Novel oral anticoagulants and trauma: the results of a prospective AAST Multi-Institutional Trial.

BACKGROUND: The number of anticoagulated trauma patients is increasing. Trauma patients on warfarin have been found to have poor outcomes, particularly following intracranial hemorrhage (ICH). However, the effect of novel oral anticoagulants (NOAs) on trauma outcomes is unknown. We hypothesized that patients on NOAs would have higher rates of ICH, ICH progression, and death compared to patients on traditional anticoagulant and antiplatelet agents. METHODS: This was a prospective observational trial across 16 trauma centers. Inclusion criteria was any trauma patient admitted on aspirin, clopidogrel, warfarin, dabigatran, rivaroxaban, or apixaban. Demographic data, admission vital signs, mechanism of injury, injury severity scores, laboratory values, and interventions were collected. Outcomes included ICH, progression of ICH, and death. RESULTS: A total of 1847 patients were enrolled between July 2013-June 2015. Mean age was 74.9 years (SD +/- 13.8), 46% were female, 77% were Non-Hispanic White. At least one co-morbidity was reported in 94% of patients. Blunt trauma accounted for 99% of patients and the median ISS was 9 (IQR 4-14). 50% of patients were on antiplatelet agents, 33% on warfarin, 10% on NOAs, and 7% on combination therapy or subcutaneous agents. Patients taking NOAs were not at higher risk for ICH on univariate (24% vs. 31%) or multivariate analysis (IRR 0.78, CI 0.61-1.01, p=0.05). Compared to all other agents, patients on aspirin (90% 81mg, 10% 325mg) had the highest rate (35%), and risk (IRR 1.27, CI 1.13-1.43, p

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