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Review
. 2024 Jun 24;13(13):3669.
doi: 10.3390/jcm13133669.

Traumatic Brain Injury in Patients under Anticoagulant Therapy: Review of Management in Emergency Department

Vincenzo G Menditto  1 , Giulia Rossetti  2 , Mattia Sampaolesi  1 , Marta Buzzo  1 , Giovanni Pomponio  3
Affiliations
Review

Traumatic Brain Injury in Patients under Anticoagulant Therapy: Review of Management in Emergency Department

Vincenzo G Menditto et al. J Clin Med. .

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.

Keywords: biomarkers; intracranial injury; neurosurgery; oral anticoagulant; traumatic brain injury.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Some of the most studied brain biomarkers have been proposed as diagnostic and prognostic markers of traumatic brain injury. Modified from ref. [50]. S100B: calcium-binding protein B; NSE: neuron-specific enolase; UCHL1: ubiquitin carboxyl-terminal hydrolase isozyme L1; GFAP: glial fibrillary acidic protein.
Figure 2
Figure 2
Different phases of traumatic brain injury can be monitored by a range of serum biomarkers: in the figure are some of the most studied ones. Modified from ref. [51]. S100B: calcium-binding protein B; NSE: neuron-specific enolase; UCHL1: ubiquitin carboxyl-terminal hydrolase isozyme L1; GFAP: glial fibrillary acidic protein.
Scheme 1
Scheme 1
Hypothesis of new management of minor head injury based on the use of biomarkers in anticoagulated patients admitted to emergency departments. MHI: minor head injury; CT: computed tomography.
Figure 3
Figure 3
Site of anticoagulants and reversal agents in the coagulation cascade. Modified from ref. [95].
Figure 4
Figure 4
Steps in the management of anticoagulation after traumatic brain injury. Modified from ref. [103].
See this image and copyright information in PMC

References

    1. Faul M., Xu L., Wald M.M., Coronado V.G. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; Atlanta, GA, USA: 2010.
    1. Pandor A., Harnan S., Goodacre S., Pickering A., Fitzgerald P., Rees A. Diagnostic accuracy of clinical characteristics for identifying CT abnormality after minor brain injury: A systematic review and meta-analysis. J. Neurotrauma. 2012;29:707–718. doi: 10.1089/neu.2011.1967. - DOI - PubMed
    1. Maas A.I.R., Menon D.K., Adelson P.D., Andelic N., Bell M.J., Belli A., Bragge P., Brazinova A., Büki A., Chesnut R.M., et al. Traumatic brain injury: Integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017;16:987–1048. doi: 10.1016/S1474-4422(17)30371-X. - DOI - PubMed
    1. Barnes G.D., Lucas E., Alexander G.C., Goldberger Z.D. National Trends in Ambulatory Oral Anticoagulant Use. Am. J. Med. 2015;128:1300–1305.e2. doi: 10.1016/j.amjmed.2015.05.044. - DOI - PMC - PubMed
    1. Vedin T., Lundager Forberg J., Anefjäll E., Lehtinen R., Faisal M., Edelhamre M. Antiplatelet therapy contributes to a higher risk of traumatic intracranial hemorrhage compared to anticoagulation therapy in ground-level falls: A single-center retrospective study. Eur. J. Trauma Emerg. Surg. 2022;48:4909–4917. doi: 10.1007/s00068-022-02016-8. - DOI - PMC - PubMed

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