Nonoperative management of blunt abdominal solid organ injury: Are we paying enough attention to patients on preinjury anticoagulation? - 08/11/22
, Tanya Anand , Sai K. Bhogadi , Adam Nelson , Hamidreza Hosseinpour , Michael Ditillo , Khaled El-Qawaqzeh , Lourdes Castanon , Collin Stewart , Bellal Joseph ⁎ Abstract |
Background |
This study aims to assess the impact of pre-injury anticoagulant use on outcomes of isolated blunt abdominal SOI patients who underwent NOM.
Methods |
A 1-year(2017) analysis of the ACS-TQIP. We included all ≥18yrs trauma patients with isolated blunt abdominal-SOI who underwent NOM. Patients were stratified into two groups based on their history of pre-injury anticoagulant use. Propensity score matching was performed.
Results |
A matched cohort of 2709 patients (AC, 903; No-AC,1806) was analyzed. Compared to the No-AC group, the AC group had higher rates of failure of NOM(2.6% vs. 4.5%, p = 0.03), cardiac arrest (1.2%vs. 3.1%, p = 0.02), acute kidney injury (2.4% vs. 4.2%, p < 0.01), myocardial infarction (0.6% vs. 1.4%,p = 0.03), and mortality (5.1%vs. 7.6%,p = 0.01), and longer hospital LOS (17[10–24]vs.17[12–26]days,p = 0.04) and ICU LOS (11[6–17]vs.11[7–18]days,p = 0.01).
Conclusion |
Among nonoperatively managed blunt abdominal SOI patients, preinjury use of anticoagulants negatively impacts outcomes. Extra surveillance is required while managing patients with blunt abdominal SOI on pre-injury anticoagulants.
Level of evidence |
Level III.
Study type |
Therapeutic/care management.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Highlights |
• | The use of direct-acting oral anticoagulants (DOAC) is rising rapidly across the country for the primary and secondary prevention of thromboembolic diseases. |
• | Patients with Blunt abdominal solid organ injury (ASOI) on preinjury chronic anticoagulation could have increased risk of failure of nonoperative management (NOM) due to hemorrhage or other major complications. |
• | Blunt ASOI patients on preinjury anticoagulation have higher rates of failure of NOM, cardiac arrest, AKI, MI, and mortality compared to patients without prior anticoagulation. |
• | Further prospective studies are required to help develop proper management protocols among this subset of trauma patients. |
Keywords : Adults, Trauma, Blunt abdominal injury, Solid organ injury, Preinjury anticoagulation
Plan
Vol 224 - N° 5
P. 1308-1313 - novembre 2022 Retour au numéro
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