TY - JOUR
T1 - The Severity of Bleeding and Mortality in Trauma Patients Taking Dabigatran
AU - Dezman, Zachary D.W.
AU - Comer, Angela C.
AU - Smith, Gordon S.
AU - Narayan, Mayur
AU - Hess, John R.
AU - Hirshon, Jon Mark
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Background Dabigatran, a direct thrombin inhibitor, has been shown to be more effective than warfarin in the prevention of stroke in patients with atrial fibrillation. Until recently, it lacked a reversal agent, and its contribution to the risk of transfusion in injured patients is unknown. Objective We sought to determine whether patients who sustain traumatic injuries while taking dabigatran receive more blood transfusions than matched patients taking warfarin, aspirin, clopidogrel, or controls. Methods This retrospective, single-center cohort consisted of injured patients who were taking dabigatran before admission to a major trauma center (January 2010–December 2013) who were compared with cohorts of patients taking warfarin, clopidogrel, or aspirin and a control group. The outcome was bleeding risk as measured by the use of blood products, with mortality as a secondary outcome. Outcomes were controlled for by age, sex, injury severity, and blunt mechanism. Results Thirty-eight patients were taking dabigatran. Compared with the general trauma population, patients taking dabigatran were more likely to be male, older, and to have higher injury severity. Patients taking dabigatran received transfusions (odds ratio [OR] 1.31 [95% confidence interval {CI} 0.56–3.04]), packed red blood cells (OR 1.43 [95% CI 0.54–3.77]), frozen plasma (OR 1.20 [95% CI 0.42–3.49]), and platelets (OR 2.01 [95% CI 0.63–6.37]) as often as matched controls. The mortality rate among patients on dabigatran was 12.5% (OR 1.51 [95% CI 0.39–5.89]) compared with 9.1% in matched controls. None of these results was statistically significant. Conclusions In this small study, injured patients taking dabigatran were transfused as often and had similar in-hospital mortality as matched controls who were not taking anticoagulants.
AB - Background Dabigatran, a direct thrombin inhibitor, has been shown to be more effective than warfarin in the prevention of stroke in patients with atrial fibrillation. Until recently, it lacked a reversal agent, and its contribution to the risk of transfusion in injured patients is unknown. Objective We sought to determine whether patients who sustain traumatic injuries while taking dabigatran receive more blood transfusions than matched patients taking warfarin, aspirin, clopidogrel, or controls. Methods This retrospective, single-center cohort consisted of injured patients who were taking dabigatran before admission to a major trauma center (January 2010–December 2013) who were compared with cohorts of patients taking warfarin, clopidogrel, or aspirin and a control group. The outcome was bleeding risk as measured by the use of blood products, with mortality as a secondary outcome. Outcomes were controlled for by age, sex, injury severity, and blunt mechanism. Results Thirty-eight patients were taking dabigatran. Compared with the general trauma population, patients taking dabigatran were more likely to be male, older, and to have higher injury severity. Patients taking dabigatran received transfusions (odds ratio [OR] 1.31 [95% confidence interval {CI} 0.56–3.04]), packed red blood cells (OR 1.43 [95% CI 0.54–3.77]), frozen plasma (OR 1.20 [95% CI 0.42–3.49]), and platelets (OR 2.01 [95% CI 0.63–6.37]) as often as matched controls. The mortality rate among patients on dabigatran was 12.5% (OR 1.51 [95% CI 0.39–5.89]) compared with 9.1% in matched controls. None of these results was statistically significant. Conclusions In this small study, injured patients taking dabigatran were transfused as often and had similar in-hospital mortality as matched controls who were not taking anticoagulants.
KW - dabigatran
KW - epidemiology
KW - hematology
KW - mortality
KW - transfusion
KW - trauma
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U2 - 10.1016/j.jemermed.2016.05.005
DO - 10.1016/j.jemermed.2016.05.005
M3 - Article
C2 - 27364823
AN - SCOPUS:84977618507
SN - 0736-4679
VL - 51
SP - 238
EP - 245
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
IS - 3
ER -