PDF(Pubmed)
Abstract：
The best management of patients who suffer from traumatic brain injury (TBI) while on oral anticoagulants is one of the most disputed problems of emergency services. Indeed, guidelines, clinical decision rules, and observational studies addressing this topic are scarce and conflicting. Moreover, relevant issues such as the specific treatment (and even definition) of mild TBI, rate of delayed intracranial injury, indications for neurosurgery, and anticoagulant modulation are largely empiric. We reviewed the most recent evidence on these topics and explored other clinically relevant aspects, such as the promising role of dosing brain biomarkers, the strategies to assess the extent of anticoagulation, and the indications of reversals and tranexamic acid administration, in cases of mild TBI or as a bridge to neurosurgery. The appropriate timing of anticoagulant resumption was also discussed. Finally, we obtained an insight into the economic burden of TBI in patients on oral anticoagulants, and future directions on the management of this subpopulation of TBI patients were proposed. In this article, at the end of each section, a \"take home message\" is stated.
摘要：
口服抗凝剂时遭受创伤性脑损伤（TBI）的患者的最佳管理是急诊服务中最有争议的问题之一。的确,指导方针,临床决策规则，针对这一主题的观察性研究很少且相互矛盾。此外，相关问题，如轻度TBI的具体治疗(甚至定义)，迟发性颅内损伤的发生率，神经外科的适应症,抗凝血调制在很大程度上是经验性的。我们回顾了这些主题的最新证据，并探讨了其他临床相关方面，例如给药大脑生物标志物的有希望的作用，评估抗凝程度的策略，以及逆转和氨甲环酸给药的适应症，在轻度TBI的情况下或作为神经外科手术的桥梁。还讨论了抗凝恢复的适当时机。最后,我们对口服抗凝药患者的TBI经济负担进行了深入了解，并提出了该TBI患者亚群管理的未来方向。在这篇文章中,在每个部分的末尾，陈述了“带回家的消息”。
