The epidemic of pre-injury oral antiplatelet and anticoagulant use.
Background: As the population ages, an increasing number of trauma patients are taking antiplatelet and anticoagulant medications (ACAP) prior to their injuries. These medications increase their risk of hemorrhagic complications, particularly intracerebral hemorrhage. Clopidogrel and warfarin are co...
| Publicado en: | European Journal of Trauma & Emergency Surgery Vol. 40; no. 6; pp. 657 - 670 |
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| Autores principales: | , |
| Formato: | review tables/charts Journal Article |
| Publicado: |
Springer Nature
Dec2014
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103921242&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 103921242 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 18639933 3C05 jtl: European Journal of Trauma & Emergency Surgery issn: 18639933 maglogo: N pubinfo: dt: Dec2014 vid: 40 iid: 6 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 103921242 99707547 10.1007/s00068-014-0404-9 103921242 ppf: 657 ppct: 13 formats: fmt: @attributes: type: P tig: atl: The epidemic of pre-injury oral antiplatelet and anticoagulant use. aug: au: Berndtson, A. Coimbra, R. affil: Division of Trauma, Surgical Critical Care and Burns, Department of Surgery, University of California San Diego, 200 West Arbor Drive San Diego 92103 USA sug: subj: Administration, Oral Antifibrinolytic Agents Adverse Effects Anticoagulants Adverse Effects Antifibrinolytic Agents Administration and Dosage Emergency Medicine Surgery, Operative Hemorrhage Risk Factors Anticoagulants Administration and Dosage Intracranial Hemorrhage Risk Factors Intracranial Hemorrhage Diagnosis Trauma Clopidogrel Bisulfate Administration and Dosage Clopidogrel Bisulfate Adverse Effects Outcomes (Health Care) Warfarin Therapeutic Use Warfarin Adverse Effects Diagnostic Imaging International Normalized Ratio Subarachnoid Hemorrhage Diagnosis Tomography, X-Ray Computed ab: Background: As the population ages, an increasing number of trauma patients are taking antiplatelet and anticoagulant medications (ACAP) prior to their injuries. These medications increase their risk of hemorrhagic complications, particularly intracerebral hemorrhage. Clopidogrel and warfarin are common and their mechanisms well understood, but optimal reversal methods continue to evolve. The novel direct thrombin and factor Xa inhibitors are less well described and do not have existing antidotes. Methods: This article reviews the relevant literature on traumatic outcomes with use of ACAP medications, as well as data on ideal reversal strategies. Suggested algorithms are introduced, and future research directions discussed. Results: Although they are beneficial in preventing clot formation, once bleeding occurs ACAP medications contribute to increased morbidity and mortality, particularly in geriatric patient populations. The efficacy of clopidogrel reversal with platelet transfusions and DDAVP remains unclear. Warfarin use is best treated with the algorithm-driven use of plasma, vitamin K, prothrombin complex concentrates (PCCs) and possibly recombinant factor VIIa depending upon specific patient and injury factors. Optimal treatment for direct thrombin and factor Xa inhibitors has yet to be developed, but PCCs are promising for rivaroxaban and apixaban while dabigatran is best treated with medication cessation and the possible addition of activated PCCs or hemodialysis. Conclusion: New developments in reversal of the ACAP medications are promising, particularly PCCs for warfarin and the factor Xa inhibitors. Function assays and clear antidotes are needed for the thrombin and Xa inhibitors. Research on outcomes and appropriate treatments is actively ongoing. pubtype: Academic Journal doctype: review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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