pulmonary embolism if their medication is abruptly stopped — as is common following multisystem trauma — a retrospective review presented Monday finds.

The issue is especially significant in light of rising anticoagulant use among trauma center patients, said Samuel Kingsley, MD, Advocate Illinois Masonic Medical Center, Chicago, IL. Similar results have been found in two large randomized trials involving patients taking factor Xa inhibitors, which now carry a black box label warning about the risk of thrombotic events when discontinued.

The authors drew from a database of all adult admissions in the National Trauma Database from 2011–2014, a total of 2,693,887 patient records. The researchers identified for comparison purposes two groups: 1) all atrial fibrillation atrial flutter (AFAF) patients identified by diagnostic code as presenting with bleeding diathesis; and 2) all trauma patients in the period. All deep vein thrombosis and pulmonary emboli events were aggregated into a venous thromboembolism (VTE) index.

Using multivariate regression, the researchers then compared the unadjusted VTE rate within the general trauma population to that in the AFAF group, controlling for nearly 20 confounders such as age, type and severity of injury, hospital length of stay and others.

They found an unadjusted VTE rate of 1.07 percent across all trauma patients, compared with 2.28 percent among the AFAF population of 3,536 AFAF patients. The increased risk of VTE in AFAF patients held through the multivariate analysis, revealing an odds ratio of 1.876, which is larger in magnitude than for obesity and lower extremity trauma risk factors.

“Even after controlling for all those (confounders) we found we could not make the statistically significant odds ratio within this population with anticoagulants on board go away. So they are at a statistically significant increased risk compared with the baseline population,” Dr. Kingsley said.

He said that the results do not have clinical implications yet, but are a “jumping off point” for a prospective trial to help clarify best practices for managing anticoagulants in trauma patients.

Additional Information:
The Scientific Forum, Rebound Hypercoagulation in the Trauma Patient, was held October 23, at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available online at FACS.org/clincon2017.

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