Fighting bleeding – High-risk groups of severely injured patients on Vitamin K antagonists

Introduction

Vitamin K antagonist (VKA) therapy is a known risk factor for an increased mortality risk following severe trauma. Little is known about the distribution of the mortality risk within the group. We ventured a first approach to divide the group of above-mentioned risk patients into subgroups according to their mortality risk.

Methods

We conducted two retrospective registry studies using data sets from the Traumaregister DGU of the German Trauma Society. Inclusion criteria required an age >=55 years and a MAIS>=3.

Results

We observed that the mortality risk remains significantly increased despite the advances in the management of patients on VKA. A high-risk group (INR >= 3.5) was identified within the cohort, which had a 61% higher mortality risk than VKA patients outside the therapeutic range (reference group, INR <1.5). Interestingly, subgroups with an INR between 1.5 and 3.5 did not show an increased mortality risk compared to the above-mentioned reference group.

Conclusions

Based on the aforementioned results, future studies should consider the discrimination of severely injured patients on VKA on the basis of INR values.

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