Reversal of anticoagulation in trauma: a North-American survey on clinical practices among trauma surgeons.
BACKGROUND
Recent studies addressing reversal of anticoagulation in trauma have reported conflicting results. We hypothesized that current clinical practice is variable throughout North America.


METHODS
We surveyed 100 trauma surgeons to obtain information regarding variability in current clinical practice.


RESULTS
Seventy-five of 100 trauma surgeons surveyed responded, and the majority (98.7%) agreed that preinjury anticoagulation poses problems in trauma management that include bleeding, increased complications, and mortality. Nine participants (12.2%) had a protocol addressing reversal of anticoagulation in their institution. Most use fresh frozen plasma based on the type and location of injury, initial international normalized ratio (INR), and targeted INR value. Fresh frozen plasma was consistently used in patients with positive head computed tomographic scans, hemothorax, nonoperative solid organ injury management, pelvic and long bone fractures, and any operative intervention. Practice inconsistencies were found in patients with loss of consciousness and normal head computed tomographic scan, facial and rib fractures, and pulmonary contusion. Significant variability was found in the reversal INR target. One third of participants agreed that anticoagulation could be restarted 5 to 7 days after craniotomy; one sixth would do so within 72 hours and one third would wait 10 or more days. Most agreed that anticoagulation could be restarted 3 days after chest, abdominal, and orthopedic operations. Significant inconsistencies were also observed regarding when to restart anticoagulation in closed head injury patients treated nonoperatively.


CONCLUSIONS
On the basis of the discrepancies observed in this survey, a clinical trial addressing specific injury location and patterns, INR thresholds, and type of strategy to achieve reversal is warranted, and most would agree to participate.
Coimbra
Raul
R
Division of Trauma, Surgical Critical Care, and Burns, Department of Surgery, University of California San Diego School of Medicine, CA 92103-8896, USA. rcoimbra@ucsd.edu
Hoyt
David B
DB
Anjaria
Devashish J
DJ
Potenza
Bruce M
BM
Fortlage
Dale
D
Hollingsworth-Fridlund
Peggy
P
D000007:Abdominal Injuries / Q000601:surgery; D000925:Anticoagulants; D002170:Canada; D006259:Craniocerebral Trauma / Q000601:surgery*; D005121:Extremities / Q000293:injuries; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D019934:International Normalized Ratio; D010949:Plasma; D010818:Practice Patterns, Physicians'; D013898:Thoracic Injuries / Q000601:surgery; D014474:Unconsciousness; D014481:United States; D014947:Wounds and Injuries / Q000601:surgery*
D000925:Anticoagulants