title: Direct oral anticoagulants compared with warfarin in patients with severe blunt trauma.
abstract: METHODS
  We queried our Trauma Quality Improvement Program registry for patients who presented between 6/1/2011 and 9/1/2015 with severe (injury severity score (ISS)>15) blunt traumatic injury during anticoagulant use. Patients were then grouped into those prescribed warfarin and patients prescribed any of the available novel Direct Oral Anticoagulants (DOAC) medications. We excluded severe (AIS≧4) head injuries.
  
  
  RESULTS
  There were no differences between DOAC and warfarin groups in terms of age, gender mean ISS, median hospital or intensive care unit lengths of stay, complication proportions, numbers of complications per patient, or the proportion of patients requiring transfusion. Finally, excluding patients who died, the observed proportion of discharge to skilled nursing facility was similar. In our sample of trauma patients, DOAC use was associated with significantly lower mortality (DOAC group 8.3% vs. warfarin group 29.5%, p<0.015). The ratio of units transfused per patient was also lower in the DOAC group (2.8±1.8 units/patient in the DOAC group vs. 6.7±6.4 units per patient in the warfarin group; p=0.001).
  
  
  CONCLUSIONS
  In conclusion, we report an association with decrease in mortality and a decrease in transfused blood products in severely injured trauma patients with likely minimal or no head injury taking novel DOACs over those anticoagulated with warfarin for outpatient anticoagulation.
authors: Saint Francis Hospital and Medical Center, Department of Surgery, 114 Woodland St. Hartford, CT 06103, USA; University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT 06030, USA. Electronic address: feeneymd@yahoo.com.
authors: James M
authors: JM
authors: Feeney
authors: Saint Francis Hospital and Medical Center, Department of Emergency Medicine, 114 Woodland St. Hartford, CT 06103, USA; University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT 06030, USA.
authors: Matthew
authors: M
authors: Neulander
authors: Trinity College, 300 Summit Street, Hartford, CT 06106, USA.
authors: Monica
authors: M
authors: DiFiori
authors: Trinity College, 300 Summit Street, Hartford, CT 06106, USA.
authors: Lilla
authors: L
authors: Kis
authors: Saint Francis Hospital and Medical Center, Department of Surgery, 114 Woodland St. Hartford, CT 06103, USA; University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT 06030, USA.
authors: David S
authors: DS
authors: Shapiro
authors: Saint Francis Hospital and Medical Center, Department of Surgery, 114 Woodland St. Hartford, CT 06103, USA; University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT 06030, USA.
authors: Vijay
authors: V
authors: Jayaraman
authors: Saint Francis Hospital and Medical Center, Department of Surgery, 114 Woodland St. Hartford, CT 06103, USA; University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT 06030, USA.
authors: William T
authors: WT
authors: Marshall
authors: Saint Francis Hospital and Medical Center, Department of Surgery, 114 Woodland St. Hartford, CT 06103, USA; University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT 06030, USA.
authors: Stephanie C
authors: SC
authors: Montgomery
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D001780:Blood Coagulation Tests; D006259:Craniocerebral Trauma / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D058996:Quality Improvement; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014481:United States; D014859:Warfarin / Q000009:adverse effects*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000401:mortality / Q000628:therapy*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Acquired coagulopathy; Direct oral anticoagulants; Severe trauma; Warfarin