Role of Anti Coagulants in Head Trauma

Abstract

Traumatic brain injury (TBI) constitutes a major health and socioeconomic problem throughout the world. It is one of the major causes of disability and death. It reflects an insult to the brain from an external mechanical force that might cause a temporary or permanent impairment of physical and cognitive functions along with changes in mental status. Most of these injuries are a direct result of falls, motor vehicle accidents, and assaults. TBI may be divided into primary injury and secondary injury. Primary injury is induced by mechanical force and occurs at the moment of injury. Secondary injury is not mechanically induced. It may be delayed from the moment of impact, and it may superimpose injury on a brain already affected by a mechanical injury. Uncontrolled hemorrhage is a leading and preventable cause of death in patients with traumatic injury, accounting for 30-40% of all trauma fatalities .It is primarily caused by direct injury to the vasculature and secondary coagulopathy. The cause of trauma-associated coagulopathy is multifactorial, including the consumption and/or dilution of coagulation factors and platelets, dysfunctions of platelet and coagulation system, and an increase in fibrinolysis (A deteriorating physiology in severely injured patients, represented by a vicious cycle of coagulopathy, hypothermia, and acidosis, is often referred to as a lethal triad. The transfusion of blood products, such as platelets, and fresh frozen plasma, has been a standard treatment. Transfusion may also cause fluid volume overload to the patients with isolated TBI and transfusion-related complications. The present review focuses on incidence of post-trauma VTE, the efficacy of nonpharmacological approaches to limit VTE, the pharmacological options for VTE prophylaxis, and finally current data on the impact of pre hospital use of anticoagulants in traumatized patients with elevated risk of VTE due to comorbidities such as atrial fibrillationpharmacological thromboprophylaxisis known to be effective, but handled with extreme caution and therefore frequently delayed for some days after insult. The primary objective is the risk of cerebral bleeding or intracranial hematoma. VTE patients can be presented in unstable conditions like circulatory collapse (cardiac arrest, shock) and it is most probably due to massive embolism, so need aggressive management throughout the evaluation period, patients with suspected MPE often require aggressive resuscitation and ongoing stabilization.