Abstract
Background: The percentage of elderly trauma patients under anticoagulation and antiplatelet agents has been rising lately. With time, newer agents have been introduced with certain advantages and precautions. We aimed to investigate the demographic data, causes, and type of maxillofacial trauma, concomitant injuries, hospitalization time, haemorrhagic complications, and total costs of emergency department (ED) care in elderly patients admitted to the ED with maxillofacial trauma while receiving anticoagulation (AC) or antiplatelet therapy (APT).
Methods: Data were gathered from the ED of Bern University Hospital. In this retrospective analysis, patients older than 65 years with maxillofacial trauma presenting to our ED between 2013 and 2019 with therapeutic AC/APT were included.
Results: A total of 196 patients were included. The median age was 81 years (interquartile range [IQR]: 74-87), and 111 (56.6%) were men. 54.1% (n=106) were 80 years or older. One hundred thirty-seven of the patients (69.9%) suffered from a cardiovascular disease. Previous thromboembolic events (n=82, 41.8%) and atrial fibrillation (n=50, 25.5%) were the most reported indications for oral anticoagulation or antithrombotic therapy intake. Falls (n=162, 82.7%) were the leading cause of facial injury, followed by road traffic injuries (n=26, 13.2%). The most reported primary injuries were orbital fracture (n=46, 23,5%) along with a fracture of the zygomatic bone (n=38, 19,4%) and fracture of the midface (Le Fort I, II, III) (n=35, 17,9%) followed by zygomatic bone fracture (n=38, 19.4%) and mandible fracture (n=20, 10.2%). Epistaxis was noted in 23 cases (11.7%) and oral bleeding in 10 (5.1%). In 120 patients (61.2%), haematomas involved the middle third of the face, which were operated on most frequently in absolute terms. Fourteen patients suffered an intracerebral haemorrhage (n=14, 7.1%), whereas retrobulbar bleeding was observed in 20 patients (10.2%). The overall in-hospital mortality rate was 2.6% (n=5).
Conclusions: This study reaffirms the link between falls and the prevalence of maxillofacial trauma in older individuals. Additionally, it underscores the substantial occurrence of mid-face haematomas in geriatric patients undergoing AC/APT. Considering the increasing growth of the geriatric population, enhancing prevention strategies and refining safety guidelines are urgently necessary.