Several recent national guidelines and reviews conclude that pharmacologic, in addition to mechanical thromboprophylaxis, appears to be safe among TBI patients with stabilized hemorrhagic patterns. Despite this, there are many issues concerning efficiency and safety in severe TBI, especially in patients with coagulopathies.
|Titel på värdpublikation||Management of Severe Traumatic Brain Injury|
|Redaktörer||T Sundstrøm, P-O Grände, T Luoto, C Rosenlund, J Undén, KG Wester|
|Status||Published - 2020 juli 6|
Bibliografisk informationTips, Tricks, and Pitfalls
• Today we have no optimal laboratory
technique to monitor various anticoagulants
or thromboprophylactic drugs.
• There is a thin balance between aggravating
TBI haemorrage with too early
pharmacologic thromboprophylaxis and
increasing risk for thromboembolism by
• Clinical judgement and evaluation from
repetitive CT scans during the first 2–5
(or longer) days is the mainstay.
• Calf compression and then starting with
low dose LMWH thromboprophylaxis
after 2–4 days if the TBI induced haemorrhage
seems to be stabilised is recommended
by most guidelines.
• High alert to stop LMWH if haemorrhage
is expanded – protamin can revert
some of its effect depending on the anti-
Xa/anti-Iia ratio of the specific LMWH.
• LMWH should be stopped 12 h before
manipulation or withdrawal of intracerebral
• Simultaneous DIC, thrombocytopenia
should be resolved/treated before considering