Nonoperative management of blunt abdominal solid organ injury: Are we paying enough attention to patients on preinjury anticoagulation?

Am J Surg. 2022 Nov;224(5):1308-1313. doi: 10.1016/j.amjsurg.2022.06.019. Epub 2022 Jun 25.

Abstract

Background: This study aims to assess the impact of pre-injury anticoagulant use on outcomes of isolated blunt abdominal SOI patients who underwent NOM.

Methods: A 1-year(2017) analysis of the ACS-TQIP. We included all ≥18yrs trauma patients with isolated blunt abdominal-SOI who underwent NOM. Patients were stratified into two groups based on their history of pre-injury anticoagulant use. Propensity score matching was performed.

Results: A matched cohort of 2709 patients (AC, 903; No-AC,1806) was analyzed. Compared to the No-AC group, the AC group had higher rates of failure of NOM(2.6% vs. 4.5%, p = 0.03), cardiac arrest (1.2%vs. 3.1%, p = 0.02), acute kidney injury (2.4% vs. 4.2%, p < 0.01), myocardial infarction (0.6% vs. 1.4%,p = 0.03), and mortality (5.1%vs. 7.6%,p = 0.01), and longer hospital LOS (17[10-24]vs.17[12-26]days,p = 0.04) and ICU LOS (11[6-17]vs.11[7-18]days,p = 0.01).

Conclusion: Among nonoperatively managed blunt abdominal SOI patients, preinjury use of anticoagulants negatively impacts outcomes. Extra surveillance is required while managing patients with blunt abdominal SOI on pre-injury anticoagulants.

Level of evidence: Level III.

Study type: Therapeutic/care management.

Keywords: Adults; Blunt abdominal injury; Preinjury anticoagulation; Solid organ injury; Trauma.

MeSH terms

  • Abdominal Injuries* / complications
  • Abdominal Injuries* / therapy
  • Anticoagulants / therapeutic use
  • Humans
  • Injury Severity Score
  • Propensity Score
  • Retrospective Studies
  • Spleen / injuries
  • Wounds, Nonpenetrating* / complications
  • Wounds, Nonpenetrating* / therapy

Substances

  • Anticoagulants