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Nonoperative management of blunt abdominal solid organ injury: Are we paying enough attention to patients on preinjury anticoagulation?

      Highlights

      • The use of direct-acting oral anticoagulants (DOAC) is rising rapidly across the country for the primary and secondary prevention of thromboembolic diseases.
      • Patients with Blunt abdominal solid organ injury (ASOI) on preinjury chronic anticoagulation could have increased risk of failure of nonoperative management (NOM) due to hemorrhage or other major complications.
      • Blunt ASOI patients on preinjury anticoagulation have higher rates of failure of NOM, cardiac arrest, AKI, MI, and mortality compared to patients without prior anticoagulation.
      • Further prospective studies are required to help develop proper management protocols among this subset of trauma patients.

      Abstract

      Background

      This study aims to assess the impact of pre-injury anticoagulant use on outcomes of isolated blunt abdominal SOI patients who underwent NOM.

      Methods

      A 1-year(2017) analysis of the ACS-TQIP. We included all ≥18yrs trauma patients with isolated blunt abdominal-SOI who underwent NOM. Patients were stratified into two groups based on their history of pre-injury anticoagulant use. Propensity score matching was performed.

      Results

      A matched cohort of 2709 patients (AC, 903; No-AC,1806) was analyzed. Compared to the No-AC group, the AC group had higher rates of failure of NOM(2.6% vs. 4.5%, p = 0.03), cardiac arrest (1.2%vs. 3.1%, p = 0.02), acute kidney injury (2.4% vs. 4.2%, p < 0.01), myocardial infarction (0.6% vs. 1.4%,p = 0.03), and mortality (5.1%vs. 7.6%,p = 0.01), and longer hospital LOS (17[10–24]vs.17[12–26]days,p = 0.04) and ICU LOS (11[6–17]vs.11[7–18]days,p = 0.01).

      Conclusion

      Among nonoperatively managed blunt abdominal SOI patients, preinjury use of anticoagulants negatively impacts outcomes. Extra surveillance is required while managing patients with blunt abdominal SOI on pre-injury anticoagulants.

      Level of evidence

      Level III.

      Study type

      Therapeutic/care management.

      Graphical abstract

      Keywords

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