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Menditto VG, Rossetti G, Sampaolesi M, Buzzo M, Pomponio G. Traumatic Brain Injury in Patients under Anticoagulant Therapy: Review of Management in Emergency Department. J Clin Med 2024; 13:3669. [PMID: 38999235 PMCID: PMC11242576 DOI: 10.3390/jcm13133669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/15/2024] [Accepted: 06/17/2024] [Indexed: 07/14/2024] Open
Abstract
The best management of patients who suffer from traumatic brain injury (TBI) while on oral anticoagulants is one of the most disputed problems of emergency services. Indeed, guidelines, clinical decision rules, and observational studies addressing this topic are scarce and conflicting. Moreover, relevant issues such as the specific treatment (and even definition) of mild TBI, rate of delayed intracranial injury, indications for neurosurgery, and anticoagulant modulation are largely empiric. We reviewed the most recent evidence on these topics and explored other clinically relevant aspects, such as the promising role of dosing brain biomarkers, the strategies to assess the extent of anticoagulation, and the indications of reversals and tranexamic acid administration, in cases of mild TBI or as a bridge to neurosurgery. The appropriate timing of anticoagulant resumption was also discussed. Finally, we obtained an insight into the economic burden of TBI in patients on oral anticoagulants, and future directions on the management of this subpopulation of TBI patients were proposed. In this article, at the end of each section, a "take home message" is stated.
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Affiliation(s)
- Vincenzo G Menditto
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
| | - Giulia Rossetti
- Internal Medicine, Santa Croce Hospital AST1 Pesaro Urbino, 61032 Fano, Italy
| | - Mattia Sampaolesi
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
| | - Marta Buzzo
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
| | - Giovanni Pomponio
- Clinica Medica, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
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Kim BJ, Lee C. Optimizing inferior vena cava filter design: A computational fluid dynamics study on strut configuration for enhanced hemodynamic performance and thrombosis reduction. Heliyon 2024; 10:e32667. [PMID: 38912484 PMCID: PMC11193039 DOI: 10.1016/j.heliyon.2024.e32667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/27/2024] [Accepted: 06/06/2024] [Indexed: 06/25/2024] Open
Abstract
Background and objective Inferior vena cava filters have been shown to be effective in preventing deep vein thrombosis and its secondary complication, pulmonary embolism, thereby reducing the high mortality rate. Although inferior vena cava filters have evolved, specific complications like inferior vena cava thrombosis-induced deep vein thrombosis worsening and recurrent pulmonary embolism continue to pose challenges. This study analyzes the effects of geometric parameter variations of inferior vena cava filters, which have a significant impact on the thrombus formation inside the filter, the capture, dissolution, and hemodynamic flow of thrombus, as well as the shear stress on the filter and vascular wall. Methods This study used computational fluid dynamic simulations with the carreau model to investigate the impact of varying inferior vena cava filter design parameters (number of struts, strut arm length, and tilt angle) on hemodynamics. Results Recirculation and stagnation areas due to flow velocity and pressure, along with wall shear stress values, were identified as key factors. It is important to find a balance between wall shear stress high enough to aid thrombolysis and low enough to prevent platelet activation. The results of this paper show that the risk of platelet activation and thrombus filtration may be lowest when the wall shear stress of the filter ranges from 0 to 4 [Pa], minimizing stress concentration within the filter. Conclusion 16 arm struts with a length of 20 mm and a tilt angle of 0° provide the best balance between thrombus capture and minimization of hemodynamic disturbance. This configuration minimizes the size of the stagnation and recirculation zones while maintaining sufficient wall shear stress for thrombus dissolution.
