Background: Bleeding represents the most well-known and the most feared complications caused by the use of\nantithrombotic agents. There is, however, limited documentation whether pre-injury use of antithrombotic agents\naffects outcome after head trauma. The aim of this study was to define the relationship between the use of\npreinjury antithrombotic agents and mortality among elderly people sustaining blunt head trauma.\nMethods: A retrospective cohort analysis was performed on the hospital based trauma registry at Oslo University\nHospital. Patients aged 55 years or older sustaining blunt head trauma between 2004 and 2006 were included.\nMultivariable logistic regression analyses were used to identify independent predictors of 30-day mortality.\nSeparate analyses were performed for warfarin use and platelet inhibitor use.\nResults: Of the 418 patients admitted with a diagnosis of head trauma, 137 (32.8 %) used pre-injury antithrombotic\nagents (53 warfarin, 80 platelet inhibitors, and 4 both). Seventy patients died (16.7 %); 15 (28.3 %) of the warfarin users,\n12 (15.0 %) of the platelet inhibitor users, and two (50 %) with combined use of warfarin and platelet inhibitors,\ncompared to 41 (14.6 %) of the non-users. There was a significant interaction effect between warfarin use and the\nTriage Revised Trauma Score collected upon the patients� arrival at the hospital. After adjusting for potential confounders,\nwarfarin use was associated with increased 30-day mortality among patients with normal physiology (adjusted OR\n8,3; 95 % CI, 2.0 to 34.8) on admission, but not among patients with physiological derangement on admission.\nUse of platelet inhibitors was not associated with increased mortality.\nConclusions: The use of warfarin before trauma was associated with increased 30-day mortality among a subset\nof patients. Use of platelet inhibitors before trauma was not associated with increased mortality. These results indicate\nthat patients on preinjury warfarin may need closer monitoring and follow up after trauma despite normal physiology\non admission to the emergency department.
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