Dell Seton Medical Center at the University of Texas at Austin, TX, United States.
University of California, San Diego, United States.
Am J Surg. 2021 Aug;222(2):264-269. doi: 10.1016/j.amjsurg.2020.12.034. Epub 2021 Jan 6.
Drug-specific agents for the reversal of direct oral anticoagulants (DOACs) were recently approved. We hypothesized that the approval of these reversal agents would lead improved outcomes for trauma patients taking DOACs.
A multicenter, prospective (2015-2018), observational study of all adult trauma patients taking DOACs who were admitted to one of fifteen participating trauma centers was performed. The primary outcome was mortality.
For 606 trauma patients on DOACs, those reversed were older (78 vs. 74, p = 0.007), more severely injured (ISS: 16 vs. 5, p < 0.0001), had more severe head injuries (Head AIS: 2.9 vs. 1.3, p < 0.0001), and higher mortality (11% vs. 3%, p = 0.001). Patients who received drug-specific agents (idarucizumab, andexanet alfa) had higher mortality (30% vs. 8%, p = 0.04) than those reversed with factor concentrates. However, the low usage of drug-specific reversal agents limits our ability to assess their efficacy and safety.
DOAC reversal was not independently associated with mortality. At present, the overall usage of drug-specific reversal agents is too sparing to meaningfully assess outcomes in trauma.
直接口服抗凝剂（DOAC）的特异性药物最近已获得批准。我们假设这些逆转剂的批准将改善服用 DOAC 的创伤患者的预后。
进行了一项多中心、前瞻性（2015-2018 年）观察性研究，纳入了 15 家参与的创伤中心收治的所有服用 DOAC 的成年创伤患者。主要结局为死亡率。
对于 606 例服用 DOAC 的创伤患者，逆转组的年龄更大（78 岁比 74 岁，p=0.007），损伤更严重（ISS：16 分比 5 分，p<0.0001），颅脑损伤更严重（头部 AIS：2.9 比 1.3，p<0.0001），死亡率更高（11%比 3%，p=0.001）。接受特异性药物（依达鲁单抗、andexanet Alfa）逆转的患者死亡率更高（30%比 8%，p=0.04），而接受因子浓缩物逆转的患者死亡率较低。然而，特异性逆转药物的低使用率限制了我们评估其疗效和安全性的能力。
DOAC 逆转与死亡率无独立相关性。目前，特异性逆转药物的总体使用率过低，无法对创伤患者的结局进行有意义的评估。
