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low trauma anticoagulation

Jing Li Huang, Theo A Woehrle, Pat Conway, Catherine A McCarty, Madeline M Eyer, Steven D Eyer
PURPOSE: In 2007, Essentia Health St. Mary's Medical Center (SMMC), a Level II trauma center in northeastern Minnesota, implemented a protocol for patients who presented with blunt head trauma and were receiving warfarin for anticoagulation. The purpose of this study was to determine the incidence and risk factors of early delayed, warfarin-associated intracranial hemorrhage (ICH). METHODS: Adult patients with signs and symptoms of head injury on warfarin who were admitted by protocol to SMMC between March 2007 and June 2015 were included...
March 14, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Joshua H Hill, Paul Bonner, M Shay O'Mara, Teresa Wood, Michael Lieber
OBJECTIVE: We postulate that in patients with blunt trauma on anticoagulant or antiplatelet agents, incidence and complication rate of delayed intracranial hemorrhage (DICH) after an initially negative head CT is low and routine repeat head CT is not warranted. DESIGN: A retrospective, observational study performed from 2008 to 2012. PATIENTS: A total of 338 patients with blunt trauma with pre-admission history of any anticoagulant use, who had an initially negative head CT, followed by a repeat CT within 48 hours...
February 27, 2018: Brain Injury: [BI]
James A Chenoweth, Samuel D Gaona, Mark Faul, James F Holmes, Daniel K Nishijima
Importance: Current guidelines conflict on the management of older adults who have blunt head trauma taking anticoagulant and antiplatelet medications. This is partially due to the limited data comparing patients who are taking these medications with those who are not. Objective: To investigate the incidence of delayed traumatic intracranial hemorrhage in older adults with head trauma, including those taking anticoagulant and antiplatelet medications. Design, Setting, and Participants: This prospective observational cohort study included patients 55 years and older who had blunt head trauma and were transported via emergency medical services between August 1, 2015, and September 30, 2016...
February 14, 2018: JAMA Surgery
Brian Shiu, Elizabeth Le, Ehsan Jazini, Tristan B Weir, Timothy Costales, Nicholas Caffes, Ebrahim Paryavi, Nathan O'Hara, Daniel E Gelb, Eugene Y Koh, Steven C Ludwig
STUDY DESIGN: A retrospective review (2001-2014) was conducted using prospectively collected data at a level I trauma center. OBJECTIVE: We sought to determine the incidence and characteristics of complications occurring secondary to therapeutic anticoagulation in adult spine trauma patients. SUMMARY OF BACKGROUND DATA: Numerous studies have assessed prophylactic anticoagulation after spine surgery, but none has investigated the risks of therapeutic doses of anticoagulation for treatment of postoperative thromboembolic events...
December 5, 2017: Spine
Jordan R Stern, Danielle E Cafasso, Andrew J Meltzer, Darren B Schneider, Sharif H Ellozy, Peter H Connolly
PURPOSE: Inferior vena cava filters (IVCFs) are often placed for prophylactic indications. We sought to better define the range of practice indications for placement of prophylactic IVCFs, as well as the specific retrieval rate and risk factors for nonretrieval. METHODS: A retrospective, single-institution review of patients undergoing IVCF placement over a 2-year period was performed. Patients undergoing prophylactic IVCF placement were selected from a prospectively collected database...
January 1, 2017: Vascular and Endovascular Surgery
Magdalene Brooke, Atul Patel, Federico Castro-Moure, Gregory P Victorino
BACKGROUND: Rapidly resolving acute subdural hematomas (RRASDHs) have been described in case reports and case series but are still poorly understood. We hypothesized that a cohort analysis would confirm previously reported predictors of RRASDH including coagulopathy, additional intracranial hemorrhage, and low-density band on imaging. We also hypothesized that rapid resolution would be associated with improved trauma outcomes. METHODS: We reviewed all nonoperative acute subdural hematomas (ASDHs) treated at our center from 2011 to 2015...
November 2017: Journal of Surgical Research
Eric J Hohenwalter, James R Stone, Paul V O'Moore, Steven J Smith, J Bayne Selby, Robert J Lewandowski, Shaun Samuels, Paul M Kiproff, David W Trost, David C Madoff, Jeremy Handel, Eric J Gandras, Athanasios Vlahos, William S Rilling
PURPOSE: To demonstrate rates of successful filter conversion and 6-month major device-related adverse events in subjects with converted caval filters. MATERIALS AND METHODS: An investigational device exemption multicenter, prospective, single-arm study was performed at 11 sites enrolling 149 patients. The VenaTech Convertible Vena Cava Filter (B. Braun Interventional Systems, Inc, Bethlehem, Pennsylvania) was implanted in 149 patients with venous thromboembolism and contraindication to or failure of anticoagulation (n = 119), with high-risk trauma (n = 14), and for surgical prophylaxis (n = 16)...
