对于潜在或已知摄入口服抗凝剂和创伤性脑损伤(TBI)的患者的最佳护理存在高度不确定性。抗凝治疗会加重脑出血的风险,但是,另一方面,患者服用抗凝剂是因为潜在的血栓形成风险,创伤后这种情况可能会增加。治疗决定必须适当考虑这两种风险。召集了一个由奥地利专家组成的跨学科小组,以制定最佳临床实践建议。目的是提供务实的,clear,以及易于遵循的临床指导,用于患有TBI和潜在或已知摄入血小板抑制剂的成年患者的凝血管理,维生素K拮抗剂,或非维生素K拮抗剂口服抗凝剂。诊断,凝血试验,抗凝逆转被认为是出现后的关键步骤。还探讨了创伤后管理(预防血栓栓塞和恢复长期抗凝治疗)。缺乏强有力的证据作为治疗建议的基础,突出了在这种情况下进行随机对照试验的必要性。
There is a high degree of uncertainty regarding optimum care of patients with potential or known intake of oral anticoagulants and traumatic brain injury (TBI). Anticoagulation therapy aggravates the risk of intracerebral hemorrhage but, on the other hand, patients take anticoagulants because of an underlying prothrombotic risk, and this could be increased following trauma. Treatment decisions must be taken with due consideration of both these risks. An interdisciplinary group of Austrian experts was convened to develop recommendations for best clinical practice. The aim was to provide pragmatic, clear, and easy-to-follow clinical guidance for coagulation management in adult patients with TBI and potential or known intake of platelet inhibitors, vitamin K antagonists, or non-vitamin K antagonist oral anticoagulants. Diagnosis, coagulation testing, and reversal of anticoagulation were considered as key steps upon presentation. Post-trauma management (prophylaxis for thromboembolism and resumption of long-term anticoagulation therapy) was also explored. The lack of robust evidence on which to base treatment recommendations highlights the need for randomized controlled trials in this setting.