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Management of Antit...
Management of Antithrombotic Drugs in Patients with Isolated Traumatic Brain Injury : An Intersociety Consensus Document
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- Iaccarino, Corrado (författare)
- Univ Modena & Reggio Emilia, Sch Neurosurg, Dept Biomed Metab & Neural Sci, Modena, Italy.;Univ Hosp Modena, Nocsae Hosp Baggiovara, Neurosurg Div, Modena, Italy.;ASMN Hosp Reggio Emilia, Emergency Neurosurg Unit, AUSL RE IRCCS, Reggio Emilia, Italy.,University of Modena and Reggio Emilia,University Hospital of Modena,Arcispedale Santa Maria Nuova
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- Carretta, Alessandro (författare)
- Univ Bologna, Dept Biomed & Neuromotor Sci DIBINEM, Bologna, Italy.
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- Demetriades, Andreas K. K. (författare)
- Royal Infirm Edinburgh NHS Trust, Dept Neurosurg, Edinburgh, Midlothian, Scotland.,Royal Infirmary of Edinburgh
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- Di Minno, Giovanni (författare)
- Federico II Univ Hosp, Reg Reference Ctr Coagulat Disorders, Naples, Italy.;Federico II Univ Naples, Dept Clin & Surg Med, Naples, Italy.,Azienda Ospedaliera Universitaria Federico II,University of Naples Federico II
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- Giussani, Carlo (författare)
- Fdn IRCCS San Gerardo Tintori, Dept Neurosurg, Monza, Italy.;Univ Milano Bicocca, Sch Med & Surg, Milan, Italy.,San Gerardo Hospital,University of Milano-Bicocca
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- Marcucci, Rossella (författare)
- Univ Florence, Careggi Univ Hosp, Ctr Atherothrombot Dis, Dept Expt & Clin Med, Florence, Italy.,Careggi University Hospital
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- Marklund, Niklas (författare)
- Uppsala University,Lund University,Lunds universitet,Uppsala universitet,Neurokirurgi,Lund Univ, Skane Univ Hosp, Dept Clin Sci, Dept Neurosurg, Lund, Sweden.,Sektion IV,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,LUBIN Lab- Lunds laboratorium för neurokirurgisk hjärnskadeforskning,Forskargrupper vid Lunds universitet,Neurosurgery,Section IV,Department of Clinical Sciences, Lund,Faculty of Medicine,LUBIN Lab- Lund Brain Injury laboratory for Neurosurgical research,Lund University Research Groups,Skåne University Hospital
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- Mastrojanni, Gianmattia (författare)
- Colleferro Hosp, Dept Emergency, ASLRM5, Colleferro, Italy.
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- Pompucci, Angelo (författare)
- ASL Latina Osped Santa Maria Goretti, Neurosurg Div, Latina, Italy.
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- Stefini, Roberto (författare)
- Osped Civile Legnano, Dept Neurosci Head Neck & Neurosurg, Neurosurg Div, Legnano, Italy.,Ospedale civile di Legnano
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- Zona, Gianluigi (författare)
- IRCCS Osped Policlin San Martino, Dept Neurosci DINOGMI, Neurosurg Div, Genoa, Italy.,Ospedale Policlinico San Martino
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- Cividini, Andrea (författare)
- Osped Civile Legnano, Dept Neurosci Head Neck & Neurosurg, Neurosurg Div, Legnano, Italy.,Ospedale civile di Legnano
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- Petrella, Gianpaolo (författare)
- ASL Latina Osped Santa Maria Goretti, Neurosurg Div, Latina, Italy.
