Major trauma in the elderly and the use of direct oral anticoagulants (DOACs) have increased simultaneously in the past decade. The probability of encountering an elderly trauma patient treated with DOACs is therefore considerable. Because randomized trials in trauma are challenging, establishing animal models to evaluate additional potential therapeutic interventions may help to examine potential novel management strategies.

In this issue of the Journal, the article by Rayatdoost et al. provides novel data from an established polytrauma pig model. In brief, a high rivaroxaban plasma concentration (approximately 400 ng/ml) was established in anesthetized pigs before inflicting a standardized major trauma of blunt liver injury and bilateral femur fractures. The authors administered increasing doses of prothrombin complex concentrate (PCC; 12.5, 25, and 50 U/kg) along with combinations of PCC plus tranexamic acid and fibrinogen concentrate, and determined total...

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