T.J. Miles1, J.E. Mendez-Reyes1,2, M.J. Wall1,2, R.K. Ghanta1,2, C.T. Wilson1,2 1Baylor College Of Medicine, Michael E. DeBakey Department Of Surgery, Houston, TX, USA 2Ben Taub General Hospital, Houston, TX, USA
Introduction: Requirement for long-term anticoagulation has important implications in selection of prosthetic valve type for patients with valvular heart disease. Anticoagulation has been shown to adversely affect trauma outcomes. However, despite being potentially higher risk, trauma outcomes have not been reported in this population.
Methods: Patients with a history of valve replacement were queried from the National Trauma Data Bank (2015-2022) and stratified based on anticoagulation status and requirement for anticoagulation reversal. Primary outcomes were in-hospital mortality, major morbidity, and intensive care unit (ICU) admission. Multivariate logistic regression was utilized to assess the independent effect of anticoagulation on outcomes. Statistical significance was determined by a P-value less than 0.05.
Results: A total of 633 patients were identified, of which 57% were on anticoagulation. The median age was 78 [IQR 71-84] and the mean (SD) Injury Severity Score (ISS) was 9.5 (7.0). The majority (98.9%) sustained blunt trauma, most commonly due to a fall (84.2%). Overall mortality was 6.3% with a 42.8% rate of ICU admission. Anticoagulation was not independently associated with mortality (OR [95% CI]: 1.31 [0.54-3.45]), major morbidity (1.47 [0.69-3.34]), or ICU admission (1.56 [0.96-2.55]). Amongst anticoagulated patients, 8.8% required anticoagulation reversal. Reversal was associated with increased ISS (14.9 vs. 9.2, p<0.001), traumatic brain injury (TBI) incidence (62.5% vs. 39.9%, p=0.022), ICU admission (71.9% vs. 42.0%, p=0.002), and mortality (18.8% vs. 5.1%, p=0.008).
Conclusion: Anticoagulation does not appear to be associated with adverse trauma outcomes in patients with prior valve replacement. This likely can be attributed to the overall low burden of injury observed in this population as reflected by the high rate of falls and low ISS. Within the anticoagulated cohort, reversal is most common after sustaining a TBI and is associated with worse outcomes. These findings may better inform shared decision making in selection of prosthetic valve type for patients with valvular heart disease.