Coagulopathy and Bleeding · Neurotrauma · Traumatic Brain Injury

Crash-3 has enrolled 9653 patients!

Crash-2 showed that TXA reduced mortality due to bleeding and all-cause mortality in trauma patients with extra cranial bleeding. The Crash-3 trial will provide reliable evidence about the effect of TXA on mortality and disability in patients with TBI. the effect of TXA on the risk of vascular occlusive vents and seizures will also be… Continue reading Crash-3 has enrolled 9653 patients!

Acute Cerebrovascular Conditions · Coagulopathy and Bleeding · TBI General

To CT or not CT? Intracranial Haemorrhage in Patients on Warfarin

There´s a paucity of guidelines and recommendations on diagnostic pathways in patients on warfarin who sustain head injuries. This article by Alrajhi et al from 2015 (J Emerg Med) looked at an historical cohort of patients on warfarin admitted for either minor (Glasgow Coma Score 13-15, with loss of consciousness, amnesia, or confusion) or minimal (Glasgow Coma Score… Continue reading To CT or not CT? Intracranial Haemorrhage in Patients on Warfarin

Acute Cerebrovascular Conditions · Coagulopathy and Bleeding · Haemodynamics

ATACH II Trial – No Benefit From Aggressive BP-lowering in ICH

Published in NEJM 2016, the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-II) trial compared two BP-management regimes in intracerebral haemorrhage patients with hypertension (SBP>180 mmHg): Intensive lowering to SBP 110-139 mm Hg. vs. standard treatment to within the 140-179 mm Hg range. The trial was discontinued early after an interim analysis showed no difference between the groups in… Continue reading ATACH II Trial – No Benefit From Aggressive BP-lowering in ICH

Acute Cerebrovascular Conditions · Coagulopathy and Bleeding

PATCH – Trial: Platelets in ICH Harmful

Transfusing thrombocytes to patients taking anti-platelet therapy who develop an intracerebral hemorrhage seems to confer harm, according to the authors of the PATCH trial (abstract). Published recently in the Lancet by Baharoglu et al, this multicentre RCT included 190 patients in order to determine whether platelet transfusion reduces extent of haemorrhage, thereby improving outcome, in ICH associated with… Continue reading PATCH – Trial: Platelets in ICH Harmful

Coagulopathy and Bleeding · discussions · Intracranial Surgery General

Anticoagulants and Neurosurgery – What´s Your Policy?

On behalf of our colleague Dr. Ann-Christine Lindroos of Töölö Hospital in Helsinki, Finland we´d like to solicit your opinion on the discontinuation of anticoagulant medication in neurosurgical practice. We´d love to hear from as many of our colleagues as possible. Feel free to comment below and share your institution´s policy with NeuroScand users. In Dr. Lindroos´own… Continue reading Anticoagulants and Neurosurgery – What´s Your Policy?

Acute Cerebrovascular Conditions · Coagulopathy and Bleeding · European Guidelines · US Guidelines

Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage

This guideline, issued jointly by the Neurocritical Care Society and Society of Critical Care Medicine and published in Neurocrit Care December 2015, provides timely and evidence-based reversal strategies to assist practitioners in the care of patients with antithrombotic-associated intracranial hemorrhage. Read the statement here. Best regards, Riikka Takala.