Management of dabigatran-induced anticoagulation in trauma and acute care surgery patients

摘要

Acute care surgeons regularly encounter patients antico-agulated by medication or an acute physiologic derangement. Traditional drugs such as heparin, vitamin K antagonists (warfarin), and antiplatelet agents (aspirin and clopidogrel) are common in inpatient and outpatient settings. The use of anticoagulants increases the morbidity and mortality of injury.1 In the case of warfarin, this increased risk is directly related to the level of anticoagulation.Guidelines for dealing with trauma, life-threatening bleeding, or emergency surgery in these anticoagulated patients are well described and used with success almost daily in acute care surgery (ACS) practice. Traditional protocols and products-fresh frozen plasma (FTP), vitamin K, protamine sulfate, or simply discontinuing the drag-are very well understood,, and their efficacy in correcting coagulopathy is extensively documented. The use of newer agents such as recombinant factor VILA. (rVIIA) and prothrombin complex concentrate (PCC) continues to be investigated.