title: The impact of preinjury antithrombotic medication on hemostatic interventions in trauma patients.
abstract: OBJECTIVE
  The purpose of this study was to determine whether preinjury medication with antithrombotic agents was related to an increase in hemostatic interventions in patients with severe trauma without traumatic brain injury.
  
  
  METHODS
  Consecutive trauma patients who were admitted to the emergency departments of the study hospitals with an injury severity score ≥16 were enrolled in this retrospective, observational, multicenter study of coagulation in the acute phase of severe trauma. Patients without a traumatic brain injury with an abbreviated injury scale ≥3 were evaluated. Patients were divided into those with and those without preinjury medication with antithrombotic agents. The impact of preinjury antithrombotic medication on the composite primary outcome, defined as administration of fresh frozen plasma ≥10 U and/or hemostatic treatment (surgery and/or interventional radiology) within 24 hours, was analyzed.
  
  
  RESULTS
  The preinjury medication group consisted of 20 (6.4%) of the total 312 patients. Preinjury medication was one of the independent risk factors for the composite outcome (odds ratio, 3.16; 95% confidence interval, 1.08-9.10; P < .05) adjusting for age, sex, and injury severity score on multivariate analysis. Preinjury antithrombotic therapy was also associated with hemostatic treatments within 24 hours (odds ratio, 3.40; 95% confidence interval, 1.16-9.85; P = .026). Survival time was not different between the 2 groups on Cox regression analysis.
  
  
  CONCLUSIONS
  Preinjury antithrombotic medication in severe trauma patients without traumatic brain injury may be associated with a higher risk of hemostatic interventions.
authors.affiliation: Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-0871, Japan. Electronic address: kudodaisuke@med.tohoku.ac.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kudo
authors.affiliation: Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-0871, Japan. Electronic address: kussie@emergency-medicine.med.tohoku.ac.jp.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kushimoto
authors.affiliation: Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan; Emergency Department, Kameda Medical Center, 929 Higashimachi, Kamogawa, 296-8602, Japan. Electronic address: siris.accm@tmd.ac.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiraishi
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, 565-0871, Japan. Electronic address: ogura@hp-emerg.med.osaka-u.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ogura
authors.affiliation: Department of Emergency Medicine and Critical Care, National Center For Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-0052, Japan. Electronic address: kudodaisuke@med.tohoku.ac.jp.
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Hagiwara
authors.affiliation: Division of Traumatology, Research Institute, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-0042, Japan. Electronic address: ds0711@ndmc.ac.jp.
authors.forename: Daizoh
authors.initials: D
authors.lastname: Saitoh
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy; D016913:Blood Component Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006489:Hemostatic Techniques / Q000706:statistics & numerical data*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy; D016017:Odds Ratio; D010949:Plasma; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*
chemical_list: D000925:Anticoagulants; D006490:Hemostatics; D010975:Platelet Aggregation Inhibitors