The impact of preinjury antiplatelet and anticoagulant pharmacotherapy on outcomes in elderly patients with hemorrhagic brain injury

Fortuna, Gerald R.; Mueller, Eric; James, Laura E.; Shutter, Lori; Butler, Karyn L.

doi:10.1016/j.surg.2008.06.009

Cited by 119 publications

(89 citation statements)

References 18 publications

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“…Similar data were reported by Downey in a retrospective study involving two level 1 Trauma Centres over a 4 years period [36]. Ivascu [37] and Fortuna [38] in two separate studies observed a non significant trend towards higher mortality in patients with traumatic brain injury treated with platelets transfusion, but patients transfused were older and presented a lower GCS and higher ISS [35]. All of these studies though, have some weakness: they are retrospective, relative small and the indication and timing for platelet transfusion were not standardized.…”

Section: Resultssupporting

confidence: 86%

Prevention and treatment of trauma induced coagulopathy (TIC). An intended protocol from the Italian trauma update research group

Agostini¹,

Rondinelli²,

Bocci³

et al. 2013

J Anesthesiol Clin Sci

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In recent years, a strong focus has been put on the need to assure early coagulation support in order to prevent and treat coagulopathy in patients with severe trauma, and to improve survival. Aggressive plasma administration with high plasma/ red blood cells ratio is increasingly used worldwide. However, plasma transfusion is associated with increased risks of multiple organ dysfunction syndrome (MODS), adult respiratory distress syndrome (ARDS) and infection, which may prolong hospital stay and the need for artificial ventilation. Moreover, in the majority of European hospitals plasma cannot be immediately available and therefore it has been reported a significant delay in coagulation support. This has lead to the proposal of using clotting factors as an alternative to plasma. However, strong evidence to define the best strategy is still missing, and the only published protocols are Institution-specific, thus depending on the local organization and the available resources. The Italian Trauma Centers Network (TUN) recently developed a treatment protocol aiming at shortening the interval before the onset of coagulation support and at reducing the use of plasma. We present this protocol-Early Coagulation Support (ECS) Protocol -and discuss its rationale. Its implications for the trauma-team workflow and hospital organization are also addressed. The ECS protocol must be considered as an integrated part of a comprehensive Damage Control Strategy. The impact of the ECS Protocol on blood products consumption, trauma mortality and morbidity as well as its financial aspects, will be strictly monitored by the TUN hospitals.

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Section: Resultssupporting

confidence: 86%

Prevention and treatment of trauma induced coagulopathy (TIC). An intended protocol from the Italian trauma update research group

Agostini¹,

Rondinelli²,

Bocci³

et al. 2013

J Anesthesiol Clin Sci

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“…Warfarin is known to have unfavorable effects, but whether the use of AP agents is associated with unfavorable outcomes remains controversial. [2][3][4][5][6]12,13) Therefore, the adverse effects of AP and AC agents must be evaluated separately in future studies. We combined AP and AC agents mainly because of the small number of patients in each age group.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, preinjury medication with anti-platelet/anti-coagulant (AP/AC) agents, which are commonly prescribed to treat or prevent cerebro-and cardiovascular diseases, may be associated with unfavorable outcomes in elderly patients with TICH. [2][3][4][5][6]9) The present study divided elderly patients with fall-related TICH into 3 age groups according to the Centers for Disease Control and Prevention (CDC) classification, 1) and evaluated intergroup differences in the demographics and outcomes at discharge, as well as investigating whether the use of AP/AC agents was associated with unfavorable outcomes.…”

Section: Introductionmentioning

confidence: 99%

Influence of Age and Anti-platelet/Anti-coagulant Use on the Outcome of Elderly Patients With Fall-Related Traumatic Intracranial Hemorrhage

Inamasu

Nakatsukasa

Kuramae

et al. 2010

Neurol. Med. Chir.(Tokyo)

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Ground-level fall is the most common cause of traumatic intracranial hemorrhage (TICH) in the elderly. Many studies on geriatric TICH have regarded patients aged AE65 years as a single group, but substantial heterogeneity is likely to exist within this population. Eighty-two elderly patients with fall-related TICH treated in our institution during a 6-year period were stratified into 3 age groups (65-74, 75-84, and AE85 years), and intergroup differences in the demographics and outcomes at discharge were evaluated. The influence of the use of anti-platelet/anti-coagulant (AP/AC) agent on outcomes was also investigated. Comparison of demographic variables demonstrated significant differences in the frequency of preinjury alcohol consumption and use of AP/AC agents between the 3 groups, indicating that the causes or triggers of fall might be substantially different between the 65-74 years group and the other two groups combined. The frequency of unfavorable outcomes increased with age, and the increase was statistically significant. The 82 patients were divided into two subgroups depending on the use of AP/AC agents. The outcomes of the AE85 years group taking AP/AC agents were particularly poor compared with those of the AE85 years group not using AP/AC agents. Advancing age may be associated with unfavorable outcomes in elderly patients with fall-related TICH, and patients aged AE85 years taking AP/AC have the greatest risk of unfavorable outcomes. Physicians must consider the risk/benefit analysis before prescribing AP/AC agents to patients aged AE85 years.

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“…Anticoagulant use before a fall has been linked to traumatic intracerebral hemorrhage, need for admission to intensive care units, and mortality [15,16]. While anticoagulants increase the likelihood of sustaining an intracerebral hemorrhage, they also may have a modest neuroprotective quality, by countering the hypercoagulable state that follows trauma [17,18]. However, newer anticoagulant medications are increasingly being used in the elderly population with atrial fibrillation.…”

Section: Etiologymentioning

confidence: 99%

Rehabilitation Considerations for Traumatic Brain Injury in the Geriatric Population: Epidemiology, Neurobiology, Prognosis, and Management

Crownover

Galang

Wagner³

2012

Curr Tran Geriatr Gerontol Rep

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The impact of preinjury antiplatelet and anticoagulant pharmacotherapy on outcomes in elderly patients with hemorrhagic brain injury

Cited by 119 publications

References 18 publications

Prevention and treatment of trauma induced coagulopathy (TIC). An intended protocol from the Italian trauma update research group

Prevention and treatment of trauma induced coagulopathy (TIC). An intended protocol from the Italian trauma update research group

Influence of Age and Anti-platelet/Anti-coagulant Use on the Outcome of Elderly Patients With Fall-Related Traumatic Intracranial Hemorrhage

Rehabilitation Considerations for Traumatic Brain Injury in the Geriatric Population: Epidemiology, Neurobiology, Prognosis, and Management

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