Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
Department of Surgical Intensive Care, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
Sci Rep. 2021 Jul 26;11(1):15172. doi: 10.1038/s41598-021-94675-7.
Preinjury anticoagulation therapy (AT) is associated with a higher risk for major bleeding. We aimed to evaluated the influence of preinjury anticoagulant medication on the clinical course after moderate and severe trauma. Patients in the TraumaRegister DGU ≥ 55 years who received AT were matched with patients not receiving AT. Pairs were grouped according to the drug used: Antiplatelet drugs (APD), vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC). The primary end points were early (< 24 h) and total in-hospital mortality. Secondary endpoints included emergency surgical procedure rates and surgery rates. The APD group matched 1759 pairs, the VKA group 677 pairs, and the DOAC group 437 pairs. Surgery rates were statistically significant higher in the AT groups compared to controls (APD group: 51.8% vs. 47.8%, p = 0.015; VKA group: 52.4% vs. 44.8%, p = 0.005; DOAC group: 52.6% vs. 41.0%, p = 0.001). Patients on VKA had higher total in-hospital mortality (23.9% vs. 19.5%, p = 0.026), whereas APD patients showed a significantly higher early mortality compared to controls (5.3% vs. 3.5%, p = 0.011). Standard operating procedures should be developed to avoid lethal under-triage. Further studies should focus on detailed information about complications, secondary surgical procedures and preventable risk factors in relation to mortality.
受伤前抗凝治疗（AT）与大出血风险增加相关。我们旨在评估受伤前抗凝药物对中重度创伤后临床病程的影响。在 TraumaRegister DGU ≥ 55 岁且接受 AT 的患者中，与未接受 AT 的患者进行匹配。根据使用的药物将患者分为抗血小板药物（APD）、维生素 K 拮抗剂（VKA）和直接口服抗凝剂（DOAC）组。主要终点为早期（<24 小时）和总住院死亡率。次要终点包括急诊手术率和手术率。APD 组匹配了 1759 对，VKA 组匹配了 677 对，DOAC 组匹配了 437 对。与对照组相比，AT 组的手术率明显更高（APD 组：51.8%比 47.8%，p=0.015；VKA 组：52.4%比 44.8%，p=0.005；DOAC 组：52.6%比 41.0%，p=0.001）。VKA 组总住院死亡率较高（23.9%比 19.5%，p=0.026），而 APD 患者的早期死亡率明显高于对照组（5.3%比 3.5%，p=0.011）。应制定标准操作程序以避免致命的分诊不足。进一步的研究应重点关注与死亡率相关的并发症、二次手术和可预防风险因素的详细信息。
