The impact of antiplatelet drugs on trauma outcomes

Ferraris, Victor A.; Bernard, Andrew C.; Hyde, Brannon R.; Kearney, Paul A.

doi:10.1097/ta.0b013e31825b85f1

Cited by 35 publications

(24 citation statements)

References 20 publications

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“…Given the controversy which continues in the trauma and acute surgery literature, a number of observations can be made [30, 32–37]. Patients receiving antiplatelet agents have an increased number of comorbidities.…”

Section: Protocolsmentioning

confidence: 99%

Management of the Bleeding Patient Receiving New Oral Anticoagulants: A Role for Prothrombin Complex Concentrates

Kreuziger

Keenan

Morton

et al. 2014

BioMed Research International

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Ease of dosing and simplicity of monitoring make new oral anticoagulants an attractive therapy in a growing range of clinical conditions. However, newer oral anticoagulants interact with the coagulation cascade in different ways than traditional warfarin therapy. Replacement of clotting factors will not reverse the effects of dabigatran, rivaroxaban, or apixaban. Currently, antidotes for these drugs are not widely available. Fortunately, withholding the anticoagulant and dialysis are freqnently effective treatments, particularly with rivaroxaban and dabigatran. Emergent bleeding, however, requires utilization of Prothrombin Complex Concentrates (PCCs). PCCs, in addition to recombinant factor VIIa, are used to activate the clotting system to reverse the effects of the new oral anticoagulants. In cases of refractory or emergent bleeding, the recommended factor concentrate in our protocols differs between the new oral anticoagulants. In patients taking dabigatran, we administer an activated PCC (aPCC) [FELBA] due to reported benefit in human in vitro studies. Based on human clinical trial evidence, the 4-factor PCC (Kcentra) is suggested for patients with refractory rivaroxaban- or apixaban-associated hemorrhage. If bleeding continues, recombinant factor VIIa may be employed. With all of these new procoagulant agents, the risk of thrombosis associated with administration of factor concentrates must be weighed against the relative risk of hemorrhage.

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Section: Protocolsmentioning

confidence: 99%

Management of the Bleeding Patient Receiving New Oral Anticoagulants: A Role for Prothrombin Complex Concentrates

Kreuziger

Keenan

Morton

et al. 2014

BioMed Research International

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“…Unfortunately, none of these studies evaluated the associated blood loss. Furthermore, Ferraris et al . reported that post‐trauma bleeding was not significantly associated with pre‐injury antiplatelet drug use among all trauma patients, although the methods for evaluating bleeding were not clear in that study.…”

Section: Discussionmentioning

confidence: 82%

“…The effects of pre‐injury anticoagulant and antiplatelet agent use on traumatic brain injury and mortality have been widely reported, although few reports have examined these effects for non‐head injuries . Furthermore, there are reports regarding the associated risk of mortality, although very few studies have evaluated the associated blood loss . In one report regarding non‐head injuries, Dossett et al .…”

Section: Discussionmentioning

confidence: 99%

“…In this context, anticoagulant or antiplatelet agents are commonly prescribed to prevent and treat thromboembolic events, and many elderly patients with trauma receive these treatments. However, the number of elderly patients using these agents before their injury is also increasing . It has also been widely reported that pre‐injury use of anticoagulant and antiplatelet agents can affect traumatic brain injury and the associated risk of mortality, although few reports have examined the effects of bleeding at non‐head injury sites .…”

Section: Introductionmentioning

confidence: 99%

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Effect of pre‐injury anticoagulant and antiplatelet agents on blood loss in elderly patients with severe trauma

