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Basic concepts and common misconceptions about coagulation and the management of anticoagulation in the trauma patient

GarcĂ­a Erce JA, Quintana DĂ­az M, Enrique Rodiles R

Servicio de Hematología y Hemoterapia, Hospital San Jorge, Huesca, Spain. AWGE (Anemia Working Group), España. Servicio de Medicina Intensiva, Servicio de Urgencias, Hospital Universitario La Paz, Madrid, Spain.

Trauma is a common reason for seeking emergency care, and when a patient is on oral
anticoagulants the management of trauma becomes more complex. Advances have
been made steadily in relation to vitamin K agonists, but even though these drugs have
been available for over 50 years there is great variability in the handling of reversion and
complications. The introduction of new oral anticoagulants with significant advantages
and more convenient dosing further complicates management; craniocerebral trauma is
an area that poses special problems. Control of hemostasis and the safe reversion of
anticoagulation are reviewed in this article. We believe that multidisciplinary
management governed by protocol is necessary. Protocols should be based on the best
available evidence and be certified by relevant scientific associations as we wait for
guidelines supported by adequate evidence to become available.

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