Concomitant antithrombotic therapy and substance use in older adult trauma patients: a secondary evaluation of an EAST Multicenter Trial

Abstract

Background: The concurrent use of antithrombotic agents and intoxicants in older trauma patients (≥65) poses a potential risk for adverse outcomes. As the prevalence of substance use among older adults rises, understanding the impact of these combined factors on trauma outcomes is crucial. This study evaluates the impact of combined intoxication and antithrombotic use on trauma outcomes in older adults. Methods: We conducted a secondary analysis of data from an Eastern Association for the Surgery of Trauma-sponsored multicenter prospective observational study involving 15 Level I and II trauma centers from February 2018 to June 2019. Included patients were on antithrombotic therapy and had blood alcohol concentration (BAC) and/or urine toxicology (UT) samples collected at trauma evaluation. Intoxication was defined as BAC >0.08 mg/dL or a positive UT. Patient demographics, injury characteristics, and outcomes were analyzed using linear and logistic regression models. Results: Of 2793 trauma patients on antithrombotics, 862 met inclusion criteria, with 155 (18.0%) testing positive for intoxicants. Positive tests were associated with younger age (74 years vs 79 years, p<0.001), lower Charlson Comorbidity Index (4 vs 5, p<0.001), and similar Injury Severity Scores (6 vs 9, p=0.38). Patients with positive tests had more penetrating mechanisms of injury (11.0% vs 3.7%, p=0.01) and similar hospital stays (3 days vs 4 days, p=0.311). ICU admission rates were lower (32.9% vs 42.2%, p=0.041), with no difference in ICU length of stay or mortality. Higher ICU admissions (p=0.039) and increased ICU stays were seen in those on two substances (OR: 5.26, 95% CI 0.76 to 9.76, p=0.022). Conclusions: Older trauma patients on antithrombotic therapy with concurrent intoxicant use did not exhibit worse clinical outcomes, despite higher rates of penetrating injuries and polysubstance use. These findings underscore the importance of tailored discharge planning and comprehensive care strategies for this vulnerable population.