Influence of Antithrombotics on Severely Injured Patients Over 50 With Blunt Abdominal Trauma

Severe abdominal trauma represents a critical subset of injuries, particularly in the aging European population, where the prevalence of preexisting anticoagulant or antiplatelet therapy is increasing. While the impact of such medications on outcomes in traumatic brain injury is well studied, limited data exist regarding their influence in patients with abdominal trauma.

This retrospective cohort study used data from the TraumaRegister DGU^® between January 2015 and December 2023. Inclusion criteria were patients aged ≥ 50 years with severe blunt abdominal trauma (AIS Abdomen ≥ 3) without relevant head injury (AIS Head ≤ 3) from Austria, Germany, or Switzerland. Patients were grouped according to pre-injury antithrombotic medication (no medication [NM] vs. antithrombotic medication [AM], with subgroups). Statistical analysis included descriptive comparisons, standardized mortality ratios (SMR) using RISC III, and multivariate logistic regression to identify independent predictors of hospital mortality.

Of 328,281 patients, 4,069 met inclusion criteria (2,831 NM; 1,238 ATM). Patients in the AM group were older (74.1 vs. 62.3 years) and had higher mortality (25.0% vs. 10.4%), particularly in the DOAC subgroup (30.3%). SMR analysis demonstrated increased mortality in the AM group compared to expected rates. In multivariate logistic regression, antithrombotic medication remained an independent predictor of mortality (OR 1.28, 95% CI 1.03-1.58; p = 0.025). Prehospital management differed significantly, with lower intubation and tranexamic acid use in the AM group. Surgical management was largely comparable.

Antithrombotic therapy is independently associated with increased mortality in patients aged ≥ 50 years with severe abdominal trauma. In addition to distinct treatment patterns and possible undertriage, these findings highlight the need for tailored trauma management strategies in this high-risk population.