Management of prehospital antiplatelet and anticoagulant therapy in traumatic head injury: a review.
Trauma and emergency department clinicians encounter a growing number of patients admitted with traumatic head injury on prehospital antithrombotic therapies. These patients appear to be at increased risk of developing life-threatening intracranial hemorrhage. It is imperative that trauma clinicians understand the mechanism and duration of commonly prescribed outpatient antithrombotics in order to appropriately assess and treat patients who develop intracranial hemorrhage. This review summarizes current literature on the morbidity and mortality associated with premorbid non-steroidal anti-inflammatory drugs, aspirin, clopidogrel, warfarin, and heparinoids in the setting of traumatic head injury, and also examines the current strategies for reversal of these therapies.
McMillian
Wesley D
WD
Department of Pharmacotherapy, Fletcher Allen Health Care, University of Vermont College of Medicine, Burlington, VT 05401, USA. wes.mcmillian@vtmednet.org
Rogers
Frederick B
FB
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001930:Brain Injuries / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D020202:Cerebral Hemorrhage, Traumatic / Q000139:chemically induced* / Q000188:drug therapy / Q000401:mortality; D003131:Combined Modality Therapy; D003422:Critical Care; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage; D004632:Emergency Medical Services; D015942:Factor VIIa / Q000008:administration & dosage; D006407:Hematoma, Epidural, Cranial / Q000139:chemically induced / Q000188:drug therapy / Q000401:mortality; D006408:Hematoma, Subdural / Q000139:chemically induced / Q000188:drug therapy / Q000401:mortality; D006490:Hemostatics / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D008875:Middle Aged; D010949:Plasma; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D017713:Platelet Transfusion; D011479:Protamines / Q000008:administration & dosage; D011994:Recombinant Proteins / Q000008:administration & dosage; D012307:Risk Factors; D010837:Vitamin K 1 / Q000008:administration & dosage
D000925:Anticoagulants; D006490:Hemostatics; D010975:Platelet Aggregation Inhibitors; D011479:Protamines; D011994:Recombinant Proteins; D010837:Vitamin K 1; C103587:recombinant FVIIa; D015942:Factor VIIa; D003894:Deamino Arginine Vasopressin