ArticleScandinavian journal of trauma, resuscitation and emergency medicine2017
The Anticoagulated trauma patient in the age of the direct oral anticoagulants: a Canadian perspective.
Article in Scandinavian journal of trauma, resuscitation and emergency medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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14 citing papers in PubMed, 32 citations in OpenAlex.
- Hematoma Coagulation is Associated with Perihematoma Edema Volume in Patients with Acute Intracerebral Hemorrhage.Neurocritical care · 2026Article
- [Point of care coagulation diagnostics-Absolutely necessary or only a reasonable supplement?]Die Anaesthesiologie · 2025Review
- Outcomes of trauma patients on chronic antithrombotic therapies in a trauma center in a rural state.Surgery in practice and science · 2023Article
- Review of perioperative outcomes and management of hip fracture patients on direct oral anticoagulants.EFORT open reviews · 2023Review
- Long-term outcomes after traumatic brain injury in elderly patients on antithrombotic therapy.Acta neurochirurgica · 2023Article
- Coagulopathy management of multiple injured patients - a comprehensive literature review of the European guideline 2019.EFORT open reviews · 2022Review
- Mortality in relation to presence and type of oral antithrombotic agent among adult trauma patients: a single-center retrospective cohort study.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022Article
- Acute haemorrhage rate in 28,000 Out-of-Hours CT heads.The British journal of radiology · 2022Article
- Impact of anticoagulation and antiplatelet drugs on surgery rates and mortality in trauma patients.Scientific reports · 2021Article
- Idarucizumab in major trauma patients: a single centre real life experience.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2021Article
- Retrospective Analysis of Geriatric Major Trauma Patients Admitted in the Shock Room of a Swiss Academic Hospital: Characteristics and Prognosis.Journal of clinical medicine · 2020Article
- Application of NICE or SNC guidelines may reduce the need for computerized tomographies in patients with mild traumatic brain injury: a retrospective chart review and theoretical application of five guidelines.Scandinavian journal of trauma, resuscitation and emergency medicine · 2019Article
- Exploring the effect of factor Xa inhibitors on rotational thromboelastometry: a case series of bleeding patients.Journal of thrombosis and thrombolysis · 2019Article
- The impact of direct oral anticoagulants in traumatic brain injury patients greater than 60-years-old.Scandinavian journal of trauma, resuscitation and emergency medicine · 2018Article
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe anticoagulated trauma patient presents a particular challenge to the critical care physician. Our understanding of these patients is defined and extrapolated by experience with patients on warfarin pre-injury. Today, many patients who would have been on warfarin are now prescribed the Direct Oral Anticoagulants (DOACs) a class of anticoagulants with entirely different mechanisms of action, effects on routine coagulation assays and approach to reversal.
methodsTrauma registry data from Toronto's (Ontario, Canada) two Level 1 trauma centres were used to identify patients on oral anticoagulation pre-injury from June 1, 2014 to June 1, 2015. The trauma registry and medical records were reviewed and used to extract demographic and clinical data.
resultsWe found 81 patients were on oral anticoagulants pre-injury representing 3.2% of the total trauma population and 33% of the orally anticoagulated patients were prescribed a DOAC prior to presentation. Comparison between the DOAC and warfarin groups showed similar age, mechanisms of injury, indications for anticoagulation, injury severity score and rate of intracranial hemorrhage. Patients on DOACs had higher initial mean hemoglobin vs warfarin (131 vs 120) and lower serum creatinine (94.8 vs 129.5). The percentage of patients receiving a blood transfusion in the trauma bay and total in-hospital transfusion was similar between the two groups however patients on DOACs were more likely to receive tranexamic acid vs patients on warfarin (32.1% vs 9.1%) and less likely to receive prothrombin concentrates (18.5% vs 60%). Patients on DOACs were found to have higher survival to discharge (92%) vs patients on warfarin (72%).
conclusionPatients on DOACs pre-injury now represent a significant proportion of the anticoagulated trauma population. Although they share demographic and clinical similarities with patients on warfarin, patients on DOACs may have improved outcomes despite lack of established drug reversal protocols and challenging interpretation of coagulation assays. LEVEL OF EVIDENCE: III; Study Type: Retrospective Review.
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