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.
MetroHealth Medical Center, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH 44109-1998, USA.
Joseph F
JF
Golob
Mark J
MJ
Sando
Justin C
JC
Kan
Charles J
CJ
Yowler
Mark A
MA
Malangoni
Jeffrey A
JA
Claridge
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