Diagnostic and therapeutic approach in adult patients with traumatic brain injury receiving oral anticoagulant therapy: an Austrian interdisciplinary consensus statement

Abstract

There is a high degree of uncertainty regarding optimum care of patients with potential or known intake of oral anticoagulants and traumatic brain injury (TBI). Anticoagulation therapy aggravates the risk of intracerebral hemorrhage but, on the other hand, patients take anticoagulants because of an underlying prothrombotic risk, and this could be increased following trauma. Treatment decisions must be taken with due consideration of both these risks. An interdisciplinary group of Austrian experts was convened to develop recommendations for best clinical practice. The aim was to provide pragmatic, clear, and easy-to-follow clinical guidance for coagulation management in adult patients with TBI and potential or known intake of platelet inhibitors, vitamin K antagonists, or non-vitamin K antagonist oral anticoagulants. Diagnosis, coagulation testing, and reversal of anticoagulation were considered as key steps upon presentation. Post-trauma management (prophylaxis for thromboembolism and resumption of long-term anticoagulation therapy) was also explored. The lack of robust evidence on which to base treatment recommendations highlights the need for randomized controlled trials in this setting.

Accuracy of a Rapid Diagnostic Test for the Presence of Direct Oral Factor Xa or Thrombin Inhibitors in Urine—A Multicenter Trial

“…The 30 ng/mL threshold in plasma has been proposed for safe hemostasis by several experts. [14][15][16] Using the same threshold for a positive result in urine samples was therefore a very conservative approach in the present study.…”

The abnormalities of coagulation and fibrinolysis in acute lung injury caused by gas explosion

“…Coagulation dysfunction is a common occurrence in traumatic injuries, and often appears in a hypercoagulable condition, leading to the manifestation of venous thromboembolism, even pulmonary embolism 18–20 . Moreover, abnormalities in the blood coagulation complex appear before lung injury in traumatic brain injury of rats, and are significantly correlated with lung injury degree, highlighting that abnormal functioning of the blood coagulation complex might lead to lung injury 13 .…”

Change in Age Distribution of the Injuries and Comparison of Different Scoring Tools in Predicting Mortality Among Geriatric Trauma Patients

“…Therefore, it may be necessary to identify these patients and revisal appropriately. Due to paucity of high quality studies, the standard management of these patients remain unclear [34]. In conclusion, ageing population brings great challenge to the management of trauma patients.…”