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Master Thesis

Impact des traitements antithrombotiques sur la morbi-mortalité des patients traumatisés

Abstract : Context: Nowadays, occidental population has to face 2 important trends implicated in serious public health issues. First, the use of anticoagulant (AC) and antiplatelet agent (APA) is growing. Secondly, traumas are more frequent and as a result increase death by trauma. Objective: The aim of this study was to compare mortality and outcome in 2 groups of traumatized patients: one group with preinjury AC or APA, and one group without preinjury treatment. Methods: A retrospective study was lead in 3 level I or II trauma centres (Grenoble university hospital and Annecy and Chambéry regional hospitals). Patients with trauma and preinjury use of anticoagulant or antiplatelet agent were included. Demographic, clinical, biological and outcome data were abstracted from an existing traumatic injury data base, the “Trauma REseau Nord Alpin des Urgences”. This data base was completed then with the help of the medical files. Mortality was compared in the 2 groups: with or without preinjury treatment. Results: Between 2012 and 2014, 3784 suffered from a traumatism and 163 patients had preinjury treatment: 46.6% with preinjury VKA use, 39.9% with preinjury aspirin use and 13.5% with preinjury clopidogrel use. Inhospital mortality in the group without preinjury treatment was 6.5% whereas in the group with preinjury treatment it was 13.5%. The hospital length of stay (HLOS) in this treated group was 18.9 ± 22.5 days and 46% of the cohort had good recovery. Among all the patients with preinjury treatment, 30.5% received blood products and 34.4% received medicinal products made from human blood. A surgery was required in 31.3 % of cases and a radio-intervention in 6.1 % of cases. The preinjury use of AC and/or APA was significantly associated with higher mortality (p<0.05) and with an increase of HLOS (p<0.001) and a clinical status at hospital discharge altered (p<0.001). Conclusion: Preinjury use of antithrombotic treatment have been demonstrated to be an independent predictive factor of mortality and bad outcome in traumatized patients. Clinicians managing major trauma patients under those medications need to be aware of the vulnerability of those patients and of the specificities of their management.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01289052
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Submitted on : Wednesday, March 16, 2016 - 9:02:59 AM
Last modification on : Wednesday, July 15, 2020 - 8:58:04 AM
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  • HAL Id : dumas-01289052, version 1

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Bénédicte Zerr. Impact des traitements antithrombotiques sur la morbi-mortalité des patients traumatisés. Médecine humaine et pathologie. 2016. ⟨dumas-01289052⟩

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