In this retrospective study, the authors looked at mortality rates in trauma patients treated with direct oral anticoagulants (DOACs) or warfarin. The authors used multiple data sources to identify over 3000 trauma patients, including 485 patients treated with oral anticoagulants (112 [3.3%] with DOACs and 373 [11.0%] with warfarin).

Using multivariable logistic regression analysis, the authors found an increased risk of death in patients treated with warfarin (odds ratio: 2.215; 95% confidence interval, 1.365-3.596; P = 0.001) but not in those treated with DOACs (odds ratio: 0.871; 95% confidence interval, 0.258-2.939; P = 0.823).

The results of this study should be interpreted with caution. The retrospective design of the study did not enable the authors to strictly compare the two populations. Even though the demographic characteristics seem comparable, the authors were not able to adjust for all possible confounders. Little is known about the management strategy, the incidence of massive haemorrhage, the type and dose of coagulation factors/blood products administered. Last but not least, the power of the study is mainly influenced by a large control group, and only 3.3% (n=112) of the study population received DOACs. The difference in outcome could be explained by multiple variables that were not included into the model.

In conclusion, the difference in mortality observed between trauma patients treated with warfarin and DOACs is interesting, but should be interpreted with caution. Further large studies are needed to confirm the increased risk of mortality in trauma patients treated with warfarin compared with DOACs.

– David Faraoni