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Outcomes of Recreational Activity-Associated Trauma in Elderly Persons on Blood-Thinning Medications.

Abstract With increasing life expectancy, the elderly are participating in recreational activities traditionally pursued by younger persons. Elderly patients have many reasons for worse outcomes after trauma, one of which may be the rising use of anticoagulant and/or antiplatelet medications. This study aimed to determine whether preinjury use of these agents yielded worse outcomes in geriatric patients injured during high-impact recreational activities. The National Trauma Data Bank was reviewed from 2007 to 2010 for patients ≥65 years admitted to Level I or II trauma centers with ICD-9 E-codes for specific mechanisms of injury. These included motorcycles, bicycles, snowmobiles, all-terrain vehicles, equestrian, water and alpine skiing, snowboarding, and others. Patients with preinjury bleeding disorder (BD), including warfarin and clopidogrel use, were compared with controls via a coarsened exact matching analysis. BD patients (294) were compared with 3929 controls. Although increased in BD patients, no significant mortality differences were observed in unmatched or matched analyses. BD patients yielded greater hospital length of stay (5 vs 4 days, P = 0.020) with increased odds of receiving five units or more of blood (7.0% vs 2.1%, odds ratio = 4.7, P < 0.001) and of deep vein thrombosis (7.6% vs 3.8%, odds ratio = 2.1, P = 0.018). Elderly patients with BD, including warfarin or clopidogrel use, do not seem to have significantly increased mortality after injury during specified recreational activities. BD patients had greater hospital length of stay, transfusion requirements, and deep vein thrombosis rates. These findings may inform counseling for those taking such medications as to the potential for adverse outcomes.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title the american surgeon
Publication Year Start




PMID- 28424132
OWN - NLM
STAT- In-Process
DA  - 20170420
LR  - 20170420
IS  - 1555-9823 (Electronic)
IS  - 0003-1348 (Linking)
VI  - 83
IP  - 4
DP  - 2017 Apr 01
TI  - Outcomes of Recreational Activity-Associated Trauma in Elderly Persons on
      Blood-Thinning Medications.
PG  - 371-376
AB  - With increasing life expectancy, the elderly are participating in recreational
      activities traditionally pursued by younger persons. Elderly patients have many
      reasons for worse outcomes after trauma, one of which may be the rising use of
      anticoagulant and/or antiplatelet medications. This study aimed to determine
      whether preinjury use of these agents yielded worse outcomes in geriatric
      patients injured during high-impact recreational activities. The National Trauma 
      Data Bank was reviewed from 2007 to 2010 for patients &gt;/=65 years admitted to
      Level I or II trauma centers with ICD-9 E-codes for specific mechanisms of
      injury. These included motorcycles, bicycles, snowmobiles, all-terrain vehicles, 
      equestrian, water and alpine skiing, snowboarding, and others. Patients with
      preinjury bleeding disorder (BD), including warfarin and clopidogrel use, were
      compared with controls via a coarsened exact matching analysis. BD patients (294)
      were compared with 3929 controls. Although increased in BD patients, no
      significant mortality differences were observed in unmatched or matched analyses.
      BD patients yielded greater hospital length of stay (5 vs 4 days, P = 0.020) with
      increased odds of receiving five units or more of blood (7.0% vs 2.1%, odds ratio
      = 4.7, P &lt; 0.001) and of deep vein thrombosis (7.6% vs 3.8%, odds ratio = 2.1, P 
      = 0.018). Elderly patients with BD, including warfarin or clopidogrel use, do not
      seem to have significantly increased mortality after injury during specified
      recreational activities. BD patients had greater hospital length of stay,
      transfusion requirements, and deep vein thrombosis rates. These findings may
      inform counseling for those taking such medications as to the potential for
      adverse outcomes.
FAU - DeBoard, Zachary M
AU  - DeBoard ZM
FAU - Grotts, Jonathan
AU  - Grotts J
FAU - Ferrigno, Lisa
AU  - Ferrigno L
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am Surg
JT  - The American surgeon
JID - 0370522
EDAT- 2017/04/21 06:00
MHDA- 2017/04/21 06:00
CRDT- 2017/04/21 06:00
PST - ppublish
SO  - Am Surg. 2017 Apr 1;83(4):371-376.

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