vitamin-k-semiquinone-radical and Wounds-and-Injuries

Trauma-induced coagulopathy (TIC) occurs early after severe injury. TIC is associated with a substantial increase in bleeding rate, transfusion requirements, and a 4-fold higher mortality. Rapid surgical control of blood loss and early aggressive hemostatic therapy are essential steps in improving survival. Since the publication of the CRASH-2 study, early administration of tranexamic acid is considered as an integral step in trauma resuscitation protocols of severely injured patients in many trauma centers. However, the advantage of en route administration of tranexamic acid is not proven in prospective studies. Fibrinogen depletes early after severe trauma; therefore, it seems to be reasonable to maintain plasma fibrinogen as early as possible. The effect of prehospital fibrinogen concentrate administration on outcome in major trauma patients is the subject of an ongoing prospective investigation. The use of prothrombin complex concentrate is potentially helpful in patients anticoagulated with vitamin K antagonists who experience substantial trauma or traumatic brain injury. Beyond emergency reversal of vitamin K antagonists, safety data on prothrombin complex concentrate use in trauma are lacking.

Topics: Antifibrinolytic Agents; Blood Coagulation; Blood Coagulation Factors; Blood Transfusion; Brain Injuries; Emergency Medical Services; Emergency Medicine; Fibrinogen; Hemorrhage; Hemostasis; Humans; Platelet Count; Randomized Controlled Trials as Topic; Tranexamic Acid; Treatment Outcome; Vitamin K; Wounds and Injuries

Topics: Amino Acids; Animals; Ascorbic Acid; Chick Embryo; Copper; Dogs; Fatty Acids, Unsaturated; Humans; Iron; Proteins; Trace Elements; Vitamin A; Vitamin B Complex; Vitamin E; Vitamin K; Wound Healing; Wound Infection; Wounds and Injuries; Zinc

Topics: Age Factors; Anemia; Anticoagulants; Antifibrinolytic Agents; Bacterial Infections; Child; Child, Preschool; Disseminated Intravascular Coagulation; Fibrinolysis; Fibrinolytic Agents; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Kidney Diseases; Leukemia; Purpura; Shock; Virus Diseases; Vitamin K; Wounds and Injuries

We determine the efficacy of active reversal of warfarin anticoagulation with intravenous vitamin K compared to withholding warfarin in patients requiring urgent orthopedic trauma surgery.. This was a prospective cohort with immediate prehypothesis consecutive retrospective comparative case series conducted at a level 1 university hospital trauma unit.. Forty-eight consecutive patients between 1998 and 2004 in a study composed of a prospective cohort were compared with a retrospective consecutive case series of warfarinized orthopedic trauma patients requiring urgent surgery. The prospective arm directly followed the historic case series from which the hypothesis was generated.. Vitamin K administration.. Primary outcome was time to surgery. Secondary outcomes were problems with active reversal, length of time for warfarin stabilization after surgery, and complications.. The mean time to surgery in warfarinized patients not given vitamin K was 111.9 hours; in the intervention group, it was 67.4 hours, giving a mean difference of 44.5 hours (P = 0.01). Vitamin K reduced the international normalized ratio (INR) to less than 2.0 in 74% of patients within 24 hours. There were no complications of vitamin K administration. A dose of vitamin K costs approximately 1/1000 of a hospital bed day cost. A loading dose of warfarin on the second postoperative day took approximately 1 day longer to reach an INR of greater than 2.0 in the intervention patients than in those who had not been given vitamin K.. Warfarin reversal with vitamin K was successful and facilitated earlier surgery in all patients; the first dose was effective in approximately three quarters of patients. It is cost-effective, with no side effects caused in this study.

Topics: Administration, Oral; Anticoagulants; Blood Coagulation; Blood Coagulation Disorders; Cohort Studies; Drug Administration Schedule; Female; Humans; Injections, Intravenous; Male; Orthopedic Procedures; Preoperative Care; Thrombosis; Treatment Outcome; Vitamin K; Warfarin; Wounds and Injuries

Preinjury anticoagulation therapy (AT) is associated with a higher risk for major bleeding. We aimed to evaluated the influence of preinjury anticoagulant medication on the clinical course after moderate and severe trauma. Patients in the TraumaRegister DGU ≥ 55 years who received AT were matched with patients not receiving AT. Pairs were grouped according to the drug used: Antiplatelet drugs (APD), vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC). The primary end points were early (< 24 h) and total in-hospital mortality. Secondary endpoints included emergency surgical procedure rates and surgery rates. The APD group matched 1759 pairs, the VKA group 677 pairs, and the DOAC group 437 pairs. Surgery rates were statistically significant higher in the AT groups compared to controls (APD group: 51.8% vs. 47.8%, p = 0.015; VKA group: 52.4% vs. 44.8%, p = 0.005; DOAC group: 52.6% vs. 41.0%, p = 0.001). Patients on VKA had higher total in-hospital mortality (23.9% vs. 19.5%, p = 0.026), whereas APD patients showed a significantly higher early mortality compared to controls (5.3% vs. 3.5%, p = 0.011). Standard operating procedures should be developed to avoid lethal under-triage. Further studies should focus on detailed information about complications, secondary surgical procedures and preventable risk factors in relation to mortality.

