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

被引：58

作者：

Wiegele, Marion ^{[1
]}

Schoechl, Herbert ^{[2
,3
]}

Haushofer, Alexander ^{[4
]}

Ortler, Martin ^{[5
,6
]}

Leitgeb, Johannes ^{[7
]}

Kwasny, Oskar ^{[8
]}

Beer, Ronny ^{[9
]}

Ay, Cihan ^{[10
]}

Schaden, Eva ^{[1
]}

机构：

[1] Med Univ Vienna, Dept Anaesthesia Crit Care & Pain Med, Div Gen Anaesthesia & Intens Care Med, Waehringer Guertel 18-20, A-1090 Vienna, Austria

[2] Paracelsus Med Univ, Acad Teaching Hosp, AUVA Trauma Ctr Salzburg, Dept Anaesthesiol & Intens Care Med, Dr Franz Rehrl Pl 5, A-5020 Salzburg, Austria

[3] AUVA Res Ctr, Ludwig Boltzmann Inst Expt & Clin Traumatol, Vienna, Austria

[4] Klinikum Wels Grieskirchen, Cent Lab, Grieskirchner Str 42, A-4600 Wels, Austria

[5] Krankenhaus Rudolfstiftung, Dept Neurosurg, Juchgasse 25, A-1030 Vienna, Austria

[6] Med Univ Innsbruck, Dept Neurosurg, Innrain 52,Christoph Probst Pl, A-6020 Innsbruck, Austria

[7] Med Univ Vienna, Div Trauma Surg, Univ Dept Orthopaed & Trauma Surg, Waehringer Guertel 18-20, A-1090 Vienna, Austria

[8] Kepler Univ Hosp Med Campus III, Dept Surg & Sports Traumatol, Krankenhausstr 9, A-4020 Linz, Austria

[9] Med Univ Innsbruck, Dept Neurol, Neurocrit Care, Anichstr 35, A-6020 Innsbruck, Austria

[10] Med Univ Vienna, Dept Med 1, Clin Div Haematol & Haemostaseol, Waehringer Guertel 18-20, A-1090 Vienna, Austria

来源：

CRITICAL CARE | 2019年 / 23卷 / 1期

关键词：

Anticoagulation reversal; Coagulation management; Idarucizumab; Intracranial hemorrhage; Non-vitamin K antagonist oral anticoagulant (NOAC); Platelet inhibitors; Prothrombin complex concentrate (PCC); Traumatic brain injury; Vitamin K antagonist (VKA); PROTHROMBIN COMPLEX CONCENTRATE; MINOR HEAD-INJURY; VENOUS THROMBOEMBOLISM PROPHYLAXIS; INTERNATIONAL NORMALIZED RATIO; CRANIAL COMPUTED-TOMOGRAPHY; HEALTH-CARE PROFESSIONALS; NERVOUS-SYSTEM HEMORRHAGE; INTRACRANIAL HEMORRHAGE; TRANEXAMIC ACID; PLATELET TRANSFUSION;

D O I：

10.1186/s13054-019-2352-6

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

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.

引用

页数：16

共 134 条

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