Abstract
The use of anticoagulant and antiplatelet medications is becoming more prevalent in the first world secondary to aging populations and expanding indications for use of these agents in the face of prothrombotic states such as coronary artery disease, cerebrovascular disease, atrial fibrillation, and venous thromboembolic (VTE) disease (Kannel et al. Am J Cardiol 82(7):2N–9N, 1998). Increased age is among risk factors for these conditions. Similarly, elderly patients are at especially high risk of falls and motor vehicle-related injuries and, thus, represent an increasingly larger proportion of trauma patients encountered annually (Coleman et al. Am J Surg 212:1237–42, 2016). Altogether, these trends mean that trauma care providers are encountering a growing number of acutely injured (and potentially bleeding) patients on anticoagulant and antiplatelet medications. This chapter will provide a discussion of when to suspect that one (or more) of these agents may be active within an injured patient and how to optimize the care of these individuals in the face of a very difficult problem: active hemorrhage in the setting of pharmacologic/iatrogenic coagulopathy, which may or may not be reversible.
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References
Adcock DM, Gosselin RC. The danger of relying on the APTT and PT in patients on DOAC therapy, a potential patient safety issue. Int J Lab Hematol. 2017;39(s1):37–40.
Babilonia K, Trujillo T. The role of prothrombin complex concentrates in reversal of target specific anticoagulants. Thromb J. 2014;12:8.
Baharoglu MI, Cordonnier C, Salman RAS, et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet theraphy (PATCH): a randomised, open-label, phase 3 trial. Lancet. 2016;387:2605–13.
Coleman J, Baldawi M, Heidt D. The effect of anticoagulation status on geriatric fall trauma patients. Am J Surg. 2016;212:1237–42.
CRASH-2 Trial Collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant hemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376:23–32.
Feeney JM, Santone E, DiFiori M, et al. Compared to warfarin, direct oral anticoagulants are associated with lower mortality in patients with blunt traumatic intracranial hemorrhage: a TQIP study. J Trauma Acute Care Surg. 2016;81(5):843–8.
Gordon JL, Fabian TC, Lee MD. Anticoagulant and antiplatelet medications encountered in emergency surgery patients: a review of reversal strategies. J Trauma Acute Care Surg. 2013;75:475–86.
Kannel KB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol. 1998;82(7):2N–9N.
Kobayashi L, Barmparas G, Bosarge P, et al. Novel oral anticoagulants and trauma: the results of a prospective American Association for the Surgery of Trauma Multi-Institutional Trial. J Trauma Acute Care Surg. 2017;82(5):827–35.
Levi M. Epidemiology and management of bleeding in patients using vitamin K antagonists. J Thromb Haemost. 2009;7(s1):103–6.
McBeth PB, Weinberg JA, Sarani B, Yeung LY, May AK. Surgeon’s guide to anticoagulant and antiplatelet medications part one: warfarin and new direct oral anticoagulant medications. Trauma Surg Acute Care Open. 2016;1:1–5.
Myers SP, Dadashzadeh ER, Cheung J, et al. Management of anticoagulation with rivaroxaban in trauma and acute care surgery: complications and reversal strategies as compared to warfarin therapy. J Trauma Acute Care Surg. 2017;82(3):542–9.
Nishijima DK, Offerman SR, Ballard DW, Vinson DR, Chettipally UK, Rauchwager AS, Reed ME, Holmes JF. Immediate and delayed traumatic hemorrhage in patients with head trauma and preinjury warfarin or clopidogrel use. Ann Emerg Med. 2012;59(6):460–8.
Veigas PV, Callum J, Rizoli S, Nascimento B, da Luz LT. A systematic review on the rotational thrombelastometry (ROTEM) values for the diagnosis of coagulopathy, prediction and guidance of blood transfusion and prediction of mortality in trauma patients. Scand J Trauma Resusc Emerg Med. 2016;24(1):114.
von Heymann C, Rosenthal C, Kaufner L, Sander M. Management of direct oral anticoagulants-associated bleeding in the trauma patient. Curr Opin Anesthesiol. 2016;29(2):222–8.
Yeung LY, Sarani B, Weinberg JA, McBeth PB, May AK. Surgeon’s guide to anticoagulant and antiplatelet medications part two: antiplatelet agents and perioperative management of long-term anticoagulation. Trauma Surg Acute Care Open. 2016;1:1–7.
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Paskar, D.D., Rizoli, S.B. (2018). Anticoagulants and Antiplatelet Agents. In: Salim, A., Brown, C., Inaba, K., Martin, M. (eds) Surgical Critical Care Therapy . Springer, Cham. https://doi.org/10.1007/978-3-319-71712-8_33
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DOI: https://doi.org/10.1007/978-3-319-71712-8_33
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