Diagnostic and therapeutic approach in adult patients with traumatic brain injury receiving oral anticoagulant therapy: an Austrian interdisciplinary consensus statement
Marion Wiegele,
Herbert Schöchl,
Alexander Haushofer,
Martin Ortler,
Johannes Leitgeb,
Oskar Kwasny,
Ronny Beer,
Cihan Ay,
Eva Schaden
Affiliations
Marion Wiegele
Department of Anaesthesia, Critical Care and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna
Herbert Schöchl
Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University
Alexander Haushofer
Central Laboratory, Klinikum Wels-Grieskirchen
Martin Ortler
Department of Neurosurgery, Krankenhaus Rudolfstiftung
Johannes Leitgeb
University Departments of Orthopaedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna
Oskar Kwasny
Department for Surgery and Sports Traumatology, Kepler University Hospital–Med Campus III
Ronny Beer
Neurocritical Care, Department of Neurology, Medical University of Innsbruck
Cihan Ay
Department of Medicine I, Clinical Division of Haematology and Haemostaseology, Medical University of Vienna
Eva Schaden
Department of Anaesthesia, Critical Care and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna
Abstract There is a high degree of uncertainty regarding optimum care of patients with potential or known intake of oral anticoagulants and traumatic brain injury (TBI). Anticoagulation therapy aggravates the risk of intracerebral hemorrhage but, on the other hand, patients take anticoagulants because of an underlying prothrombotic risk, and this could be increased following trauma. Treatment decisions must be taken with due consideration of both these risks. An interdisciplinary group of Austrian experts was convened to develop recommendations for best clinical practice. The aim was to provide pragmatic, clear, and easy-to-follow clinical guidance for coagulation management in adult patients with TBI and potential or known intake of platelet inhibitors, vitamin K antagonists, or non-vitamin K antagonist oral anticoagulants. Diagnosis, coagulation testing, and reversal of anticoagulation were considered as key steps upon presentation. Post-trauma management (prophylaxis for thromboembolism and resumption of long-term anticoagulation therapy) was also explored. The lack of robust evidence on which to base treatment recommendations highlights the need for randomized controlled trials in this setting.
