Preexisting anticoagulation is an independent predictor of mortality in geriatric trauma patients - a retrospective cohort study

Nikhil Patel; Thomas Kania; Seleshi Demissie; Timothy Le; Peter Fusco; Justin Yoon; Bryan Lee; Joseph Doran; Jacqueline Liu; Tori Singer; Galina Glinik; Basem Azab; Olivia Haney; Christopher Esposito; Indraneil Mukherjee; Krassimir Atanassov; Boris Khodorkovsky; Duraid Younan

doi:10.1097/MS9.0000000000000927

Preexisting anticoagulation is an independent predictor of mortality in geriatric trauma patients - a retrospective cohort study

Ann Med Surg (Lond). 2023 Jul 28;85(9):4223-4227. doi: 10.1097/MS9.0000000000000927. eCollection 2023 Sep.

Authors

Nikhil Patel¹, Thomas Kania¹, Seleshi Demissie², Timothy Le¹, Peter Fusco³, Justin Yoon⁴, Bryan Lee¹, Joseph Doran¹, Jacqueline Liu⁴, Tori Singer³, Galina Glinik¹, Basem Azab¹, Olivia Haney¹, Christopher Esposito¹, Indraneil Mukherjee¹, Krassimir Atanassov¹, Boris Khodorkovsky¹, Duraid Younan¹

Affiliations

¹ Department of Surgery, Staten Island University Hospital, Staten Island.
² Biostatistics Unit, Zucker School of Medicine at Hofstra/Northwell Health, Long Island.
³ CUNY Medical School.
⁴ Touro Medical School, New York, New York, USA.

Abstract

Introduction: Preexisting anticoagulation is common among geriatric trauma patients. Geriatric trauma patients have a higher risk of mortality compared to younger patients. We sought to evaluate the association of preexisting anticoagulation with mortality in a group of geriatric trauma patients.

Methods: A retrospective review of geriatric trauma patients was conducted for those admitted to a Level 1 trauma center from January 2018 to December 2020. Vital signs, demographics, injury characteristics, laboratory data, and mortality were all collected. Multivariable logistic regression analysis was performed for the association of preexisting anticoagulation and a primary endpoint of all-cause mortality. These groups were controlled for preexisting comorbidities, injury severity scores, and systolic blood pressure in the emergency department.

Results: Four thousand four hundred thirty-two geriatric patients were admitted during the study period. This cohort was made up of 36.9% men and 63.1% women. Three thousand eight hundred fifty-nine (87.2%) were white; the average age was 81±8.5 years, and the median injury severity score (ISS) was 5. The mean systolic blood pressure was 150±32 mmHg, mean heart rate was 81±16 bpm, mean lactate was 2.3±1.3, mean hematocrit was 37.3±8.8, and mean international normalized ratio (INR) was 1.7±10.3. One thousand five hundred ninety-two (35.9%) patients were on anticoagulation (AC) upon presentation. One hundred and sixty-five (3.7%) mortalities were recorded. Multivariable logistic regression analysis results show that preexisting anticoagulation [ odds ratio (OR) 1.92, 95% CI 1.36-2.72] was independently predictive of death. The analysis was adjusted for systolic BP in the emergency department less than90 mmHg (OR 5.55, 95% CI 2.83-10.9), having more than 1 comorbidity (OR 2.30, 95% CI 1.57-3.38) and ISS (OR 1.13, 95% CI 1.10-1.15).

Conclusion: Our study indicates that preexisting anticoagulation is associated with mortality among geriatric trauma patients.

Keywords: anticoagulation; geriatric; trauma.