EVALUATION OF COAGULATION AND FIBRINOLYSIS IN THE ACUTE PHASE OF GERIATRIC TRAUMA IN THE OLDEST OLD IN JAPAN

Abstract

   [Objectives] To elucidate the clinical features of severe trauma in the oldest old, as well as the kinetics of coagulation and fibrinolysis during the acute phase following an injury. [Subjects and methods] 796 patients who were hospitalized between January and December 2012 were enrolled and divided into two groups : the oldest old group (age≥85 years) and the non–oldest old group (age<85 years). A comparative study was performed based on various attribute data and indicators of coagulation and fibrinolysis kinetics. [Results] In the oldest old group, the rate of oral anticoagulant/antiplatelet agent use was significantly greater than the non–oldest old group (6.9% vs 20.0%, p<0.01). The odds ratio of in–hospital death, and death within 24 hours of admission in the oldest old group were 5.53 (p<0.001) and 4.83 (p<0.001) respectively. PT–INR levels showed no significant difference between the two groups, but tended to be prolonged in the oldest old group. The DIC scores showed no significant difference between the two groups. [Conclusions] In the oldest old population, the rate of oral anticoagulant/antiplatelet agent use is high and they are likely to cause coagulopathy. In severe trauma with an ISS 16 or over, age 85 and older independently predicts bad prognosis.