Complications of Preinjury Warfarin Use in the Trauma Patient

Abstract

We conclude that the preinjury use of warfarin does not place the trauma patient at increased risk for fatal hemorrhagic complications in the absence of head trauma. Furthermore, the presence of a head trauma alone is not predictive of mortality. However, the presence of intracranial injury is strongly associated with a mortality rate that is significantly higher than patients with head trauma who are not taking warfarin. LOC is also associated with mortality, but the absence of loss of consciousness does not reliably indicate the absence of intracranial injury or risk of death.

Translating the Results of Randomized Trials into Clinical Practice

“…More research is needed to discern absolute from relative contraindications to help guide physicians and patients in their assessment of the overall risks and benefits of therapy. [33][34][35] Strategies are needed to optimize candidacy among elderly patients, particularly interventions to reduce hemorrhage and falls. 36 -38 Prospective studies are needed to better define the true hazard of falls in the presence of anticoagulant therapy.…”

Warfarin reversal

“…43 ICH after trauma is also associated with a poorer outcome in anticoagulated patients. 44 The reasons for this increase in mortality are poorly understood, although several recent studies have identified factors that might be important. In a retrospective multicentre study of 151 patients on warfarin presenting with ICH, both the initial ICH volume and haematoma enlargement within the first 24-48 hours of admission to hospital were associated with poor outcome.…”

Prothrombin Complex Concentrates for Warfarin-Related Intracranial Hemorrhage: Should they Replace Fresh Frozen Plasma?

“…Patients undergoing treatment with oral anticoagulants, mainly warfarin, constitute 12% to 14% of patients with ICH [1,2]. Patients with warfarin-related ICH have a high mortality rate close to 60%, compared to about 40% for nonanticoagulated patients with ICH [3,4]. The poor outcome in warfarin-related ICH is mainly related to volume of hemorrhage and expansion of the hematoma size after admission [2,5].…”