Diagnostic and therapeutic approach in adult patients with traumatic brain injury receiving oral anticoagulant therapy: an Austrian interdisciplinary consensus statement

Critical Care : the Official Journal of the Critical Care Forum
Marion WiegeleEva Schaden

Abstract

There is a high degree of uncertainty regarding optimum care of patients with potential or known intake of oral anticoagulants and traumatic brain injury (TBI). Anticoagulation therapy aggravates the risk of intracerebral hemorrhage but, on the other hand, patients take anticoagulants because of an underlying prothrombotic risk, and this could be increased following trauma. Treatment decisions must be taken with due consideration of both these risks. An interdisciplinary group of Austrian experts was convened to develop recommendations for best clinical practice. The aim was to provide pragmatic, clear, and easy-to-follow clinical guidance for coagulation management in adult patients with TBI and potential or known intake of platelet inhibitors, vitamin K antagonists, or non-vitamin K antagonist oral anticoagulants. Diagnosis, coagulation testing, and reversal of anticoagulation were considered as key steps upon presentation. Post-trauma management (prophylaxis for thromboembolism and resumption of long-term anticoagulation therapy) was also explored. The lack of robust evidence on which to base treatment recommendations highlights the need for randomized controlled trials in this setting.

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Citations

Jul 10, 2020·The Kaohsiung Journal of Medical Sciences·Lin-Qiang TianWen-Jie Ren
Jul 31, 2020·The American Surgeon·Rosalynn K NguyenNicholas J Hellenthal
Sep 27, 2019·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·Daniel OberladstätterHerbert Schöchl
Nov 17, 2019·Journal of Clinical Medicine·Anna AntoniStefan Hajdu
Jul 25, 2020·Archives of Orthopaedic and Trauma Surgery·Lukas LeitnerPaul Puchwein
Nov 5, 2020·Journal of Neurotrauma·Christina M RiojasSusan L Evans
May 13, 2021·Respirology Case Reports·David K Z Ching, Edward T H Fysh

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Methods Mentioned

BETA
pharmacotherapy

Related Concepts

Related Feeds

Brain Injury & Trauma

brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.