• 作者：B. Tissot ; Ch. Tavergnier ; C. Samier ; J. Lagarrigue ; ^{lagarrigue.j@chu-toulouse.fr}
• 关键词：Anticoagulants ; Anti-agré ; gants ; Traumatismes cr&acirc ; niens ; Traumatismes rachidien
• 刊名：Neurochirurgie
• 出版年：2009
• 期刊代码：pca376_00283770
• 类别：neu
• 出版时间：December, 2009
• 卷：55
• 期：6_supp_S1
• 页码：H44-H52
• 文件大小：431 K

Justification and goals

Anticoagulant and antiaggregant drugs are often a matter of debate in head and spinal cord injuries. Is their use warranted to prevent thrombosis with regard to the risk of hemorrhagic complications? How should patients on such treatment be managed when a cerebral or spinal trauma occurs? How should thromboembolic complications in neurotraumatology be treated?

Method and results

The authors screened medical publications covering these questions. Fifty-one references were analyzed according to their level of evidence and their conclusions were compared to updated clinical guidelines.

Conclusion

The high incidence and risk of thromboembolic events warrant immediate prevention using compression stockings. Low-molecular-weight heparin can be introduced after 24 h or, in case of a subdural or intracranial hematoma, after the 72 h. A temporary inferior vena cava filter is indicated for symptomatic deep venous thrombosis. When pulmonary embolism is diagnosed, an anticoagulant treatment must be immediately started and the patient kept on close clinical, biological, and CT scan observation.

Finally, in patients treated with anticoagulation suffering from a head or spinal cord injury, it is necessary to immediately reverse the effect of their treatment and one must not wait for the biological test results.