B. Bhattacharya1, R. D. Becher1, K. M. Schuster1, K. A. Davis1, A. A. MAUNG1 1Yale University School Of Medicine,Surgery,New Haven, CT, USA
Introduction: Anticoagulation (AC) has been associated with worse outcomes after trauma in some but not all studies. In a recent, small (64 patients on AC) study, AC had no effect on mortality or length of stay (LOS) in patients with spleen and/or liver injuries. To further investigate the effect of AC on outcomes in patients with splenic injury, we performed a study utilizing the Trauma Quality Programs Participant Use File (PUF)
Methods: The 2017 PUF was used to identify adult (18+ years) with all mechanisms and grades of splenic injury. Demographics, comorbidities, hospital course and outcomes were compared between AC and non-AC patients (identified by the NTDS anticoagulant therapy co-morbid condition field which combines all anticoagulant agents).
Results: 18749 patients with splenic injury were identified, 622 were on AC. The AC patients were older (68 vs. 42 years, p < 0.001) but had comparable gender composition to non-AC patients. Injury Severity Score (18.2 vs 22.5) and rates of serious (AIS ≥ 3) injury Chest (43.1 vs 51.3%), Abdomen (50.5 vs 60.8%) and Extremity (11.1 vs 18.1%) were all lower in the AC group (p=0.001). Rates of serious (AIS ≥ 3) head injury were not statistically different between the two groups (14 .0 vs 17.4%, p=0.29)
Similar percentages in each group (26.5 vs 26.4%) were transfused packed red blood cells (RBC) within the first 4 hours thus meeting the NTDS criteria for collection of further hemorrhage control data. Within this hemorrhage control group, the AC patients received fewer units of RBC (5.7 vs 8.0 units, p < 0.001) and FFP (3.9 vs 5.4 units, p < 0.001) in the first 24 hours but underwent angiography at similar rates (23.6 vs 24.5%, p=0.8). Among those who underwent angiography, patients were however more likely to undergo embolization if they were on AC (89.7 vs 73.9%, p=0.04).
Within the whole splenic injury cohort, rates of splenic surgery were comparable between the two groups (19.3 vs 21.5%, p=0.2). Median LOS was longer in AC patients (6.3 vs 5.6 days, p=0.002). Despite being less seriously injured, the AC patients had a higher mortality (13.3 vs 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)
Conclusion: Anticoagulation is associated with increased mortality in patients with splenic injury.