The AAST prospective observational multicenter study of the initial experience with reversal of direct oral anticoagulants in trauma patients.
Adult
Aged
Aged, 80 and over
Antibodies, Monoclonal, Humanized
/ therapeutic use
Blood Coagulation Factors
/ therapeutic use
Coagulants
/ therapeutic use
Factor Xa
/ therapeutic use
Factor Xa Inhibitors
/ administration & dosage
Female
Hemorrhage
/ prevention & control
Humans
Injury Severity Score
Male
Prospective Studies
Recombinant Proteins
/ therapeutic use
Survival Rate
Trauma Centers
Wounds and Injuries
/ complications
Anticoagulation
Bleeding
Geriatric
Trauma
Journal
American journal of surgery
ISSN: 1879-1883
Titre abrégé: Am J Surg
Pays: United States
ID NLM: 0370473
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
received:
25
08
2020
revised:
07
12
2020
accepted:
20
12
2020
pubmed:
23
2
2021
medline:
16
9
2021
entrez:
22
2
2021
Statut:
ppublish
Résumé
Drug-specific agents for the reversal of direct oral anticoagulants (DOACs) were recently approved. We hypothesized that the approval of these reversal agents would lead improved outcomes for trauma patients taking DOACs. A multicenter, prospective (2015-2018), observational study of all adult trauma patients taking DOACs who were admitted to one of fifteen participating trauma centers was performed. The primary outcome was mortality. For 606 trauma patients on DOACs, those reversed were older (78 vs. 74, p = 0.007), more severely injured (ISS: 16 vs. 5, p < 0.0001), had more severe head injuries (Head AIS: 2.9 vs. 1.3, p < 0.0001), and higher mortality (11% vs. 3%, p = 0.001). Patients who received drug-specific agents (idarucizumab, andexanet alfa) had higher mortality (30% vs. 8%, p = 0.04) than those reversed with factor concentrates. However, the low usage of drug-specific reversal agents limits our ability to assess their efficacy and safety. DOAC reversal was not independently associated with mortality. At present, the overall usage of drug-specific reversal agents is too sparing to meaningfully assess outcomes in trauma.
Sections du résumé
BACKGROUND
Drug-specific agents for the reversal of direct oral anticoagulants (DOACs) were recently approved. We hypothesized that the approval of these reversal agents would lead improved outcomes for trauma patients taking DOACs.
METHODS
A multicenter, prospective (2015-2018), observational study of all adult trauma patients taking DOACs who were admitted to one of fifteen participating trauma centers was performed. The primary outcome was mortality.
RESULTS
For 606 trauma patients on DOACs, those reversed were older (78 vs. 74, p = 0.007), more severely injured (ISS: 16 vs. 5, p < 0.0001), had more severe head injuries (Head AIS: 2.9 vs. 1.3, p < 0.0001), and higher mortality (11% vs. 3%, p = 0.001). Patients who received drug-specific agents (idarucizumab, andexanet alfa) had higher mortality (30% vs. 8%, p = 0.04) than those reversed with factor concentrates. However, the low usage of drug-specific reversal agents limits our ability to assess their efficacy and safety.
CONCLUSIONS
DOAC reversal was not independently associated with mortality. At present, the overall usage of drug-specific reversal agents is too sparing to meaningfully assess outcomes in trauma.
Identifiants
pubmed: 33612255
pii: S0002-9610(20)30812-6
doi: 10.1016/j.amjsurg.2020.12.034
pii:
doi:
Substances chimiques
Antibodies, Monoclonal, Humanized
0
Blood Coagulation Factors
0
Coagulants
0
Factor Xa Inhibitors
0
PRT064445
0
Recombinant Proteins
0
prothrombin complex concentrates
37224-63-8
idarucizumab
97RWB5S1U6
anti-inhibitor coagulant complex
CS849DUN3M
Factor Xa
EC 3.4.21.6
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
264-269Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020. Published by Elsevier Inc.
Déclaration de conflit d'intérêts
Declaration of competing interest There are no conflicts of interest to report.