TY - JOUR
T1 - Proposal for the rapid reversal of coagulopathy in patients with nonoperative head injuries on anticoagulants and/or antiplatelet agents
T2 - A case study and literature review
AU - Watson, Victoria L.
AU - Louis, Nundia
AU - Seminara, Brittany V.
AU - Muizelaar, Jan Paul
AU - Alberico, Anthony
PY - 2017/12/1
Y1 - 2017/12/1
N2 - Background: Emergency room physicians, trauma teams, and neurosurgeons are seeing increasing numbers of head-injured patients on anticoagulants, many of whom are nonoperative. Head injury and anticoagulation can lead to devastating consequences. These patients need immediate evaluation and often reversal of anticoagulation in order to decrease their high rates of morbidity and mortality. Objective: To review data on the prevalence, risks, treatment, and complications of head-injured anticoagulated patients and provide a proposal for their anticoagulant management, and imaging requirements. Methods: A PubMed database search was performed for articles on the prevalence, risks, treatment, and complications of patients who have sustained a head injury while on anticoagulant or antiplatelet agents. Results: A total of 1877 articles were found, of which 64 were selected for use based on direct relevance, information quality, and contribution of the article to the current understanding of anticoagulated head injury patients. Conclusion: There are very few guidelines for the management of nonoperative headinjured patients. Rapid reversal guided by international normalized ratio values, Platelet Function Assays, computed tomography imaging of the head, and physical exam is suggested. The proposal presented in this paper enables patient management to begin quickly in a systematic approach, with the goal of achieving a significant decrease in the morbidity and mortality for the anticoagulated head-injured patient. Rapid reversal can potentially decrease mortality by as much as 38%.
AB - Background: Emergency room physicians, trauma teams, and neurosurgeons are seeing increasing numbers of head-injured patients on anticoagulants, many of whom are nonoperative. Head injury and anticoagulation can lead to devastating consequences. These patients need immediate evaluation and often reversal of anticoagulation in order to decrease their high rates of morbidity and mortality. Objective: To review data on the prevalence, risks, treatment, and complications of head-injured anticoagulated patients and provide a proposal for their anticoagulant management, and imaging requirements. Methods: A PubMed database search was performed for articles on the prevalence, risks, treatment, and complications of patients who have sustained a head injury while on anticoagulant or antiplatelet agents. Results: A total of 1877 articles were found, of which 64 were selected for use based on direct relevance, information quality, and contribution of the article to the current understanding of anticoagulated head injury patients. Conclusion: There are very few guidelines for the management of nonoperative headinjured patients. Rapid reversal guided by international normalized ratio values, Platelet Function Assays, computed tomography imaging of the head, and physical exam is suggested. The proposal presented in this paper enables patient management to begin quickly in a systematic approach, with the goal of achieving a significant decrease in the morbidity and mortality for the anticoagulated head-injured patient. Rapid reversal can potentially decrease mortality by as much as 38%.
KW - Acetylsalicylic acid
KW - Anticoagulant agents
KW - Anticoagulation reversal
KW - Antiplatelet agents
KW - Delayed intracranial hemorrhage
KW - Head trauma
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U2 - 10.1093/neuros/nyx072
DO - 10.1093/neuros/nyx072
M3 - Review article
C2 - 28368482
AN - SCOPUS:85016568619
VL - 81
SP - 899
EP - 909
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 6
ER -