Therapeutic anticoagulation in the trauma patient: is it safe?
OBJECTIVE
Trauma patients who require therapeutic anticoagulation pose a difficult treatment problem. The purpose of this study was to determine: (1) the incidence of complications using therapeutic anticoagulation in trauma patients, and (2) if any patient factors are associated with these complications.


METHODS
An 18-month retrospective review was performed on trauma patients >or= 15 years old who received therapeutic anticoagulation using unfractionated heparin (UH) and/or fractionated heparin (FH). Forty different pre-treatment and treatment patient characteristics were recorded. Complications of anticoagulation were documented and defined as any unanticipated discontinuation of the anticoagulant for bleeding or other adverse events.


RESULTS
One-hundred-fourteen trauma patients were initiated on therapeutic anticoagulation. The most common indication for anticoagulation was deep venous thrombosis (46%). Twenty-four patients (21%) had at least 1 anticoagulation complication. The most common complication was a sudden drop in hemoglobin concentration requiring blood transfusion (11 patients). Five patients died (4%), 3 of whom had significant hemorrhage attributed to anticoagulation. Bivariate followed by logistic regression analysis identified chronic obstructive pulmonary disease (OR = 9.2, 95%CI = 1.5-54.7), UH use (OR = 3.8, 95%CI = 1.1-13.0), and lower initial platelet count (OR = 1.004, 95%CI = 1.000-1.008) as being associated with complications. Patients receiving UH vs. FH differed in several characteristics including laboratory values and anticoagulation indications.


CONCLUSIONS
Trauma patients have a significant complication rate related to anticoagulation therapy, and predicting which patients will develop a complication remains unclear. Prospective studies are needed to determine which treatment regimen, if any, is appropriate to safely anticoagulate this high risk population.
Golob
Joseph F
JF
MetroHealth Medical Center, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH 44109-1998, USA.
Sando
Mark J
MJ
Kan
Justin C
JC
Yowler
Charles J
CJ
Malangoni
Mark A
MA
Claridge
Jeffrey A
JA
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects*; D015331:Cohort Studies; D016001:Confidence Intervals; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011182:Postoperative Care; D011300:Preoperative Care; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D017751:Safety Management; D016019:Survival Analysis; D013923:Thromboembolism / Q000517:prevention & control*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods; D014193:Trauma Centers; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects; D014947:Wounds and Injuries / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality* / Q000601:surgery
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin