title: The Severity of Bleeding and Mortality in Trauma Patients Taking Dabigatran.
abstract: BACKGROUND
  Dabigatran, a direct thrombin inhibitor, has been shown to be more effective than warfarin in the prevention of stroke in patients with atrial fibrillation. Until recently, it lacked a reversal agent, and its contribution to the risk of transfusion in injured patients is unknown.
  
  
  OBJECTIVE
  We sought to determine whether patients who sustain traumatic injuries while taking dabigatran receive more blood transfusions than matched patients taking warfarin, aspirin, clopidogrel, or controls.
  
  
  METHODS
  This retrospective, single-center cohort consisted of injured patients who were taking dabigatran before admission to a major trauma center (January 2010-December 2013) who were compared with cohorts of patients taking warfarin, clopidogrel, or aspirin and a control group. The outcome was bleeding risk as measured by the use of blood products, with mortality as a secondary outcome. Outcomes were controlled for by age, sex, injury severity, and blunt mechanism.
  
  
  RESULTS
  Thirty-eight patients were taking dabigatran. Compared with the general trauma population, patients taking dabigatran were more likely to be male, older, and to have higher injury severity. Patients taking dabigatran received transfusions (odds ratio [OR] 1.31 [95% confidence interval {CI} 0.56-3.04]), packed red blood cells (OR 1.43 [95% CI 0.54-3.77]), frozen plasma (OR 1.20 [95% CI 0.42-3.49]), and platelets (OR 2.01 [95% CI 0.63-6.37]) as often as matched controls. The mortality rate among patients on dabigatran was 12.5% (OR 1.51 [95% CI 0.39-5.89]) compared with 9.1% in matched controls. None of these results was statistically significant.
  
  
  CONCLUSIONS
  In this small study, injured patients taking dabigatran were transfused as often and had similar in-hospital mortality as matched controls who were not taking anticoagulants.
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland; National Study Center for Trauma and Emergency Medical Systems, University of Maryland, Baltimore, Maryland.
authors.forename: Zachary D W
authors.initials: ZD
authors.lastname: Dezman
authors.affiliation: National Study Center for Trauma and Emergency Medical Systems, University of Maryland, Baltimore, Maryland.
authors.forename: Angela C
authors.initials: AC
authors.lastname: Comer
authors.affiliation: National Study Center for Trauma and Emergency Medical Systems, University of Maryland, Baltimore, Maryland.
authors.forename: Gordon S
authors.initials: GS
authors.lastname: Smith
authors.affiliation: R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland.
authors.forename: Mayur
authors.initials: M
authors.lastname: Narayan
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, Washington.
authors.forename: John R
authors.initials: JR
authors.lastname: Hess
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland; National Study Center for Trauma and Emergency Medical Systems, University of Maryland, Baltimore, Maryland.
authors.forename: Jon Mark
authors.initials: JM
authors.lastname: Hirshon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D000991:Antithrombins / Q000009:adverse effects*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D000069604:Dabigatran / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D000069604:Dabigatran
keywords: dabigatran; epidemiology; hematology; mortality; transfusion; trauma