期刊
CURRENT OPINION IN ANESTHESIOLOGY
卷 35, 期 2, 页码 166-171出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/ACO.0000000000001117
关键词
anticoagulation; brain; thromboprophylaxis; trauma; traumatic brain injury
The timing to resume or initiate anticoagulation therapy following traumatic brain injury is controversial, and individual evaluation is needed to determine when to start anticoagulation. The use of anticoagulants in elderly patients increases the risk of rebleeding, making the decision on when to restart anticoagulation more complex.
Purpose of review When to resume or initiate anticoagulation therapy following traumatic brain injury (TBI) is controversial. This summary describes the latest evidence to guide best practice. Recent findings Following trauma, prophylactic, and therapeutic anticoagulation (TAC) have been widely encouraged to prevent major comorbidities such as pulmonary embolism and deep venous thrombosis. Increased rebleeding risk and potentially catastrophic outcome from initiation of anticoagulation treatment in TBI are mainly influenced by institutional guidelines or physician preference in the absence of level I or II recommendations. In recent years, there has been an increasing number of TBI in the elderly population on anticoagulation for other medical conditions; this complicates the decision and timing to restart anticoagulation after the injury. Strategies and timing to start prophylactic and TAC differ significantly between institutions and physicians. Each TBI patient should be evaluated on a case-by-case basis on when to start anticoagulation. More investigation is required to guide best practice.
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