Proposal for the Rapid Reversal of Coagulopathy in Patients with Nonoperative Head Injuries on Anticoagulants and/or Antiplatelet Agents: A Case Study and Literature Review

Watson, Victoria L.; Louis, Nundia; Seminara, Brittany V.; Muizelaar, J. Paul; Alberico, Anthony

doi:10.1093/neuros/nyx072

Cited by 11 publications

(6 citation statements)

References 60 publications

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“…Observational and retrospective studies have shown some benefit when platelet transfusion is guided by TEG-PM ® and ROTEM ® with MEA, PFA, or VerifyNow P2Y12. This remains an area of significant research since the administration of platelets in these patients is now determined locally by institutional preferences with variable use of TEG-PM ® and ROTEM ® with adjunctive PFAs [23,39,58,74,[173][174][175].…”

Section: Vet-guided Diagnosis and Treatment Of Platelet Dysfunction In Tbimentioning

confidence: 99%

“…This study hypothesized that whatever benefit accrued from the administration of platelets in patients on antiplatelet agents with TBI were counteracted by the effect of a local hypercoagulable state at the microvasculature in the penumbra of injured brain tissue. For this reason, and for the smaller studies that demonstrate the benefit of VET guided platelet transfusion in patients with TBI and platelet dysfunction, there is increased interest in not only the use of VET to guide platelets in patients with TBI and preinjury antiplatelet agents, but also in using desmopressin to enhance platelet function in these patients [23,52,58,61,126,144,[173][174][175]180]. DDAVP has been shown to stabilize platelet dysfunction in neurosurgical patients and those with spontaneous ICH with abnormal platelet activity who were previously on aspirin.…”

Section: Vet-guided Diagnosis and Treatment Of Platelet Dysfunction In Tbimentioning

confidence: 99%

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Viscoelastic Testing and Coagulopathy of Traumatic Brain Injury

Bradbury

Thomas

Sorg

et al. 2021

JCM

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A unique coagulopathy often manifests following traumatic brain injury, leading the clinician down a difficult decision path on appropriate prophylaxis and therapy. Conventional coagulation assays—such as prothrombin time, partial thromboplastin time, and international normalized ratio—have historically been utilized to assess hemostasis and guide treatment following traumatic brain injury. However, these plasma-based assays alone often lack the sensitivity to diagnose and adequately treat coagulopathy associated with traumatic brain injury. Here, we review the whole blood coagulation assays termed viscoelastic tests and their use in traumatic brain injury. Modified viscoelastic tests with platelet function assays have helped elucidate the underlying pathophysiology and guide clinical decisions in a goal-directed fashion. Platelet dysfunction appears to underlie most coagulopathies in this patient population, particularly at the adenosine diphosphate and/or arachidonic acid receptors. Future research will focus not only on the utility of viscoelastic tests in diagnosing coagulopathy in traumatic brain injury, but also on better defining the use of these tests as evidence-based and/or precision-based tools to improve patient outcomes.

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Section: Vet-guided Diagnosis and Treatment Of Platelet Dysfunction In Tbimentioning

confidence: 99%

Section: Vet-guided Diagnosis and Treatment Of Platelet Dysfunction In Tbimentioning

confidence: 99%

Viscoelastic Testing and Coagulopathy of Traumatic Brain Injury

Bradbury

Thomas

Sorg

et al. 2021

JCM

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“…The beneficial effect of anticoagulation reversal treatment on mortality in patients with intracranial hemorrhage using anticoagulation has recently been demonstrated (41), emphasizing the importance of implementing and comply with such protocols. With the available reversal agents throughout the study period, however, one must assume that the reversal of VKA has been more effective than the reversal of the DOAC effect, especially for direct-acting Xa-inhibitors (42)(43)(44)(45)(46). The potential benefit of anticoagulation reversal must be weighed against any potential negative effect on an individual basis.…”

Section: Anticoagulant Therapy and 30-day Mortalitymentioning

confidence: 99%

Impact of Preinjury Antithrombotic Therapy on 30–Day Mortality in Older Patients Hospitalized With Traumatic Brain Injury (TBI)

et al. 2021

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Objective: Elderly patients are frequently in need of antithrombotic therapy for reducing thrombotic events. The association between antithrombotic drugs and survival after traumatic brain injury (TBI) is, nevertheless, unclear.Methods: This retrospective study included patients ≥65 years admitted to a Norwegian Level 1 trauma center with TBI identified on cerebral computed tomography (cerebral-CT) during 2014–2019. Preinjury use of antiplatelets and anticoagulants was compared to the prescription rate in the general Norwegian population. The primary outcome was 30-day mortality. Uni- and multivariate logistic regression analyses estimated the association between the use of antithrombotic drugs and mortality.Results: The study includes 832 consecutive TBI patients ≥65 years. The median age was 76 years, 58% were males, 51% had moderate or severe TBI, and 39% had multiple traumas. Preinjury use of antithrombotics was registered in 471/832 (55.6%) patients; antiplatelet therapy alone in 268, anticoagulant therapy alone in 172, and combined antiplatelet and anticoagulant therapy in 31. Antiplatelet use did not differ between the study cohort and the general Norwegian population ≥65 years (31 vs. 31%, p = 0.87). Anticoagulant therapy was used more commonly in the study cohort than in the general Norwegian population (24 vs. 19%, p = 0.04). Combined use of antiplatelet and anticoagulant therapy was significantly associated with 30-day mortality, while preinjury antiplatelet or anticoagulation treatment alone was not. No difference in 30-day mortality between patients using VKA, DOACs, or LMWH was encountered.Conclusions: In this cohort, neither antiplatelet nor anticoagulant therapy alone was associated with increased 30-day mortality. Anticoagulant use was more prevalent among TBI patients than the general population, suggesting that anticoagulation might contribute to the initiation of intracranial bleeding after blunt head trauma. Combined antiplatelet and anticoagulant therapy posed increased risk of 30-day mortality.

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“…A large number of basic and clinical studies have found that they all have certain lung protective ef-der induced by persistence of various causes should be blocked. To avoid deep vein thrombosis and disseminated intravascular hemorrhage, the reasonable treatment plan should be to revise carefully according to the type of coagulopathy [113][114][115].…”

Section: Mirnas As Biomarkers In Ali/ardsmentioning

confidence: 99%

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2017

Transl Perioper & Pain Med

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The concept of enhanced recovery after surgery (ERAS) has gained gratifying achievements in clinical practice, but there are still many disputes and incompatibilities in its application. The reasons for this phenomenon are multifaceted, is evident at multilevels and needs further exploration and improvement.By combining previous studies and our clinical experience, we propose an enhanced concept of ERAS, i.e., precision organ function protection (POFP) for ERAS to promote lasting rehabilitation of patients after surgery. We prefer to use "important organ function outcomes" (IOFOs) as the clinical target of ERAS. Perioperative optimal organ function preservation by using a series of techniques can help patients recover quickly and return to baseline function as soon as possible. This concept has greatly expanded the connotation of the traditional ERAS, whose core idea was reducing stress, providing analgesia and humane care.

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Proposal for the Rapid Reversal of Coagulopathy in Patients with Nonoperative Head Injuries on Anticoagulants and/or Antiplatelet Agents: A Case Study and Literature Review

Cited by 11 publications

References 60 publications

Viscoelastic Testing and Coagulopathy of Traumatic Brain Injury

Viscoelastic Testing and Coagulopathy of Traumatic Brain Injury

Impact of Preinjury Antithrombotic Therapy on 30–Day Mortality in Older Patients Hospitalized With Traumatic Brain Injury (TBI)

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