Prevalence and implications of preinjury warfarin use: an analysis of the National Trauma Databank.

Dossett LA, Riesel JN, Griffin MR, Cotton BA
Arch Surg. 2011 146 (5): 565-70

PMID: 21242422 · DOI:10.1001/archsurg.2010.313

OBJECTIVES - To describe the prevalence of preinjury warfarin use in a large national sample of trauma patients and to define the relationship between preinjury warfarin use and mortality.

DESIGN - Retrospective cohort study.

SETTING - The National Trauma Databank (7.1).

PATIENTS - All patients admitted to eligible trauma centers during the study period; 1,230,422 patients (36,270 warfarin users) from 402 centers were eligible for analysis.

MAIN OUTCOME MEASURES - Prevalence of warfarin use and all-cause in-hospital mortality. Multivariate logistic regression was used to estimate the odds ratio (OR) for mortality associated with preinjury warfarin use.

RESULTS - Warfarin use increased among all patients from 2.3% in 2002 to 4.0% in 2006 (P < .001), and in patients older than 65 years, use increased from 7.3% in 2002 to 12.8% in 2006 (P < .001). Among all patients, 9.3% of warfarin users died compared with only 4.8% of nonusers (OR, 2.02; 95% confidence interval [CI], 1.95-2.10; P < .001). After adjusting for important covariates, warfarin use was associated with increased mortality among all patients (OR, 1.72; 95% CI, 1.63-1.81; P < .001) and patients 65 years and older (OR, 1.38; 95% CI, 1.30-1.47; P < .001).

CONCLUSIONS - Warfarin use is common among injured patients and its prevalence has increased each year since 2002. Its use is a powerful marker of mortality risk, and even after adjusting for confounding comorbidities, it is associated with a significant increase in death.

MeSH Terms (27)

Adult Aged Aged, 80 and over Age Factors Anticoagulants Cause of Death Cohort Studies Comorbidity Cross-Sectional Studies Databases, Factual Drug Utilization Female Hospital Mortality Humans Intracranial Hemorrhage, Traumatic Long-Term Care Male Middle Aged Odds Ratio Retrospective Studies Survival Analysis Trauma Centers Trauma Severity Indices United States Warfarin Wounds and Injuries Young Adult

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