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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

World Journal of Emergency Surgery 1/2012

Therapeutic anticoagulation can be safely accomplished in selected patients with traumatic intracranial hemorrhage

Zeitschrift:
World Journal of Emergency Surgery > Ausgabe 1/2012
Autoren:
Matthew C Byrnes, Eric Irwin, Robert Roach, Molly James, Patrick K Horst, Patty Reicks
Wichtige Hinweise

Competing interests

None of the authors have any conflicts of interest or special declarations to make regarding the contents of this manuscript.

Authors’ contribution

MB directed the design of the study, data interpretation, and was involved in the drafting and revision of the manuscript. EI was involved in the study design and the manuscript revision. PR was involved in the data acquisition, study planning, and manuscript revision. RR was involved in the data interpretation and manuscript revision. PH was involved with the data acquisition and the data interpretation. All authors read and approved the final manuscript.

Abstract

Introduction

Therapeutic anticoagulation is an important treatment of thromboembolic complications, such as DVT, PE, and blunt cerebrovascular injury. Traumatic intracranial hemorrhage has traditionally been considered to be a contraindication to anticoagulation.

Hypothesis

Therapeutic anticoagulation can be safely accomplished in select patients with traumatic intracranial hemorrhage.

Methods

Patients who developed thromboembolic complications of DVT, PE, or blunt cerebrovascular injury were stratified according to mode of treatment. Patients who underwent therapeutic anticoagulation with a heparin infusion or enoxaparin (1 mg/kg BID) were evaluated for neurologic deterioration or hemorrhage extension by CT scan.

Results

There were 42 patients with a traumatic intracranial hemorrhage that subsequently developed a thrombotic complication. Thirty-five patients developed a DVT or PE. Blunt cerebrovascular injury was diagnosed in four patients. 26 patients received therapeutic anticoagulation, which was initiated an average of 13 days after injury. 96% of patients had no extension of the hemorrhage after anticoagulation was started. The degree of hemorrhagic extension in the remaining patient was minimal and was not felt to affect the clinical course.

Conclusion

Therapeutic anticoagulation can be accomplished in select patients with intracranial hemorrhage, although close monitoring with serial CT scans is necessary to demonstrate stability of the hemorrhagic focus.
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