October 30, 2009

Study explores warfarin’s potential impact on elderly trauma patients

Study explores warfarin’s potential impact on elderly trauma patients

Researchers with Vanderbilt University Medical Center and the University of Texas Health Sciences Center have found that warfarin, an anticoagulant commonly prescribed for the prevention of heart attacks and blood clots, may cause problems for individuals who suffer some form of trauma, particularly the elderly.

Study findings concluded that warfarin was associated with a 30 percent increased risk of death among all trauma patients, and a 20 percent increase among those 65 and older.

Results of the study were recently presented at the 2009 gathering of the Clinical Congress of the American College of Surgeons in Chicago.

Lesly Dossett, M.D., M.P.H.

Lesly Dossett, M.D., M.P.H.

“Trauma is a relatively rare event for the elderly,” said Lesly Dossett, M.D., M.P.H., chief resident in Vanderbilt's Department of General Surgery and the study's lead author.

“If patients have a clear indication and can benefit by taking warfarin, then we are not suggesting they not take the drug. However, this study documents another risk of long-term anticoagulation with warfarin, which is of particular importance for those prescribing the drug.”

The study's findings could result in implications for how doctors prescribe warfarin as the use of the drug continues to increase. Warfarin is commonly used in humans as a blood-thinning drug to prevent dangerous forms of blood clotting. Approximately 31 million prescriptions for warfarin were written in 2004.

Dossett and colleagues conducted the first large-scale analysis of warfarin using the National Trauma Databank (NTDB) of the American College of Surgeons. The study involved data on 1.2 million patients from 402 centers reporting data to the NTDB.

Dossett cautions that other health problems not accounted for in the NTDB may partially explain the study's findings for increased risk of death. The study did not make a definitive connection between the use of warfarin and post-trauma death.

“If you are on warfarin and fall, this could make an otherwise innocuous event life-threatening,” Dossett said. “The message of this study is to document another risk of long-term warfarin use. Our challenge is to determine the best way for correcting blood-clotting in trauma patients on warfarin.”

Dossett's co-authors on this study are Bryan Cotton, M.D., M.P.H., of the University of Texas Health Sciences Center, Marie Griffin, M.D., M.P.H., professor of Preventive Medicine and Medicine at VUMC, and fourth-year Vanderbilt University School of Medicine student Johanna Riesel.