Prevalence and implications of preinjury warfarin use: an analysis of the National Trauma Databank.
OBJECTIVE
To describe the prevalence of preinjury warfarin use in a large national sample of trauma patients and to define the relationship between preinjury warfarin use and mortality.


METHODS
Retrospective cohort study.


METHODS
The National Trauma Databank (7.1).


METHODS
All patients admitted to eligible trauma centers during the study period; 1,230,422 patients (36,270 warfarin users) from 402 centers were eligible for analysis.


METHODS
Prevalence of warfarin use and all-cause in-hospital mortality. Multivariate logistic regression was used to estimate the odds ratio (OR) for mortality associated with preinjury warfarin use.


RESULTS
Warfarin use increased among all patients from 2.3% in 2002 to 4.0% in 2006 (P < .001), and in patients older than 65 years, use increased from 7.3% in 2002 to 12.8% in 2006 (P < .001). Among all patients, 9.3% of warfarin users died compared with only 4.8% of nonusers (OR, 2.02; 95% confidence interval [CI], 1.95-2.10; P < .001). After adjusting for important covariates, warfarin use was associated with increased mortality among all patients (OR, 1.72; 95% CI, 1.63-1.81; P < .001) and patients 65 years and older (OR, 1.38; 95% CI, 1.30-1.47; P < .001).


CONCLUSIONS
Warfarin use is common among injured patients and its prevalence has increased each year since 2002. Its use is a powerful marker of mortality risk, and even after adjusting for confounding comorbidities, it is associated with a significant increase in death.
Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA. ladossett@gmail.com
Lesly A
LA
Dossett
Johanna N
JN
Riesel
Marie R
MR
Griffin
Bryan A
BA
Cotton
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000139:chemically induced / Q000401:mortality; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D016019:Survival Analysis; D014193:Trauma Centers / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D014481:United States; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use; D014947:Wounds and Injuries / Q000401:mortality*; D055815:Young Adult
D000925:Anticoagulants; D014859:Warfarin