October 2017: Journal of Vascular and Interventional Radiology: JVIR
Ying Guo, Zhongwen Zou, Lianshun Jia, Zhi Huang, Xiong Yun, Guo Xing
BACKGROUND: To evaluate the safety and effectiveness of argatroban for the prevention of venous thromboembolism (VTE) after posterior lumbar decompressive surgery. METHODS: Included in this retrospective study were 556 patients who underwent posterior lumbar decompressive surgery for trauma and degenerative diseases. They were divided into two groups: argatroban group (n = 274), and low molecular weight heparin (LMWH) group (n = 282). The occurrence of postoperative venous thrombosis and complications including hemorrhage and allergic reaction was compared between the two groups...
August 2017: International Journal of Surgery
Victor F Tapson, Joshua P Hazelton, John Myers, Claudia Robertson, Ramyar Gilani, Julie A Dunn, Marko Bukur, Martin A Croce, Ann Peick, Sonlee West, Lawrence Lottenberg, Jay Doucet, Preston R Miller, Bruce Crookes, Rajesh R Gandhi, Chasen A Croft, Anthony Manasia, Brian A Hoey, Howard Lieberman, Oscar D Guillamondegui, Victor Novack, Gregory Piazza, Samuel Z Goldhaber
PURPOSE: To evaluate efficacy and safety of a novel device that combines an inferior vena cava (IVC) filter and central venous catheter (CVC) for prevention of pulmonary embolism (PE) in critically ill patients. MATERIALS AND METHODS: In a multicenter, prospective, single-arm clinical trial, the device was inserted at the bedside without fluoroscopy and subsequently retrieved before transfer from the intensive care unit (ICU). The primary efficacy endpoint was freedom from clinically significant PE or fatal PE 72 hours after device removal or discharge, whichever occurred first...
June 20, 2017: Journal of Vascular and Interventional Radiology: JVIR
Piergiorgio Tozzi, Carlo Banfi, Kameran Ahmadov, Roger Hullin, Philippe Meyer, Raphael Giraud, Lucas Liaudet, Fabrizio Gronchi, Christophe Huber, Matthias Kirsch
New generation devices for long-term mechanical circulatory support are centrifugal pumps having fully magnetically levitated rotors to reduce blood trauma. Recently, the novel HeartMate 3 was cleared for clinical application in Switzerland. In two Swiss University Hospitals part of the "Lausanne-Geneva Transplantation Network," 10 consecutive patients in end-stage heart failure received the HeartMate 3 (Thoratec Corporation, Pleasanton, CA). Device implantation criteria were persistent low output syndrome despite optimal medical treatment...
November 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Zachary M Bauman, John M Ruggero, Sunny Squindo, Chris McEachin, Michelle Jaskot, Will Ngo, Scott Barnes, Peter P Lopez
Anticoagulation and antiplatelet (ACAP) medications are increasingly prescribed to patients at high risk for falls. Many trauma centers have developed protocols for obtaining repeat head CT (HCT) for patients with low-altitude falls on ACAP therapy. We assess the need for routine scheduled repeat HCT in this population. Prospective, observational analysis of all low-altitude fall (<6 feet) patients on ACAP therapy evaluated at a Level II trauma center. All low-altitude fall patients with visible or suspected head trauma received an initial HCT...
May 1, 2017: American Surgeon
Alex T Lee, Arni Gagnidze, Sharon R Pan, Pimwan Sookplung, Bala Nair, Shu-Fang Newman, Alon Ben-Ari, Ahmed Zaky, Kevin Cain, Monica S Vavilala, Irene Rozet
BACKGROUND: Antiplatelet medications are usually discontinued before elective neurosurgery, but this is not an option for emergent neurosurgery. We performed a retrospective cohort study to examine whether preoperative aspirin use was associated with worse outcomes after emergency neurosurgery in elderly patients. METHODS: We analyzed all cases of emergency neurosurgical procedures for traumatic intracranial hemorrhage from 2008 to 2012 at a level 1 trauma center...
August 2017: Anesthesia and Analgesia
Wolfgang Korte, Man-Chiu Poon, Alfonso Iorio, Michael Makris
Although inherited fibrinogen disorders (IFD) are primarily considered to be bleeding disorders, they are associated with a higher thrombotic complication risk than defects in other clotting factors. Managing IFD patients with thrombosis is challenging as anticoagulant treatment may exacerbate the underlying bleeding risk which can be life-threatening. Due to the low prevalence of IFD, there is little information on pathophysiology or optimal treatment of thrombosis in these patients. We searched the literature for cases of thrombosis among IFD patients and identified a total of 128 patient reports...
