Impact of pre-injury anticoagulation on outcomes in middle-aged trauma patients: a matched-pair analysis of the TraumaRegister DGU®.

PURPOSE: Pre-injury anticoagulation is a well-known risk factor associated with adverse outcomes in geriatric trauma patients, but its impact in younger populations remains unclear. The study aimed to evaluate the association between pre-injury antithrombotic therapy and clinical outcomes in trauma patients aged 40-60 years. METHODS: Data were obtained from the TraumaRegister DGU® (2015-2023). Patients aged 40-60 years from European trauma centers with ISS ≥ 9 were included. Patients were categorized according to the presence or absence of pre-injury antithrombotic therapy. A matched-pair analysis was performed based on age group, sex, ASA classification, and injury severity by body region. The primary endpoint was in-hospital mortality; secondary outcomes included coagulopathy, transfusion requirements, emergency surgery, and organ failure. Analyses were primarily descriptive. RESULTS: A total of 64,215 patients were included, of whom 6.7% (n = 4,326) received antithrombotic therapy. Antiplatelet agents were most common (68%), followed by direct oral anticoagulants (DOAC) (18%) and Vitamin-K-Antagonists (VKA) (11%). Coagulopathy was more frequent in anticoagulated patients, particularly in those receiving VKA and DOAC. In unmatched analyses, mortality was slightly higher in anticoagulated patients (6.7% vs. 5.0%) and showed a non-significant trend towards higher mortality in patients with severe traumatic brain injury. However, no clinically relevant difference in mortality was observed after matching (6.5% vs. 6.2%). CONCLUSION: In trauma patients aged 40-60 years, pre-injury antithrombotic therapy is associated with higher rates of coagulopathy but not with clinically relevant differences in adjusted mortality. These findings suggest that, in contrast to geriatric populations, anticoagulation may not independently worsen survival in middle-aged trauma patients.