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- Coluccio, Valeria (författare)
- Univ Hosp Modena, Dept Hematol & Oncol, Hemostasis & Thrombosis Unit, Modena, Italy.,University Hospital of Modena
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- Marietta, Marco (författare)
- Univ Hosp Modena, Dept Hematol & Oncol, Hemostasis & Thrombosis Unit, Modena, Italy.,University Hospital of Modena
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Univ Modena & Reggio Emilia, Sch Neurosurg, Dept Biomed Metab & Neural Sci, Modena, Italy;Univ Hosp Modena, Nocsae Hosp Baggiovara, Neurosurg Div, Modena, Italy.;ASMN Hosp Reggio Emilia, Emergency Neurosurg Unit, AUSL RE IRCCS, Reggio Emilia, Italy. University of Modena and Reggio Emilia (creator_code:org_t)
- Springer Nature, 2024
- 2024
- Engelska.
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Ingår i: Neurocritical Care. - : Springer Nature. - 1541-6933 .- 1556-0961. ; 40:1, s. 314-327
- Relaterad länk:
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http://dx.doi.org/10...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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https://lup.lub.lu.s...
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Abstract
Ämnesord
Stäng
- BackgroundAll available recommendations about the management of antithrombotic therapies (ATs) in patients who experienced traumatic brain injury (TBI) are mainly based on expert opinion because of the lack of strength in the available evidence-based medicine. Currently, the withdrawal and the resumption of AT in these patients is empirical, widely variable, and based on the individual assessment of the attending physician. The main difficulty is to balance the thrombotic and hemorrhagic risks to improve patient outcome.MethodsUnder the endorsement of the Neurotraumatology Section of Italian Society of Neurosurgery, the Italian Society for the Study about Haemostasis and Thrombosis, the Italian Society of Anaesthesia, Analgesia, Resuscitation, and Intensive Care, and the European Association of Neurosurgical Societies, a working group (WG) of clinicians completed two rounds of questionnaires, using the Delphi method, in a multidisciplinary setting. A table for thrombotic and bleeding risk, with a dichotomization in high risk and low risk, was established before questionnaire administration. In this table, the risk is calculated by matching different isolated TBI (iTBI) scenarios such as acute and chronic subdural hematomas, extradural hematoma, brain contusion (intracerebral hemorrhage), and traumatic subarachnoid hemorrhage with patients under active AT treatment. The registered indication could include AT primary prevention, cardiac valve prosthesis, vascular stents, venous thromboembolism, and atrial fibrillation.ResultsThe WG proposed a total of 28 statements encompassing the most common clinical scenarios about the withdrawal of antiplatelets, vitamin K antagonists, and direct oral anticoagulants in patients who experienced blunt iTBI. The WG voted on the grade of appropriateness of seven recommended interventions. Overall, the panel reached an agreement for 20 of 28 (71%) questions, deeming 11 of 28 (39%) as appropriate and 9 of 28 (32%) as inappropriate interventions. The appropriateness of intervention was rated as uncertain for 8 of 28 (28%) questions.ConclusionsThe initial establishment of a thrombotic and/or bleeding risk scoring system can provide a vital theoretical basis for the evaluation of effective management in individuals under AT who sustained an iTBI. The listed recommendations can be implemented into local protocols for a more homogeneous strategy. Validation using large cohorts of patients needs to be developed. This is the first part of a project to update the management of AT in patients with iTBI.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
Nyckelord
- Anticoagulant
- Antiplatelet
- Consensus
- DOAC
- Hemorrhage progression
- Reversal strategy
- Traumatic brain injury
- Thrombotic risk
- Anticoagulant
- Antiplatelet
- Consensus
- DOAC
- Hemorrhage progression
- Reversal strategy
- Thrombotic risk
- Traumatic brain injury
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Iaccarino, Corra ...
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Carretta, Alessa ...
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Demetriades, And ...
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Di Minno, Giovan ...
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Giussani, Carlo
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Marcucci, Rossel ...
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Marklund, Niklas
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Mastrojanni, Gia ...
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Pompucci, Angelo
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Stefini, Roberto
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Zona, Gianluigi
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Cividini, Andrea
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Petrella, Gianpa ...
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Coluccio, Valeri ...
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Marietta, Marco
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MEDICIN OCH HÄLS ...
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