Outcomes of anticoagulated trauma patients

Patients on warfarin are at high risk for potentially life-threatening hemo rrhage even after relatively minor trauma. Outcomes of these patients and t he potential complications of reversing the effects of anticoagulation have received little attention. This study was performed to determine the overa ll outcome of orally anticoagulated patients who sustained injury as well a s to determine any untoward effects of reversing their anticoagulated state s. A retrospective study of injured patients on warfarin was conducted on p atients admitted to an urban, university, tertiary-referral, level I trauma center between 1/1/93 and 12/31/96, Surviving patients were followed for a period of at least 1 month. Injuries were grouped by anatomic site. Charts were reviewed for degree of anticoagulation on admission (le, initial Inte rnational normalized ratio [INR]), survival, adverse effects of reversal of anticoagulation, and reinstitution of warfarin therapy Discharged patients were contacted at home for follow up. Thirty five consecutive patients, 18 men and 17 women, on warfarin therapy at the time of their injuries were r eviewed. The mean age was 75 years, with a range of 39 to 96, The mean foll ow-up period was 12.7 months. Reasons for anticoagulation included atrial f ibrillation, prosthetic heart valves, revascularized limb, hypercoagulable state, deep venous thrombosis, pulmonary embolism, phlebitis, and aortic st enosis, Mean admission INR was 3.2, with a range of 1.6 to 10.0. There were 8 in-hospital deaths. Intracranial hemorrhages accounted for the majority of injuries, Ten patients were not given reversal therapy. Four complicatio ns were attributable to reversal therapy (upper extremity hemiplegia, trans ient ischemic attack, deep venous thrombosis, arterial thrombosis). Twenty- one patients had their warfarin reinstituted. Follow-up of surviving patien ts ranged from 1.5 to 42 months. Patients on warfarin are at high risk for intracranial hemorrhage following trauma. Patients on warfarin may be rever sed during the acute period following injury, but transient complications m ay arise. Further prospective studies need to be conducted to determine whi ch anticoagulated trauma patients may not require reversal therapy. Copyrig ht (C) 1999 by W.B. Saunders Company.