SHM Converge Conference Coverage

Resuming Anticoagulation After Major Trauma

Anthony Calabro, MA

Key Highlights

  • Less than half (46.9%) of trauma patients with indications for anticoagulation were discharged without resumption of therapy.
  • Patients discharged on anticoagulation did not experience increased major bleeding compared with those discharged without anticoagulation.
  • Patients discharged on anticoagulation had significantly lower rates of cerebrovascular accidents and transient ischemic attacks (CVA/TIA) within 1-year post-discharge.
  • Readmission rates were similar regardless of anticoagulation status at discharge.

In a retrospective analysis of trauma patients on anticoagulation, researchers found that continuing anticoagulation therapy post-discharge was associated with a lower incidence of CVA/TIA without a corresponding increase in major bleeding events. Additionally, hospital readmission rates did not significantly differ between patients discharged with or without anticoagulation therapy. Researchers presented their results of their study at the Society of Hospital Medicine Converge in Las Vegas, NV.

Physical trauma poses unique risks for patients on anticoagulation therapy, primarily concerning the potential for major bleeding. However, discontinuation of anticoagulation after trauma can expose patients to thrombotic events. Despite the widespread clinical use of anticoagulants and the known risks of both thrombosis and hemorrhage, limited data exist to guide post-trauma anticoagulation management. This study aimed to fill that gap by evaluating post-discharge outcomes in trauma patients who either resumed or discontinued anticoagulation therapy.

Researchers conducted a retrospective cohort study using data from the Mayo Clinic Trauma Registry. They identified all patients admitted to Saint Mary’s Hospital in Rochester, Minnesota, from January 1, 2012, through December 31, 2021, who were on anticoagulants at the time of trauma admission. Patient demographics, anticoagulation type and indication, Charlson Comorbidity Index, and Injury Severity Scores were collected. Outcomes assessed included major bleeding events (per ISTH criteria), thrombotic events (CVA/TIA, acute coronary syndrome, deep vein thrombosis/pulmonary embolism), and hospital readmissions within 1-year post-discharge. Data were analyzed using SAS (V9.4) with significance set at P < .05.

The study included 1056 patients, with a mean age of 77.4 years; women accounted for 45% of the study population. Warfarin was the most common anticoagulant (81.7%), and atrial fibrillation was the leading indication for therapy (70.9%). Although 46.9% of patients did not resume anticoagulation at discharge, those who did were not at increased risk for major bleeding (P = .12) and had significantly fewer CVA/TIA events (1.6% vs 5.3%, P = .001) compared with those discharged without anticoagulation. Readmission rates, including for trauma-related events, were comparable between groups.

“The decision to continue or stop anticoagulation after physical trauma is complex, especially due to lack of data in the anticoagulated trauma patient population,” the authors concluded. “More epidemiological data, including further study of direct oral anticoagulants in the setting of trauma, will be required to help both clinicians and patients with decision making.”

Reference
Russell EM, Guarda M, Boyapati RB, et al. Post-discharge outcomes in patients on anticoagulation at the time of major trauma. Paper presented at: Society of Hospital Medicine's SHM Converge 2025; April 22-25, 2025; Las Vegas, NV. Accessed April 22, 2025. https://shmconverge.hospitalmedicine.org/