Jason Hecht, BCCCP, BCPS, PharmD
Clinical Pharmacy Specialist - Surgical Critical Care
St. Joseph Mercy Ann Arbor
Ann Arbor, MI
Disclosure information not submitted.
Wendy Wahl, MD, FACS, FCCM,FCCM
Surgical ICU Director, Surgical Critical Care Fellowship Director
The Ohio State Wexner Medical Center, United States
Disclosure information not submitted.
Alyssa Divens, PharmD
Clinical Pharmacy Generalist - Surgery
University of Michigan, Michigan, United States
Disclosure information not submitted.
Title: Effect of Time to Reversal of Warfarin Following Emergent Operation for Traumatic Brain Injury
Introduction: Each year 214,000 people die from traumatic injury and of these trauma patients that present to a hospital, many are on an anticoagulant. Studies have shown that earlier reversal of warfarin in trauma patients presenting with intracranial hemorrhage leads to lower rate of hematoma enlargement and reduces mortality. While there are studies discussing traumatic injuries and warfarin reversal there is little information on patients that require reversal for emergent operations. Our study aims to fill this gap in existing literature.
Methods: This study is a multicenter observational study of data from January 2018 to December 2019 from the Michigan Trauma Quality Improvement Program. Patients were included if they were ≥18 years old, had an abbreviated injury score (AIS) head of ≥ 2, on preinjury warfarin, and had an emergency operation. Patients were excluded if presenting with no signs of life. Patients were stratified by time to reversal into < 2 hours and 2 hours to 6 hours.
Results: Overall 40 patients were included from 27 unique hospitals. There were 22 patients who received reversal within 2 hours and 18 in the 2 – 6 hour group. The mean age (70.3 and 73.7 years) and GCS score (11.9 vs. 12.7) were similar between the < 2 hour and 2 – 6 hour groups. The time from hospital arrival to head imaging was similar in both the < 2 hour group (101.8 minutes) as compared to the 2 – 6 hour group (110.2 minutes). Overall there were 6 patients (27.3%) in the < 2 hour group and 3 patients (16.7%) who had in-hospital mortality or discharge to hospice (p = 0.476). Hospital length of stay (LOS) was 9.1 days in the < 2 hour group and 10.6 days in the 2 – 6 hour group (p = 0.123). Similiarly there was no difference in intensive care unit LOS with 6.6 days in the < 2 hour group and 8.1 days in the 2 – 6 hour group (p = 0.155).
Conclusions: In this multicenter study of level 1 and 2 trauma centers in Michigan there was no difference in mortality or in-hospital outcomes amongst patients on preinjury warfarin requiring an emergent operation who received reversal within 2 hours as compared to 2 – 6 hours. The study is limited by its observational design, inherit patient characteristics that could not be adjusted for, and small sample size given the rare clinical occurrence of the study question.