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Affiliation(s)
- Byeong-Jun Kim
- Department of Biomedical Engineering, Graduate School, Pusan National University, Busan 49241, Republic of Korea
| | - Chiseung Lee
- Department of Biomedical Engineering, School of Medicine, Pusan National University, Busan 49241, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
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Efidi R, Rimande J, Agunloye A, Ogunseyinde A, Akinola R, Ogbole G. Sonographic Evaluation of Deep Vein Thrombosis in Hospitalized Neurosurgical Trauma Patients in Ibadan, Nigeria. Niger J Clin Pract 2023; 26:1833-1838. [PMID: 38158349 DOI: 10.4103/njcp.njcp_337_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Deep vein thrombosis (DVT) is a major cause of morbidity and mortality in hospitalized trauma patients. Ultrasonography (US) has replaced venography as the initial diagnostic tool for DVT. AIMS The study aimed to determine the incidence of lower limb DVT in hospitalized neurosurgical trauma patients in hospitalized neurosurgical patients. It also aimed to determine the effect of combined thrombo-prophylaxis on the incidence of lower limb deep DVT relative to a single regimen. PATIENTS AND METHODS This was a prospective study of 154 adult neurotrauma patients who consecutively had lower limb Doppler ultrasound, initially within 72 hours of admissions and subsequently weekly or when DVT was suspected for the first 3 weeks of admission. The study spanned a 12-month period. The data generated were analyzed using the statistical package for social sciences software version 20, Chicago IL. Inc. Chi-square test was used to compare the outcome (DVT incidence) between single and combined prophylaxis groups. RESULTS The study participants consisted of 116 (75.3%) and 38 (24.7%) cases of head and spine injuries, respectively, with a mean age of 38.8 ± 6.3 years and 85.1% being males. A total of four cases of DVT were detected during the study period, with the majority of the cases (3) detected within the first week of admission, giving an incidence of 2.6%. All four cases of DVT were detected in patients on single thrombo-prophylaxis (4/55 = 7.3%), while none was found in those on a combined regimen (0/34, P = 0.046). CONCLUSION Most cases of DVT developed in the first week of hospitalization. Combined thrombo-prophylaxis was more effective than single regimen at reducing rate of DVT in neurosurgical trauma patients. Routine Doppler ultrasound DVT surveillance should be part of the management protocol for neurosurgical trauma patients on admission to increase DVT detection and prevent possible fatal pulmonary embolism.
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Affiliation(s)
- R Efidi
- Department of Radiology, University College Hospital, Ibadan, Nigeria
| | - J Rimande
- Department of Radiology, Faculty of Health Sciences, Taraba State University, Jalingo, Nigeria
| | - A Agunloye
- Department of Radiology, University of Ibadan, Ibadan, Nigeria
| | - A Ogunseyinde
- Department of Radiology, University of Ibadan, Ibadan, Nigeria
| | - R Akinola
- Department of Radiology, Lagos State University College of Medicine, Ikeja, Nigeria
| | - G Ogbole
- Department of Radiology, University of Ibadan, Ibadan, Nigeria
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Amer M, Alshahrani MS, Arabi YM, Al-Jedai A, Alshaqaq HM, Al-Sharydah A, Al-Suwaidan FA, Aljehani H, Nouh T, Mashbari H, Tarazan N, Alqahtani S, Tashkandi W, Maghrabi K, Albugami M, Hashim S, Alsubaie NM, Alsenani M, Algethamy H, Alshammari TM, Alaklabi A, Ismail N, Altawil ES, Elhazmi A, Nahhas A, Aljuaid M, Alsadoon N, Binbraik Y, Yuan Y, Alhazzani W. Saudi Critical Care Society clinical practice guidelines on the prevention of venous thromboembolism in adults with trauma: reviewed for evidence-based integrity and endorsed by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine. Ann Intensive Care 2023; 13:41. [PMID: 37165105 PMCID: PMC10172441 DOI: 10.1186/s13613-023-01135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/23/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND To develop evidence-based clinical practice guidelines on venous thromboembolism (VTE) prevention in adults with trauma in inpatient settings. METHODS The Saudi Critical Care Society (SCCS) sponsored guidelines development and included 22 multidisciplinary panel members who completed conflict-of-interest forms. The panel developed and answered structured guidelines questions. For each question, the literature was searched for relevant studies. To summarize treatment effects, meta-analyses were conducted or updated. Quality of evidence was assessed using the Grading Recommendations, Assessment, Development, and Evaluation (GRADE) approach, then the evidence-to-decision (EtD) framework was used to generate recommendations. Recommendations covered the following prioritized domains: timing of