Division of General Surgery, Trauma and Surgical Critical Care, Yale School of Medicine, New Haven, CT.
Division of General Surgery, Trauma and Surgical Critical Care, Yale School of Medicine, New Haven, CT.
J Surg Res. 2021 Oct;266:1-5. doi: 10.1016/j.jss.2021.04.002. Epub 2021 May 8.
Anticoagulation (AC) is associated with worse outcomes after trauma in some but not all studies. To further investigate the effect of AC on outcomes in patients with splenic injury, we analyzed the Trauma Quality Programs Participant Use File (PUF) METHODS: The 2017 PUF was used to identify adult (18+ y) with all mechanisms and grades of splenic injury. Demographics, comorbidities, hospital course and outcomes were compared between AC and non-AC patients.
A total of 18,749 patients were included, 622 were on AC. The AC patients were older but had comparable gender composition to non-AC patients. Injury Severity Score (18.2 versus 22.5) and rates of serious (AIS ≥ 3) injury were all lower in the AC group (P = 0.001). AC patients received fewer units of RBC (5.7 versus 8.0 units, P < 0.001) and FFP (3.9 versus 5.4 units, P < 0.001) in the first 24 h but underwent angiography at similar rates (23.6 versus 24.5%, P = 0.8). Among those who underwent angiography, patients were more likely to undergo embolization if they were on AC (89.7 versus 73.9%, P = 0.04). Rates of splenic surgery were comparable (19.3 versus 21.5%, P = 0.2) between AC versus non-AC patients. Median LOS was longer in AC patients (6.3 versus 5.6 d, P = 0.002). AC patients had a higher mortality (13.3 versus 7.0%, P = 0.001). In a multivariable binary logistic regression, AC was an independent risk factor for mortality with OR 1.4 (95% CI: 1.1-1.9) CONCLUSIONS: Anticoagulation is associated with increased mortality in patients with splenic injury.
在一些研究中，但不是所有研究中，抗凝（AC）与创伤后不良结局相关。为了进一步研究 AC 对脾损伤患者结局的影响，我们分析了创伤质量计划参与者使用文件（PUF）
使用 2017 年 PUF 确定所有机制和脾损伤程度的成年（18+岁）患者。比较 AC 与非 AC 患者的人口统计学、合并症、住院过程和结局。
共纳入 18749 例患者，其中 622 例患者接受 AC。AC 患者年龄较大，但与非 AC 患者的性别构成比相似。AC 组的损伤严重度评分（18.2 与 22.5）和严重损伤（AIS ≥ 3）发生率均较低（P = 0.001）。AC 患者在 24 小时内接受的 RBC（5.7 与 8.0 单位，P < 0.001）和 FFP（3.9 与 5.4 单位，P < 0.001）较少，但接受血管造影的比例相似（23.6 与 24.5%，P = 0.8）。在接受血管造影的患者中，如果接受 AC，则更有可能进行栓塞（89.7 与 73.9%，P = 0.04）。AC 与非 AC 患者的脾切除术率相似（19.3 与 21.5%，P = 0.2）。AC 患者的中位 LOS 较长（6.3 与 5.6 天，P = 0.002）。AC 患者的死亡率更高（13.3 与 7.0%，P = 0.001）。在多变量二项逻辑回归中，AC 是死亡率的独立危险因素，OR 为 1.4（95%CI：1.1-1.9）
抗凝与脾损伤患者的死亡率增加相关。
