Harborview Medical Center, UW Medicine, Seattle, Washington.
Keck School of Medicine of USC, Health Sciences Campus, Los Angeles, California, USA.
Curr Opin Anaesthesiol. 2022 Apr 1;35(2):166-171. doi: 10.1097/ACO.0000000000001117.
When to resume or initiate anticoagulation therapy following traumatic brain injury (TBI) is controversial. This summary describes the latest evidence to guide best practice.
Following trauma, prophylactic, and therapeutic anticoagulation (TAC) have been widely encouraged to prevent major comorbidities such as pulmonary embolism and deep venous thrombosis. Increased rebleeding risk and potentially catastrophic outcome from initiation of anticoagulation treatment in TBI are mainly influenced by institutional guidelines or physician preference in the absence of level I or II recommendations. In recent years, there has been an increasing number of TBI in the elderly population on anticoagulation for other medical conditions; this complicates the decision and timing to restart anticoagulation after the injury.
Strategies and timing to start prophylactic and TAC differ significantly between institutions and physicians. Each TBI patient should be evaluated on a case-by-case basis on when to start anticoagulation. More investigation is required to guide best practice.
颅脑损伤 (TBI) 后何时恢复或开始抗凝治疗存在争议。本综述描述了指导最佳实践的最新证据。
创伤后，预防性和治疗性抗凝 (TAC) 已被广泛提倡，以预防肺栓塞和深静脉血栓等主要并发症。在 TBI 中开始抗凝治疗的再出血风险增加和潜在灾难性后果主要受机构指南或医生偏好的影响，而缺乏 I 级或 II 级推荐。近年来，在接受抗凝治疗的其他医疗条件下，老年人群中的 TBI 越来越多；这使受伤后重新开始抗凝的决策和时机变得复杂。
机构和医生之间开始预防性和 TAC 的策略和时机有很大差异。每个 TBI 患者都应根据具体情况进行评估，以确定何时开始抗凝。需要进一步研究来指导最佳实践。
