The AAST prospective observational multicenter study of the initial experience with reversal of direct oral anticoagulants in trauma patients

Brent Emigh, Leslie Kobayashi, Miroslav Kopp, Mitch Daley, Lindsey Teal, James Haan, Clay Cothren Burlew, Raminder Nirula, Forrest Moore, Sigrid Burruss, Stephen Kaminski, Julie Dunn, Matthew Carrick, Thomas Schroeppel, Brian Thurston, Jacob Quick, Patrick Bosarge, Carlos V. Brown

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)264-269
Number of pages6
JournalAmerican journal of surgery
Volume222
Issue number2
DOIs
StatePublished - Aug 2021
Externally publishedYes

Keywords

  • Anticoagulation
  • Bleeding
  • Geriatric
  • Trauma

ASJC Scopus subject areas

  • Surgery

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