Document Detail


Reversal of anticoagulation in trauma: a North-American survey on clinical practices among trauma surgeons.
MedLine Citation:
PMID:  16294078     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Recent studies addressing reversal of anticoagulation in trauma have reported conflicting results. We hypothesized that current clinical practice is variable throughout North America. METHODS: We surveyed 100 trauma surgeons to obtain information regarding variability in current clinical practice. RESULTS: Seventy-five of 100 trauma surgeons surveyed responded, and the majority (98.7%) agreed that preinjury anticoagulation poses problems in trauma management that include bleeding, increased complications, and mortality. Nine participants (12.2%) had a protocol addressing reversal of anticoagulation in their institution. Most use fresh frozen plasma based on the type and location of injury, initial international normalized ratio (INR), and targeted INR value. Fresh frozen plasma was consistently used in patients with positive head computed tomographic scans, hemothorax, nonoperative solid organ injury management, pelvic and long bone fractures, and any operative intervention. Practice inconsistencies were found in patients with loss of consciousness and normal head computed tomographic scan, facial and rib fractures, and pulmonary contusion. Significant variability was found in the reversal INR target. One third of participants agreed that anticoagulation could be restarted 5 to 7 days after craniotomy; one sixth would do so within 72 hours and one third would wait 10 or more days. Most agreed that anticoagulation could be restarted 3 days after chest, abdominal, and orthopedic operations. Significant inconsistencies were also observed regarding when to restart anticoagulation in closed head injury patients treated nonoperatively. CONCLUSION: On the basis of the discrepancies observed in this survey, a clinical trial addressing specific injury location and patterns, INR thresholds, and type of strategy to achieve reversal is warranted, and most would agree to participate.
Authors:
Raul Coimbra; David B Hoyt; Devashish J Anjaria; Bruce M Potenza; Dale Fortlage; Peggy Hollingsworth-Fridlund
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  59     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-11-18     Completed Date:  2005-12-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  375-82     Citation Subset:  AIM; IM    
Affiliation:
Division of Trauma, Surgical Critical Care, and Burns, Department of Surgery, University of California San Diego School of Medicine, CA 92103-8896, USA. rcoimbra@ucsd.edu
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MeSH Terms
Descriptor/Qualifier:
Abdominal Injuries / surgery
Anticoagulants
Canada
Craniocerebral Trauma / surgery*
Extremities / injuries
Hemorrhage / chemically induced*
Humans
International Normalized Ratio
Physician's Practice Patterns*
Plasma
Thoracic Injuries / surgery
Unconsciousness
United States
Wounds and Injuries / surgery*
Chemical
Reg. No./Substance:
0/Anticoagulants

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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