# Short-term impact of preinjury antithrombotic therapy on outcomes in older trauma patients

## TL;DR

This study examines how preinjury use of antithrombotic drugs affects outcomes in older trauma patients and finds no significant association with worse short-term outcomes.

## Contribution

The study is the first to explore the impact of preinjury antithrombotic therapy in a regional trauma registry with additional documentation.

## Key findings

- Half of older trauma patients used antithrombotic medication, primarily platelet inhibitors or anticoagulants.
- Preinjury antithrombotic use was not linked to higher injury severity, intracranial bleeding, mortality, or poor recovery outcomes.
- The study advocates for structured documentation of antithrombotic use in trauma registries for future research.

## Abstract

Preinjury use of antithrombotic medication (PAM) may increase bleeding risk and adverse outcomes in older trauma patients. PAM is not routinely recorded in the Dutch trauma registry, leaving its impact on outcomes unclear. This study describes PAM among older trauma patients and assesses its association with injury patterns and patient outcomes, thereby informing whether routine documentation in trauma registries would be useful.

Data from trauma patients aged ≥ 65 years admitted to hospitals within the West-Netherlands trauma region in June-September 2024 were obtained from the regional trauma registry. PAM was additionally documented during this period. Poor outcome was defined as in-hospital mortality and Glasgow Outcome Scale (GOS) score ≤ 3 at hospital discharge. Associations between PAM and outcomes were analyzed using multivariable logistic regression.

Of 1,112 patients, 50% used antithrombotic medication, most commonly platelet aggregation inhibitors (47%) or direct oral anticoagulants (37%). Users were older, more often male, had more comorbidities, and more frequently sustained low-energy falls and minor head injuries. PAM was not associated with higher ISS (median 9 in both groups, p = 0.80), more intracranial hemorrhages (74% vs. 71%, p = 0.85), increased mortality (adjusted odds ratio [OR], 0.79; 95% Confidence Interval [CI], 0.41–1.53), or poor GOS at discharge (OR, 1.06; 95% CI, 0.79–1.43).

PAM is common among older trauma patients. In this exploratory study, PAM did not seem to be associated with more severe injuries or poorer short-term outcomes. To evaluate the in-depth and long-term effects structured documentation of PAM in trauma registries is advocated.

The online version contains supplementary material available at 10.1007/s00068-026-03115-6.