Intracranial Complications of Preinjury Anticoagulation in Trauma Patients with Head Injury

Mina, Alfred; Knipfer, John F; Park, David Y.; Bair, Holly A.; Howells, Greg A.; Bendick, Phillip J.

doi:10.1097/00005373-200210000-00008

Cited by 191 publications

(112 citation statements)

References 7 publications

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“…Altogether, many TBI patients have multiple reasons for developing delayed hemorrhagic complications and ethanol levels may be another factor necessary to consider during management of TBI patients. Ethanol has been found to decrease collagen induced platelet aggregation and this may be a problem viewed in the light of the finding that patients on NSAIDs have a higher mortality rate after TBI [4,32]. In our study we also found a prolongation of CFT that may be interpreted as an impairment of the platelet activity.…”

Section: Discussionsupporting

confidence: 57%

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Ethanol impairs coagulation and fibrinolysis in whole blood: a study performed with rotational thromboelastometry

Engström

Schött

Reinstrup

2006

Blood Coagulation &Amp; Fibrinolysis

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Objective: The objective of the study was to study the effects of ethanol on the coagulation and the fibrinolysis in whole blood. Methods: Blood samples from healthy volunteers were analysed before and after in vitro addition of ethanol in order to achieve ethanol concentrations of 0‰, 1‰, 2‰ and 4‰ respectively (0, 22, 44 and 88 mmol/l). Coagulation and fibrinolysis were then assessed using rotational thromboelastometry. Results: We found that increasing ethanol levels increasingly impaired coagulation as evaluated with rotational thromboelastometry with a maximum prolongation of Clot Formation Time of 118% at an ethanol level of 4‰ (p<0.000001). We also found a very strong impairment of fibrinolysis already at an ethanol level of 1‰. Conclusions: This is the first study assessing the effects of ethanol on coagulation and fibrinolysis in a whole blood model. The impairment of coagulation is similar in nature to the impairment found in patients suffering from hypothermia. The impairment is at a level that may be of clinical importance, e.g. in patients suffering from trauma. The inhibition of fibrinolysis is obvious already at an ethanol level of 1‰ and it may be a contributing factor to the increased amount of coronary and cerebrovascular ischemic events after binge drinking.

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Section: Discussionsupporting

confidence: 57%

“…It is also known that impairment of the coagulation of different origins, e.g. NSAID treatment or consumption coagulopathy, is associated with worse outcome in TBI patients [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Ethanol impairs coagulation and fibrinolysis in whole blood: a study performed with rotational thromboelastometry

Engström

Schött

Reinstrup

2006

Blood Coagulation &Amp; Fibrinolysis

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show abstract

“…(21) These abnormalities in coagulation factors are closely associated with increased intake of anticoagulants, such as aspirin and warfarin, due to the recent increase in cardiovascular and cerebrovascular diseases, and patients who took such medicines increased the mortality rate four times compared to patients who did not take the medicines. (22) In this study, two patients who had a history of cerebral infarction and were taking aspirin and anticoagulants died after surgery. Of nine patients who had thrombocytopenia, seven died, revealing that thrombocytopenia itself has an adverse effect on the prognosis regardless of whether or not surgery is administered.…”

Section: Discussionmentioning

confidence: 91%

Assessment of the Clinical and the Radiological Prognostic Factors that Determine the Management of a Delayed, Traumatic, Intraparenchymal Hemorrhage (DTIPH)

Ryu

Kim

et al. 2015

Journal of Trauma and Injury

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Purpose: Delayed, traumatic, intraparenchymal hemorrhage (DTIPH) is a well-known contributing factor to secondary brain damage that evokes severe brain edema and intracranial hypertension. Once it has occurred, it adversely affects the patient's outcome. The aim of this study was to evaluate the prognosis factors for DTIPH by comparing clinical, radiological and hematologic results between two groups of patients according to whether surgical treatment was given or not.Methods: The author investigated 26 patients who suffered DTIPH during the recent consecutive five-year period. The 26 patients were divided according to their having undergone either a decompressive craniectomy (n=20) or continuous conservative treatment (n=6). A retrospective investigation was done by reviewing their admission records and radiological findings.Results: This incidence of DTIPH was 6.6% among the total number of patients admitted with head injuries. The clinical outcome of DTIPH was favorable in 9 of the 26 patients (34.6%) whereas it was unfavorable in 17 patients (65.4%). The patients with coagulopathy had an unexceptionally high rate of mortality. Among the variables, whether the patient had undergone a decompressive craniectomy, the patient's preoperative clinical status, and the degree of midline shift had significant correlations with the ultimate outcome.Conclusion: In patients with DTIPH, proper evaluation of preoperative clinical grading and radiological findings can hamper deleterious secondary events because it can lead to a swift and proper decompressive craniectomy to reduce the intracranial pressure. Surgical decompression should be carefully selected, paying attention to the patient's accom-

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“…10 Franko et al also found a significant increase in mortality in patients that were anticoagulated, 23.9% versus controls, 4.9%. 19 Pieracci et al demonstrated increased risk of mortality in patients using warfarin before ICH compared with patients who did not.…”

Section: Warfarinmentioning

confidence: 90%

Outcomes in Traumatic Brain Injury Patients on Preinjury Anticoagulation and Antiplatelet Agents

Ba¹,

Thakkar²,

Jallo³

2013

JHN Journal

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Intracranial Complications of Preinjury Anticoagulation in Trauma Patients with Head Injury

Cited by 191 publications

References 7 publications

Ethanol impairs coagulation and fibrinolysis in whole blood: a study performed with rotational thromboelastometry

Ethanol impairs coagulation and fibrinolysis in whole blood: a study performed with rotational thromboelastometry

Assessment of the Clinical and the Radiological Prognostic Factors that Determine the Management of a Delayed, Traumatic, Intraparenchymal Hemorrhage (DTIPH)

Outcomes in Traumatic Brain Injury Patients on Preinjury Anticoagulation and Antiplatelet Agents

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