April 2017: Transfusion Medicine and Hemotherapy
Michael Ganetsky, Gregory Lopez, Tara Coreanu, Victor Novack, Steven Horng, Nathan I Shapiro, Kenneth A Bauer
OBJECTIVES: Anticoagulant and antiplatelet medications are known to increase the risk and severity of traumatic intracranial hemorrhage (tICH), even with minor head trauma. Most studies on bleeding propensity with head trauma are retrospective, are based on trauma registries, or include heterogeneous mechanisms of injury. The goal of this study was to determine the rate of tICH from only a common low-acuity mechanism of injury, that of a ground-level fall, in patients taking one or more of the following antiplatelet or anticoagulant medications: aspirin, warfarin, prasugrel, ticagrelor, dabigatran, rivaroxaban, apixaban, or enoxaparin...
October 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Andrea G Scherer, Ian K White, Kashif A Shaikh, Jodi L Smith, Laurie L Ackerman, Daniel H Fulkerson
OBJECTIVE The risk of venous thromboembolism (VTE) from deep venous thrombosis (DVT) is significant in neurosurgical patients. VTE is considered a leading cause of preventable hospital deaths and preventing DVT is a closely monitored quality metric, often tied to accreditation, hospital ratings, and reimbursement. Adult protocols include prophylaxis with anticoagulant medications. Children's hospitals may adopt adult protocols, although the incidence of DVT and the risk or efficacy of treatment is not well defined...
July 2017: Journal of Neurosurgery. Pediatrics
Belinda H McCully, Christopher R Connelly, Kelly A Fair, John B Holcomb, Erin E Fox, Charles E Wade, Eileen M Bulger, Martin A Schreiber
BACKGROUND: Altered coagulation function after trauma can contribute to development of venous thromboembolism (VTE). Severe trauma impairs coagulation function, but the trajectory for recovery is not known. We hypothesized that enhanced, early recovery of coagulation function increases VTE risk in severely injured trauma patients. STUDY DESIGN: Secondary analysis was performed on data from the Pragmatic Randomized Optimal Platelet and Plasma Ratio (PROPPR) trial, excluding patients who died within 24 hours or were on pre-injury anticoagulants...
July 2017: Journal of the American College of Surgeons
Tomasz Andrzej Dziedzic, Przemysław Kunert, Andrzej Marchel
OBJECTIVE: An apparent increase of use of drugs affecting hemostasis in our neurosurgical department since the 1990s has encouraged us to investigate whether these drugs influence the clinical course and results of surgery for chronic subdural hematoma (CSDH). METHODS: This retrospective analysis included 178 patients admitted for CSDH from 2007 to 2011 who were divided into two groups: on drugs affecting hemostasis (40; 22%) and no bleeding disorders (138; 78%)...
March 2017: Journal of Korean Neurosurgical Society
José Ramírez Villaescusa, Marcela Restrepo Pérez, David Ruiz Picazo
INTRODUCTION: Spinal epidural hematoma (SEH) is a rare disease that causes cord compression and neurologic deficit. Spontaneous SEH is related to minor trauma, bleeding disorders, and anticoagulant medications. Posttraumatic SEH has been associated with low-energy spine hyperextension injuries in patients with ankylosing spinal disorders such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis (DISH). A variant named atypical DISH-like with SEH is reported. OBJECTIVE: To describe the management, diagnosis, and treatment of an unusual SEH case in a patient causing delayed neurologic deficit with rigid atypical DISH-like spine...
March 2017: Geriatric Orthopaedic Surgery & Rehabilitation
Walid El Kininy, Shane Davy, Murali Sayana
The Morel-Lavallee lesion (MLL) of the knee region has been described in the Orthopaedic literature, and all of those were fit and healthy young participants sustaining sports-related trauma to the knee. We describe a case of an elderly woman, on aspirin and prophylactic clexane, who sustained a low-energy injury to the right knee and developed an MLL of the knee region. A delayed recognition, led to the persistence of the MLL as a diffuse haematoma, which subsequently became colonised with methicillin-resistant Staphylococcus aureus We discuss the management of a case and highlight the importance of early identification and management of MLL of the knee region...
March 1, 2017: BMJ Case Reports
Brian W Gross, Maria Gillio, Cole D Rinehart, Caitlin A Lynch, Frederick B Rogers
Polyunsaturated fatty acids such as omega-3 eicosapentaenoic acid and omega-6 docosahexaenoic acid, found in over-the-counter fish oil supplements, are often consumed for their beneficial, prophylactic, anti-inflammatory effects. Although the mechanisms of action are not fully known, a diet rich in polyunsaturated fats may reduce the risk of hyperlipidemia, atherosclerosis, high low-density lipoprotein cholesterol levels, hypertension, and inflammatory diseases. Masked by its many benefits, the risks of omega-3 fatty acid supplementation are often underappreciated, particularly its ability to inhibit platelet aggregation and promote bleeding in patients taking anticoagulant medications...
January 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
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