vitamin-k-1 and Hematoma--Subdural

Trauma and emergency department clinicians encounter a growing number of patients admitted with traumatic head injury on prehospital antithrombotic therapies. These patients appear to be at increased risk of developing life-threatening intracranial hemorrhage. It is imperative that trauma clinicians understand the mechanism and duration of commonly prescribed outpatient antithrombotics in order to appropriately assess and treat patients who develop intracranial hemorrhage. This review summarizes current literature on the morbidity and mortality associated with premorbid non-steroidal anti-inflammatory drugs, aspirin, clopidogrel, warfarin, and heparinoids in the setting of traumatic head injury, and also examines the current strategies for reversal of these therapies.

Topics: Aged; Anticoagulants; Brain Injuries; Cerebral Hemorrhage, Traumatic; Combined Modality Therapy; Critical Care; Deamino Arginine Vasopressin; Emergency Medical Services; Factor VIIa; Hematoma, Epidural, Cranial; Hematoma, Subdural; Hemostatics; Hospital Mortality; Humans; Middle Aged; Plasma; Platelet Aggregation Inhibitors; Platelet Transfusion; Protamines; Recombinant Proteins; Risk Factors; Vitamin K 1

We report on 2 cases associating retinal (RH) and cerebral hemorrhages (CH), which first suggested the diagnosis of shaken baby syndrome (SBS). After an etiologic search, the diagnosis was corrected: the first case was a late hemorrhagic disease of the newborn and the second case hemophilia A. RH is a major feature of SBS, although not pathognomonic. There is no specific RH of SBS but they usually affect the posterior retinal pole. Typically, RHs of SBS are present in both eyes, although unilateral RHs do not exclude the diagnosis of SBS. The relationship between RH and CH has been reported in SBS but also in other diseases. Thus, one must search for hemostasis abnormalities, even though the clinical presentation suggests SBS. Ignoring SBS as well as coming to the conclusion of SBS too quickly should be avoided. Diagnostic difficulties may be related to the number of physicians involved and their interpretation of the facts. These 2 cases underline the need for working as a team that includes hematologists able to interpret coagulation parameters.

Topics: Antifibrinolytic Agents; Cerebral Hemorrhage; Coagulants; Consanguinity; Diagnosis, Differential; Factor VIII; Fatal Outcome; Hematoma, Subdural; Hemophilia A; Humans; Infant; Infant, Newborn; Male; Retinal Hemorrhage; Risk Factors; Shaken Baby Syndrome; Vitamin K 1; Vitamin K Deficiency Bleeding

Topics: Antifibrinolytic Agents; Blood Coagulation Tests; Diagnosis, Differential; Diagnostic Imaging; Echoencephalography; Epistaxis; Hematoma, Subdural; Humans; Infant, Newborn; Magnetic Resonance Imaging; Male; Melena; Subarachnoid Hemorrhage; Vitamin K 1; Vitamin K Deficiency