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Tytuł pozycji:

Management of blunt cerebrovascular injury (BCVI) in the multisystem injury patient with contraindications to immediate anti-thrombotic therapy.

Tytuł:
Management of blunt cerebrovascular injury (BCVI) in the multisystem injury patient with contraindications to immediate anti-thrombotic therapy.
Autorzy:
McNutt MK; Department of Surgery, University of Texas Health Science Center at Houston, Memorial Hermann Hospital Red Duke Trauma Institute,United States. Electronic address: .
Kale AC; McGovern Medical School at the University of Texas Medical School at Houston, United States. Electronic address: .
Kitagawa RS; Department of Neurosurgery, University of Texas Health Science Center at Houston, Mischer Neuroscience Institute, Texas Medical Center, United States. Electronic address: .
Turkmani AH; Department of Neurosurgery, University of Texas Health Science Center at Houston, United States. Electronic address: .
Fields DW; McGovern Medical School at the University of Texas Medical School at Houston, United States. Electronic address: .
Baraniuk S; The Center for Translational Injury Research (CeTIR), Houston, United States. Electronic address: .
Gill BS; Department of Surgery, University of Texas Health Science Center at Houston, United States. Electronic address: .
Cotton BA; Department of Surgery, University of Texas Health Science Center at Houston, Memorial Hermann Hospital Red Duke Trauma Institute,United States. Electronic address: .
Moore LJ; Department of Surgery, University of Texas Health Science Center at Houston, Memorial Hermann Hospital Red Duke Trauma Institute,United States. Electronic address: .
Wade CE; Department of Surgery, University of Texas Health Science Center at Houston, The Center for Translational Injury Research (CeTIR), Houston, United States. Electronic address: .
Day A; Department of Neurosurgery, University of Texas Health Science Center at Houston, Mischer Neuroscience Institute, Texas Medical Center, United States. Electronic address: .
Holcomb JB; Department of Surgery, University of Texas Health Science Center at Houston, Memorial Hermann Hospital Red Duke Trauma Institute,United States. Electronic address: .
Źródło:
Injury [Injury] 2018 Jan; Vol. 49 (1), pp. 67-74. Date of Electronic Publication: 2017 Jul 31.
Typ publikacji:
Journal Article
Język:
English
Imprint Name(s):
Publication: <2002->: Amsterdam : Elsevier
Original Publication: Bristol, Wright.
MeSH Terms:
Cerebrovascular Trauma/*drug therapy
Fibrinolytic Agents/*adverse effects
Multiple Trauma/*therapy
Stroke/*prevention & control
Wounds, Nonpenetrating/*drug therapy
Adult ; Cerebrovascular Trauma/physiopathology ; Contraindications ; Drug Administration Schedule ; Female ; Fibrinolytic Agents/therapeutic use ; Guidelines as Topic ; Humans ; Male ; Middle Aged ; Multiple Trauma/physiopathology ; Retrospective Studies ; Secondary Prevention ; Stroke/chemically induced ; Time Factors ; Tomography, X-Ray Computed ; Trauma Centers ; Treatment Outcome ; Wounds, Nonpenetrating/physiopathology
Contributed Indexing:
Keywords: Antithrombotic therapy; BCVI; Solid organ injury; Stroke; Traumatic brain injury (TBI)
Substance Nomenclature:
0 (Fibrinolytic Agents)
Entry Date(s):
Date Created: 20170810 Date Completed: 20180919 Latest Revision: 20220330
Update Code:
20240105
DOI:
10.1016/j.injury.2017.07.036
PMID:
28789779
Czasopismo naukowe
Introduction: Practice management guidelines for screening and treatment of patients with blunt cerebrovascular injury (BCVI) have been associated with a decreased risk of ischemic stroke.
Treatment: of patients with BCVI and multisystem injuries that delays immediate antithrombotic therapy remains controversial. The purpose of this study was to determine the timing of BCVI treatment initiation, the incidence of stroke, and bleeding complications as a result of antithrombotic therapy in patients with isolated BCVI in comparison to those with BCVI complicated by multisystem injuries.
Materials and Methods: This study was a retrospective review of all adult blunt trauma patients admitted to a level 1 trauma center from 2009 to 2014 with a diagnosis of BCVI.
Results: A total of 28,305 blunt trauma patients were admitted during the study period. Of these, 323 (1.1%) had 481 BCEVIs and were separated into two groups. Isolated BCVI was reported in 111 (34.4%) patients and 212 (65.6%) patients had accompanying multisystem injuries (traumatic brain injury (TBI), solid organ injury, or spinal cord injury) that contraindicated immediate antithrombotic therapy.
Treatment: started in patients with isolated BCVI at a median time of 30.3 (15, 52) hours after injury in contrast to 62.4 (38, 97) hours for those with multisystem injuries (p<0.001). The incidence of stroke was identical (9.9%) between groups and no bleeding complications related to antithrombotic therapy were identified.
Conclusion: The lack of bleeding complications and equivalent stroke rates between groups suggests that the presence of TBI, solid organ injury, and spinal cord injury are not contraindications to anti-thrombotic therapy for stroke prevention in patients with BCVI.
(Copyright © 2017 Elsevier Ltd. All rights reserved.)
Comment in: Injury. 2018 Mar;49(3):735-736. (PMID: 29402423)

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