The utility of coagulation factor testing in non-anticoagulated elderly patients presenting with low-risk mechanical falls in the emergency department.

Introduction: Data on the utility of coagulation factor testing (INR, aPTT) in non-anticoagulated patients with low-risk trauma is limited. In this study, we describe the rate in which coagulation studies are ordered this population and report the frequency in which these tests were abnormal and resulted in intervention.

Methods: This was a multi-center retrospective observational study evaluating patients aged 65 years and older with low-risk mechanical falls not on chronic oral anticoagulation. If blood work was obtained, we documented the initial/highest INR and the initial/highest aPTT. Our primary outcome was the frequency of intervention due to abnormal coagulation studies, defined as (1) administration of vitamin K, FFP, PCC, or protamine and/or (2) admission/observation due to the abnormal coagulation study.

Results: A total of 1208 patients were included. The frequency in which an INR was obtained was 559 (46.3 %). The median value of the INR was 1.1 (range 0.9-1.6). There were 536 patients (44.4 %) who had aPTT drawn. The median value was 26.2 (range 20.1-43.4). There were no instances of our primary outcome (abnormal INR or aPTT that required intervention).

Conclusion: In this cohort of 1208 patients, approximately 45 % percent had coagulation studies ordered and nearly 95 % of these studies were normal. None of them were critically elevated, necessitating intervention. Our findings suggest that for patients similar to those in our study cohort, routine coagulation studies may have limited utility and are unlikely to result in changes in ED management.