Ohmori¹,

Kitamura²,

Onishi³

et al. 2015

Acute Medicine & Surgery

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Aim: It has been widely reported that pre-injury use of anticoagulant and antiplatelet agents can affect traumatic brain injury and the associated risk of mortality, however, the effect of these agents on non-head injury site-related blood loss remains unclear. Therefore, we investigated the effects of pre-injury anticoagulant and antiplatelet agents on the transfusion amount and the need for massive transfusion in elderly patients with severe trauma. Methods:We retrospectively reviewed a cohort of elderly patients with severe trauma (age, ≥65 years; Injury Severity Score, ≥16)between September 2006 and March 2014. The selected patients were subsequently divided into patients who were: only taking warfarin, aspirin, or clopidogrel; taking various combinations of these agents; and a control group who were not taking any of these agents.Results: During the study period, 67 patients (20%) were taking anticoagulant and antiplatelet agents and 272 patients were included in the control group. Among these patients, 10 were receiving only warfarin, 28 were receiving only aspirin, 14 were receiving only clopidogrel, and 13 were receiving various combinations of these medications. The amount of red cell concentrate and need for massive transfusions were only significantly increased in the warfarin group (P < 0.05). Furthermore, the warfarin group had a significantly higher risk of needing a massive transfusion with multivariate logistic regression analysis (odds ratio, 5.03; 95% confidence interval, 1.25-20.20; P < 0.05). Conclusion:Patients who were receiving only warfarin before their injury had an increased risk of bleeding due to non-head injuries.

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“…3 Estudo recente mostrou o aumento de três vezes do número de pacientes em uso de drogas antiplaquetárias que apresentaram lesões traumáticas num período de cinco anos. 4 A aspirina e o clopidogrel são os agentes antiplaquetários mais comumente prescritos. O clopidogrel, uma tienopiridina, foi introduzido na década de 90, mostrando-se mais efetivo que a aspirina para prevenção secundária de eventos cardiovasculares.…”

Section: Introductionunclassified

Anesthetic management of a patient with traumatic brain injury in use of clopidogrel: case report and literature review

Tavares¹,

Silva²,

Laurentys³

2014

Revista Médica De Minas Gerais

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RESUMOCom o envelhecimento da população, os anestesiologistas têm se confrontado com um número crescente de pacientes do trauma que usam medicações antiplaquetárias e anticoagulantes. No caso do trauma cranioencefálico (TCE), o uso de agentes antiplaquetários pode estar associado ao aumento da extensão da lesão hemorrágica intracraniana (LHI) e da morbimortalidade. Além disso, a retirada desse medicamento expõe esses pacientes às complicações cardiovasculares. Relato de caso: paciente, sexo masculino, 74 anos, hipertenso e diabético, em uso de aspirina e clopidogrel devido à angioplastia coronariana, com stent farmacológico há seis meses. Sofreu queda da própria altura e foi diagnosticado hematoma subdural agudo volumoso, sendo indicada craniotomia de urgência. No perioperatório, recebeu duas plaquetaféreses, 12 UI de concentrado de plaquetas e desmopressina (0,3 mcg/kg) endovenosos, com o intuito de reduzir sangramento. Paciente recuperou sem sequelas neurológicas e sem complicações cardiovasculares no 13 o dia de internação. Até o momento, a literatura é escassa de evidências sobre o manejo do paciente idoso com TCE em uso de agentes antiplaquetários, portanto, este relato de caso teve o objetivo de realizar a revisão de literatura e discutir opções terapêuticas em reverter a ação do clopidogrel. ABSTRACTConsidering the aging of the population, anesthesiologists have been confronted with an increasing number of trauma patients using antiplatelet and anticoagulants medications. In the case of traumatic brain injury (TBI), the use of antiplatelet agents can be linked to increased extension of hemorrhagic intracranial lesion (LHI) and morbidity and mortality. In addition, the withdrawal of these drug exposes these patients to cardiovascular complications. Case report: male patient, 74 years old, hypertensive and diabetic, in use of aspirin and clopidogrel due to coronary angioplasty with drug-eluting stent for six months. He fell down over his own height and was diagnosed with acute bulky subdural hematoma; an urgent craniotomy was indicated. In the perioperative period, he received two plateletpheresis and intravenous 12 IU of platelet concentrate and desmopressin (0.3 mcg/kg) to reduce bleeding. The patient recovered without neurological sequelae and without cardiovascular complications in 13th day of hospitalization. So far, the literature shows scarce evidences of management of elderly patients with TBI in use of antiplatelet agents, therefore, this case report aimed to carry out a literature review and discuss treatment options to revert the action of clopidogrel.

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The impact of antiplatelet drugs on trauma outcomes

Cited by 35 publications

References 20 publications

Management of the Bleeding Patient Receiving New Oral Anticoagulants: A Role for Prothrombin Complex Concentrates

Management of the Bleeding Patient Receiving New Oral Anticoagulants: A Role for Prothrombin Complex Concentrates

Effect of pre‐injury anticoagulant and antiplatelet agents on blood loss in elderly patients with severe trauma

Anesthetic management of a patient with traumatic brain injury in use of clopidogrel: case report and literature review

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