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Management of Prehospital Antiplatelet and Anticoagulant Therapy in Traumatic Head Injury: A Review

McMillian, Wesley D. PharmD*†; Rogers, Frederick B. MD, FACS

The Journal of Trauma: Injury, Infection, and Critical Care: March 2009 - Volume 66 - Issue 3 - p 942-950
doi: 10.1097/TA.0b013e3181978e7b
Review Article
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Trauma and emergency department clinicians encounter a growing number of patients admitted with traumatic head injury on prehospital antithrombotic therapies. These patients appear to be at increased risk of developing life-threatening intracranial hemorrhage. It is imperative that trauma clinicians understand the mechanism and duration of commonly prescribed outpatient antithrombotics in order to appropriately assess and treat patients who develop intracranial hemorrhage. This review summarizes current literature on the morbidity and mortality associated with premorbid non-steroidal anti-inflammatory drugs, aspirin, clopidogrel, warfarin, and heparinoids in the setting of traumatic head injury, and also examines the current strategies for reversal of these therapies.

From the *Department of Pharmacotherapy, Fletcher Allen Health Care; and †Department of Surgery, Division of Trauma/Critical Care, University of Vermont College of Medicine, Burlington, VT.

Submitted for publication June 30, 2008.

Accepted for publication November 26, 2008.

Address for reprints: Wesley D. McMillian, PharmD, Clinical Pharmacy Specialist, Critical Care, Fletcher Allen Health Care, Department of Pharmacotherapy, 111 Colchester Avenue, Burlington, VT 05401; email: wes.mcmillian@vtmednet.org.

© 2009 by Lippincott Williams & Wilkins