pharmacologic VTE prophylaxis initiation in non-operative blunt solid organ injuries; isolated blunt traumatic brain injury (TBI); isolated blunt spine trauma or fracture and/or spinal cord injury (SCI); type and dose of pharmacologic VTE prophylaxis; mechanical VTE prophylaxis; routine duplex ultrasonography (US) surveillance; and inferior vena cava filters (IVCFs). RESULTS The panel issued 12 clinical practice recommendations-one, a strong recommendation, 10 weak, and one with no recommendation due to insufficient evidence. The panel suggests starting early pharmacologic VTE prophylaxis for non-operative blunt solid organ injuries, isolated blunt TBIs, and SCIs. The panel suggests using low molecular weight heparin (LMWH) over unfractionated heparin (UFH) and suggests either intermediate-high dose LMWH or conventional dosing LMWH. For adults with trauma who are not pharmacologic candidates, the panel strongly recommends using mechanical VTE prophylaxis with intermittent pneumatic compression (IPC). The panel suggests using either combined VTE prophylaxis with mechanical and pharmacologic methods or pharmacologic VTE prophylaxis alone. Additionally, the panel suggests routine bilateral lower extremity US in adults with trauma with elevated risk of VTE who are ineligible for pharmacologic VTE prophylaxis and suggests against the routine placement of prophylactic IVCFs. Because of insufficient evidence, the panel did not issue any recommendation on the use of early pharmacologic VTE prophylaxis in adults with isolated blunt TBI requiring neurosurgical intervention. CONCLUSION The SCCS guidelines for VTE prevention in adults with trauma were based on the best available evidence and identified areas for further research. The framework may facilitate adaptation of recommendations by national/international guideline policymakers.
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Affiliation(s)
- Marwa Amer
- Medical/Critical Pharmacy Division, King Faisal Specialist Hospital and Research Center, Al Mathar Ash Shamali, Riyadh, 11564, Saudi Arabia.
- College of Medicine and Pharmacy, Alfaisal University, Riyadh, Saudi Arabia.
| | - Mohammed S Alshahrani
- Department of Emergency and Critical Care, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Yaseen M Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed Al-Jedai
- College of Medicine and Pharmacy, Alfaisal University, Riyadh, Saudi Arabia
- Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - Hassan M Alshaqaq
- Emergency Medicine Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz Al-Sharydah
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal A Al-Suwaidan
- Clinical Excellence Administration and King Fahad Medical City, Second Health Cluster in Riyadh, Ministry of Health, Riyadh, Saudi Arabia
| | - Hosam Aljehani
- Department of Interventional Neuroradiology, Neurosurgery, Neurocritical Care, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Thamer Nouh
- Trauma and Acute Care Surgery Unit, King Saud University, Riyadh, Saudi Arabia
| | - Hassan Mashbari
- Department of Surgery, Jazan University, Jazan, Saudi Arabia
| | - Nehal Tarazan
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Saad Alqahtani
- Department of Orthopedic Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Wail Tashkandi
- Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Critical Care, Fakeeh Care Group, Jeddah, Saudi Arabia
| | - Khalid Maghrabi
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Muneerah Albugami
- Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Samaher Hashim
- Pulmonary and Critical Care Department, International Medical Center/First Clinic, Jeddah, Saudi Arabia
| | - Norah M Alsubaie
- Department of Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | | | - Haifa Algethamy
- Department of Anesthesia and Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Thamir M Alshammari
- College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ali Alaklabi
- Department of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nadia Ismail
- Department of Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Esraa S Altawil
- Pharmacy Department, Clinical Pharmacy Services, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Alyaa Elhazmi
- Dr Sulaiman Al-Habib Medical Group, Critical Care Department, Riyadh, Saudi Arabia
| | - Ahmed Nahhas
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Maha Aljuaid
- Clinical Nursing Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Naif Alsadoon
- Alshaya International Trading Company, Riyadh, Saudi Arabia
| | - Yasser Binbraik
- Department of Medicine, McMaster University, Hamilton, Canada
- Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia
| | - Yuhong Yuan
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Scientific Research Center, Directorate General of Armed Forces Medical Services, Riyadh, Saudi Arabia
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