Does Preinjury Anticoagulation Worsen Outcomes Among Traumatic Hemothorax Patients? A Nationwide Retrospective Analysis

Chronic oral anticoagulation is used in the management of many clinical conditions, including venous thromboembolism (VTE), atrial fibrillation (AF), and mechanical heart valves [1]. Long-term use of anticoagulants has shown a reduction in thromboembolic events [1]. The disease burden of AF, and VTE is more in the elderly population [2]. Elderly population continues to rise in the United States (US) and constitutes a significant proportion of patients presenting to the trauma bay [3]. With the combination of the above factors, it is expected that trauma surgeons would encounter more patients who are on preinjury anticoagulants. Preinjury anticoagulant use has been shown to worsen the outcomes in traumatic brain injury patients (TBI) [4], [5], [6], [7].

Thoracic injuries are a significant cause of trauma admissions and mortality [8], [9], [10]. Hemothorax is a common complication and may occur after either a blunt or penetrating thoracic trauma and it is the leading cause of death in the fourth decade of life [8,10]. There have been multiple reports of spontaneous hemothorax following anticoagulant use [11], [12], [13]. Traumatic hemothorax patients on pre-injury anticoagulation are a distinct subset of trauma patients with an increased risk for continued hemorrhage. There is limited data on the effect of preinjury anticoagulant use on the outcomes of patients with traumatic hemothorax. The objective of this study is to determine the impact of preinjury anticoagulant use in patients with traumatic hemothorax on outcomes, including index-admission interventions, reinterventions, complications, and mortality. We hypothesized that traumatic hemothorax patients using preinjury anticoagulants are more likely to require interventions and have increased in-hospital complications compared to a similar cohort of patients without preinjury anticoagulant use. This study was exempted from the University of Arizona Institutional Review Board approval since the ACS-TQIP contains only deidentified data.

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