When is it safe to resume anticoagulation in traumatic brain injury?

Abstract

Purpose of reviewWhen to resume or initiate anticoagulation therapy following traumatic brain injury (TBI) is controversial. This summary describes the latest evidence to guide best practice. Recent findingsFollowing 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. SummaryStrategies 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.

A Challenging Case of Anticoagulation: Acute Traumatic Brain Injury Complicated by Multifocal Venous Thromboembolism

“…A study involving 1,215 patients showed that those treated with Low Molecular Weight Heparin (LMWH) had an 18% higher risk of hemorrhage progression (24% vs. 42%) compared to patients not treated with anticoagulants [22] . The majority of literature suggests that initiating pharmacological prophylaxis for anticoagulation 24-72 hours after hemostasis in TBI is considered safe [18,[23][24][25][26] . A prospective analysis indicated that TBI patients treated with Unfractionated Heparin (UFH) after 24 hours of injury stability on CT had a bleeding progression rate of 0.78%, compared to 2.8% in patients without pharmacological prophylaxis, with no statistically signi cant difference (P = 0.33) [18,24] .…”

Venous thromboembolism in patients with isolated moderate to severe traumatic brain injury

“…раздел «Обсуждение») может привести к значимому увеличению объема исходной гематомы при рецидиве кровоизлияния. В то же время задержка медикаментозной профилактики или отказ от нее сопровождаются высоким риском ВТЭО, включая фатальные ТЭЛА [3,[12][13][14].…”

“…введение Нейрохирургические и неврологические пациенты остаются категорией больных с высоким или крайне высоким риском венозных тромбоэмболических осложнений (ВТЭО), которые включают тромбоз вен нижних конечностей и тромбоэмболию легочной артерии (ТЭЛА) [1][2][3][4]. Особенно это касается заболеваний, при которых имеют место первичные и вторичные внутричерепные кровоизлияния: геморрагический инсульт, кровоизлияния в опухоли головного и спинного мозга, ишемический инсульт с геморрагическим пропитыванием [5][6][7].…”

Anticoagulation and Antiplatelet Agent Resumption Timing following Traumatic Brain Injury

“…Ischemic cerebrovascular disease, cardiovascular disease, and thromboembolic events are common causes for taking antithrombotic agents. 24 26 29) When TBI occurs in patients with these diseases, there is a conflict between the diseases, which require an antithrombotic effect, and the neurosurgeon, who has to minimize intracranial hemorrhage. Nevertheless, there are no clear guidelines for the reversal or resumption of antithrombotic agents when TBI occurs in patients taking antithrombotic agents.…”