(Press-News.org) Warfarin use may be associated with a significant increase in the risk of death after traumatic injuries, according to a report posted online today that will appear in the May print issue of Archives of Surgery, one of the JAMA/Archives journals.
"The prevalence of warfarin use in the United States is unknown, but the Food and Drug Administration estimates that more than 31 million prescriptions for warfarin were written in 2004," according to background information in the article. "Warfarin is a commonly used anticoagulant [prevents the formation of blood clots] for the long-term management and prevention of thromboembolic (blood clot formed in one vessel carried by the blood stream to occlude another vessel) events associated with atrial fibrillation (abnormal heart rhythm), mechanical heart valves, deep venous thrombosis (clot formed in a vein deep in the body), pulmonary embolism (clot that causes blockage of a blood vessel in the lung), the antiphospholipid syndrome (condition that increases the risk of blood clot formation) and occasionally, myocardial infarction (heart attack)."
Using the National Trauma Databank, Lesly A. Dossett, M.D., M.P.H., of Vanderbilt University Medical Center, Nashville, Tenn., and colleagues, studied data from more than 1.2 million individuals admitted to eligible trauma centers between 2002 and 2007. Of these, 36,270 patients (3 percent) and 26,841 patients older than 65 (9 percent) were classified as warfarin users. The total proportion of warfarin users increased from 2.3 percent in 2002 to 4 percent in 2006, and in those age 65 and older, from 7.3 percent in 2002 to 12.8 percent in 2006.
Overall, warfarin users were also more likely to die from their injuries compared to non-users (9.3 percent vs. 4.8 percent). Warfarin users were also more likely to have blunt mechanism injuries (87 percent vs. 96 percent), were more likely to sustain their injuries in the home or residential institutions and as a group, experienced more severe injuries. Warfarin users were also more likely to be admitted with intracranial hemorrhage (bleeding within the brain). Among all individuals admitted with intracranial hemorrhage, warfarin users had a significantly increased risk of death than non-users (22 percent vs. 18 percent); however, among those 65 and older, there was no difference in risk of death between the two groups.
"The most profound impact is among younger patients with head injuries," the authors write. "While older patients with severe head injuries have high mortality rates whether or not they are warfarin users, warfarin use increases the mortality from severe head injuries by 50 percent in patients younger than 65 years."
"These data support other reports that suggest that patients who undergo pre-injury anticoagulation with warfarin are at increased risk of death after trauma," the authors conclude. "Warfarin prescribers should consider these data in the overall risk-benefit analysis when opting to prescribe warfarin, and these data provide further rationale for discontinuing warfarin when the clinical evidence no longer supports its use."
###
(Arch Surg. Published online January 17, 2011. doi:10.1001/archsurg.2010.313. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
To contact co-author Marie R. Griffin, M.D., M.P.H., call Craig Boerner at 615-322-4747 or e-mail craig.boerner@vanderbilt.edu.
For More Information: Contact the JAMA/Archives Media Relations Department at 312-464-JAMA or email: mediarelations@jama-archives.org.
END
A significant portion of the U.S. population does not have access to trauma care within an hours' drive, with certain vulnerable groups at higher risk of worse access, according to a report in the January issue of Archives of Surgery, one of the JAMA/Archives journals.
"Trauma centers are a key component of the infrastructure of the U.S. health care system because they have been shown to decrease morbidity and mortality [illness and death] for injured patients of all age ranges, from children to the elderly," the authors write as background information in the article. ...
As many as one in 16 surgeons reported having suicidal thoughts in the previous year, but few sought help from a mental health clinician, according to a report in the January issue of Archives of Surgery, one of the JAMA/Archives journals.
Death from suicide is more common among physicians than among the general population or among other professionals, according to background information in the article. "Although suicide is strongly linked to depression, the lifetime risk of depression among physicians is similar to that of the general U.S. population," the authors write. ...
Performing polysomnography (sleep study) prior to pediatric adenotonsillectomy (surgical removal of the tonsils and adenoids) may help identify children at a higher risk of developing postoperative respiratory complications, according to a report in the January issue of Archives of Otolaryngology - Head Neck Surgery, one of the JAMA/Archives journals.
"Pediatric adenotonsillectomy is a safe outpatient procedure; however, there is a subset of patients who do not meet the criteria for outpatient surgery," according to background information in the article. Guidelines for ...
A follow-up program for patients at high risk of developing skin cancer appears to be associated with the detection of melanomas at early stages and with good prognosis, according to a report posted online today that will appear in the May print issue of Archives of Dermatology, one of the JAMA/Archives journals.
Efforts to improve melanoma prognosis have focused on identifying and closely monitoring individuals at high risk, according to background information in the article. "Fair-skinned persons, persons who tan with difficulty, blond or red-haired persons and persons ...
Time constraints, other illnesses and patient embarrassment may prevent dermatologists, internists and family practitioners from conducting full-body skin examinations, according to a report in the January issue of Archives of Dermatology, one of the JAMA/Archives journals. However, dermatologists are significantly more likely than internists and family practitioners to conduct such screenings.
Skin cancer is the most frequently diagnosed cancer in the United States, according to background information in the article. "It is critical for patients to adhere to primary ...
A procedure involving only one small incision and no major modifications to bone can be used to transpose a tendon and appears helpful in reanimating the lower face after paralysis, according to a report in the January/February issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.
"The primary goal of all facial reanimation protocols is to restore facial movement that is controlled, symmetrical and spontaneous," the authors write as background information in the article. Previously, researchers reported a method of transferring the temporalis ...
Health care reform should be able to mend a disconnect that has existed between the recommendations of the U.S. Preventive Services Task Force (USPSTF), a task force charged by the government to review clinical preventive health services for older adults, and Medicare coverage for those services, a new UCLA-led study finds.
In particular, there is a need to improve coordination between assessing the risk for certain illnesses and ensuring the patient receives the appropriate tests and follow-up medical services, according to the study, which is published in the January/February ...
In three papers in the January and February issues of the Journal of General Physiology (JGP), Don Hilgemann and colleagues have extensively characterized a previously unidentified process by which up to 75% of the cell plasma membrane can be reversibly endocytosed. This massive endocytosis ("MEND") can be elicited in a variety of cell types with a range of different experimental manipulations, including internal calcium transients in the presence of ATP, membrane treatment with sphingomyelinase, and introduction of various amphiphiles into the membrane bilayer. MEND ...
Heart failure patients admitted to general wards are twice as likely to die as those admitted to cardiology wards, shows a national audit of the treatment of the condition, published online in the journal Heart.
Women fared worse than men when it comes to appropriate investigations and treatment, the findings suggest, although death rates were similar.
In 2006/7, heart failure accounted for more than a quarter of a million hospital deaths and discharges in England and Wales, equating to around 2.5 million bed days a year and at an annual cost to the NHS of £563 million.
The ...
Smoking accounts for up to 60% of the gender gap in death rates across Europe, and kills twice as many men as alcohol, reveals research published online in Tobacco Control.
The reasons why women have been outliving men in developed European countries since the mid to late 18th century, in some cases, have been hotly contested.
The gender gap in death rates has sometimes been put down to simple biology, or the fact that women seek out health care more readily than men. But the magnitude and variability of the trends suggests a rather more complex picture, say the authors, ...
