TY - JOUR
T1 - The AAST prospective observational multicenter study of the initial experience with reversal of direct oral anticoagulants in trauma patients
AU - Emigh, Brent
AU - Kobayashi, Leslie
AU - Kopp, Miroslav
AU - Daley, Mitch
AU - Teal, Lindsey
AU - Haan, James
AU - Burlew, Clay Cothren
AU - Nirula, Raminder
AU - Moore, Forrest
AU - Burruss, Sigrid
AU - Kaminski, Stephen
AU - Dunn, Julie
AU - Carrick, Matthew
AU - Schroeppel, Thomas
AU - Thurston, Brian
AU - Quick, Jacob
AU - Bosarge, Patrick
AU - Brown, Carlos V.
N1 - Publisher Copyright:
© 2020
PY - 2021/8
Y1 - 2021/8
N2 - 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.
AB - 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.
KW - Anticoagulation
KW - Bleeding
KW - Geriatric
KW - Trauma
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U2 - 10.1016/j.amjsurg.2020.12.034
DO - 10.1016/j.amjsurg.2020.12.034
M3 - Article
C2 - 33612255
AN - SCOPUS:85101341577
SN - 0002-9610
VL - 222
SP - 264
EP - 269
JO - American journal of surgery
JF - American journal of surgery
IS - 2
ER -