The Effect of Anticoagulation on Outcomes After Liver and Spleen Injuries: A Research Consortium of New England Centers for Trauma (ReCONECT) Study
Bishwajit Bhattacharya1, *Reza Askari2, Kimberly A Davis1, *Jon Dorfman3, *Ahmed I Eid4, *Ahmed E Elsharkawy4, *George Kasotakis5, *Sandra Mackey6, *Stephen Odom7, *Barbara U. Okafur2, *Michael Rosenblatt6, *Alex Rudtisky5, George Velmahos4, Adrian A Maung1
1Yale School of Medicine, New Haven, CT; 2Brigham and Women's Hospital, Boston, MA; 3UMass Medical School, Worcester, MA; 4Massachusetts General Hospital, Boston, MA; 5Boston University, Boston, MA; 6Lahey Clinic, Burlington, MA; 7Beth Israel Deaconess Medical Center, Boston, MA
Objective: Study the effect of anticoagulation (AC) in patients with liver and or spleen injuries. Design: Multicenter retrospective study. Setting: Adult trauma centers. Patients: Adult trauma patients with liver or spleen injury. Main Outcomes: Transfusion requirements, success on non-operative management, LOS, mortality. Results: 1254 patients (64 on AC) were analysed. AC patients were older (60.9 vs. 38.6 years, p < 0.001). 57.5% of patients had a splenic injury, 52.8% a liver injury and 10.5% both. The most common AC agent was warfarin (70.3%), the most common indication was atrial fibrillation (46.9%). There was no significant difference in injury grade between AC and non-AC patients. AC patients required a blood products more often (57.8 vs 40.1%, p=0.005) especially FFP (42.1 vs 18.9%, p< 0.01). Among those transfused, non-AC patients required more PRBC's (5.7 vs 3.8 units, p=0.018), similar amounts of FFP (3.2 vs 3.1 units, p=0.92). The two groups had no significant difference in the rates of initial non-operative management (50% (AC) vs 55.7% (non-AC), p=0.3)) or failure of non-operative management (7.1 vs 3.5%, p=0.16). Patients on AC were more likely to be managed initially with angiography (37.5 vs 20.3%, p=0.001) while non-AC patients with surgery (23.9% vs 12.5%, p=0.03). There was no significant difference in LOS and mortality. Conclusions: The use of anticoagulation agents did not result in a difference in outcomes.
Table 1.
Demographics | ||||
All | AC | Non-AC | Comparison (AC vs Not) | |
Age | 39.71 ± 19.01 | 60.88 ± 19.55 | 38.56 ± 18.30 | p < 0.001 |
Gender (% Male) | 68 | 70.3 (45) | 67.9 (808) | Chi Square 0.163 p=0.687 |
ISS (Mean +/- SD) | 22.37 ± 13.5 | 21.42 ± 13.6 | 22.42 ± 13.52 | p=0.566 |
Spleen % (n) | 57.5 (721) | 76.6 (49) | 56.5 (672) | Chi Square 10.032 p=0.002 |
Mean Spleen Grade | 2.51±1.256 | 2.35 ± 1.32 | 2.52 (1.25) | |
Median Spleen Grade | 2 | 2 | 2 | p = 0.346 |
Spleen IQR (25-75) | 2 (1-3) | 2 (1-3) | 2 (1-3) | |
Liver % (n) | 52.8 (662) | 35.9 (23) | 53.7 (639) | Chi Square 7.726 p=0.005 |
Mean Liver Grade | 2.31±1.239 | 2 ± 1.13 | 2.32 ± 1.24 | p = 0.218 |
Median Liver Grade | 2 | 2 | 2 | |
Liver IQR (25-75) | 2 (1-3) | 2 (1-3) | 2 (1-3) | |
% Both | 10.5 | 12.5 (8) | 10.4 (124) | Chi Square 0.2798 p=0.597 |
Table 2.
Outcomes | All | AC | Non-AC | Chi Square | P Value |
Required Transfusion % (N) | 40.9 (512) | 57.8 (37) | 40.1 (475) | 7.922 | 0.005 |
Mean # PRBC (Limited to those transfused) | 5.6 ± 8.4 | 3.8 ± 4.2 | 5.7 ± 8.7 | 0.018 | |
Mean # FFP (Limited to those transfused) | 3.2± 7.5 | 3.1 ± 4.0 | 3.2 ± 7.7 | 0.92 | |
Mean # Plts ((Limited to those transfused) | 1.7±6.8 | 1.6±4.4 | 1.8±7.0 | 0.87 | |
Initial Operative Management % (N) | 23.4 (293) | 12.5 (8) | 23.9 (285) | 4.45 | 0.035 |
Initial IR Management % (N) | 21.2 (266) | 37.5 (24) | 20.3 (242) | 10.71 | 0.001 |
Initial Non-OP Management % (N) | 55.4 (695) | 50 (32) | 55.7 (663) | 0.803 | 0.370 |
Failure of Non-Op Management (All) | 3.7 (36) | 7.1 (4) | 3.5 (32) | 1.9 | 0.168 |
Failure of Initial IR Management | 8.3 (22) | 16.7 (4) | 7.4 (18) | 2.5 | 0.117 |
Failure of Non-Op Management (No IR) | 2.0 (14) | 0 (0) | 2.1 (14) | 0.690 | 0.406 |
Subsequent IR Management (All) | 3.4(33) | 0 (0) | 3.6 (33) | 2.115 | 0.146 |
ICU Admission | 70.6 (886) | 78.1 (50) | 70.2 (836) | 1.816 | 0.178 |
LOS Days Mean ± SD | 9.6±10.9 | 12.0 ±11.6 | 9.4±11.0 | 0.069 | |
Mortality | 8.0 (100) | 4.7 (3) | 8.2 (97) | 0.993 | 0.319 |
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