title: Management of anticoagulation agents in trauma patients.
abstract: A lack of consensus on anticoagulant reversal during acute trauma is compounded by an aging population and the expanding spectrum of new anticoagulation agents. Developments in laboratory assays and transfusion medicine, including thromboelastography, recombinant factors, and factor concentrates, have revolutionized care for anticoagulated trauma patients. Accordingly, clinicians must be fully aware of drug mechanisms, assays to determine drug activity, and appropriate reversal strategies for patients on anticoagulants. Drugs include vitamin K antagonists, direct thrombin inhibitors, direct factor Xa inhibitors, low molecular weight heparin, and antiplatelet agents. This article discusses the appropriate assessment and management of trauma patients receiving these agents.
authors.affiliation: Department of Surgery, Duke University Medical Center, Duke University, Box 3443, Room 3581, White Zone, Duke South, Durham, NC 27710, USA. Electronic address: Christopher.mccoy@dm.duke.edu.
authors.forename: C Cameron
authors.initials: CC
authors.lastname: McCoy
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Duke University Medical Center, Duke University, Box 2622, Room 481 MSRB 1 Research Drive, Durham, NC 27710, USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lawson
authors.affiliation: Division of Trauma & Critical Care, Department of Surgery, Duke University Medical Center, Duke University, 1557 F Duke South, Blue Zone Box 2837, Durham, NC 27710, USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Shapiro
mesh_terms: D000284:Administration, Oral; D000818:Animals; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D016903:Drug Monitoring; D004638:Emergency Treatment; D006470:Hemorrhage / Q000139:chemically induced* / Q000209:etiology; D006801:Humans; D014947:Wounds and Injuries / Q000503:physiopathology*
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Hemorrhage; Hemostasis; Thromboelastography; Trauma