Topics: Aged; Aged, 80 and over; Anticoagulants; Case-Control Studies; Databases, Factual; Emergency Treatment; Factor Xa Inhibitors; Female; Germany; Hemorrhage; Hospital Mortality; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors; Prospective Studies; Registries; Risk Factors; Thromboembolism; Vitamin K; Wounds and Injuries

Direct oral anticoagulants (DOACs) are widely used among patients requiring anticoagulant therapy. These drugs are associated with a lower risk of bleeding than vitamin K antagonists (VKAs). However, the outcomes of elderly trauma patients receiving DOACs are not well known.. We reviewed data from trauma patients at our level I trauma center (University of Pittsburgh Medical Center, Presbyterian Hospital) seen from January 2011 to July 2018. We identified trauma patients taking DOACs or VKAs and compared these cohorts using 1:1 propensity score-matching based on patient characteristics, antiplatelet use, comorbidities, and laboratory values. The primary outcome was in-hospital mortality. Secondary outcomes included the proportion of patients discharged to skilled nursing facility/rehabilitation facility discharge or to home, and transfusion volume.. Of 32,272 trauma patients screened, 530 were taking DOACs and 1,702 were taking VKAs. We matched 668 patients in a 1:1 ratio (DOACs group, 334 vs. VKAs group, 334). The DOACs group had similar mortality (4.8% vs. 1.6%; odds ratio (OR), 3.0; 95% confidence interval (CI), 0.31-28.8; p = 0.31) among patients younger than 65 years, but mortality differed (3.0% vs. 6.6%; OR, 0.41; 95% CI, 0.17-0.99; p = 0.048) among patients older than 65 years. The proportion of patients discharged to skilled nursing facility/rehabilitation facility (50.0% vs. 50.6%; OR, 0.98; 95% CI, 0.72-1.32; p = 0.88) and to home (40.4% vs. 38.6%; OR, 1.08; 95% CI, 0.79-1.47; p = 0.64) were similar. Patients in the DOACs group received fewer fresh frozen plasma (p = 0.032), but packed red blood cells (p = 0.86) and prothrombin complex concentrate (p = 0.48) were similar.. In this matched cohort of anticoagulated trauma patients, DOACs were associated with the decreased in-hospital mortality and decreased administration of fresh frozen plasma compared with VKAs among trauma patients 65 years or older taking anticoagulant therapy.. Prognostic/Epidemiological, level III.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Female; Hospital Mortality; Humans; Male; Pennsylvania; Platelet Aggregation Inhibitors; Retrospective Studies; Survival Analysis; Trauma Centers; Trauma Severity Indices; Vitamin K; Wounds and Injuries

The population of patients on anticoagulant or antiplatelet therapy for medical conditions is increasing. The objective of this study was to investigate the effects of preinjury anticoagulation or antiplatelet therapy on outcomes after trauma.. This cohort study analyzed data from the Michigan Trauma Quality Improvement Program from 2012 to 2017 and included trauma patients age ≥16 years with an Injury Severity Score ≥5 treated at 29 hospitals. The primary outcome was in-hospital mortality.. Of 115,042 trauma patients, 44.2% were women and 78.2% were white with a mean age (standard deviation) of 59.1 (23.2) years. A total of 23,196 patients were on antiplatelet therapy, 3,855 on warfarin, 1,893 on warfarin + antiplatelet agent, 1,306 on a direct oral anticoagulant, and 717 patients on direct oral anticoagulant + antiplatelet therapy. We observed an increased risk of mortality in patients on preinjury antiplatelet (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.02-1.33), warfarin (OR 1.32; 95% CI 1.05-1.65), or warfarin + antiplatelet therapy (OR 1.59; 95% CI 1.18-2.14). Patients on a direct oral anticoagulant only were not at statistically increased risk for mortality.. Preinjury antiplatelet and/or warfarin use was associated with an increased risk of mortality after traumatic injury. Preinjury direct oral anticoagulant use was not associated with a statistically increased risk of adverse outcomes.

Topics: Administration, Oral; Aged; Anticoagulants; Cause of Death; Cohort Studies; Confidence Intervals; Female; Hospital Mortality; Humans; Male; Michigan; Middle Aged; Odds Ratio; Platelet Aggregation Inhibitors; Retrospective Studies; Survival Analysis; Trauma Centers; Trauma Severity Indices; Vitamin K; Wounds and Injuries

We examined the risks of all-cause mortality, stroke, major bleeding, and recurrent traumatic injury associated with resumption of vitamin K antagonists (VKAs) and non-VKAs oral anticoagulants (NOACs) following traumatic injury in atrial fibrillation (AF) patients.. This was a Danish nationwide registry-based study (2005-16), including 4541 oral anticoagulant (OAC)-treated AF patients experiencing traumatic injury (defined as traumatic brain injury, hip fracture, or traumatic torso or abdominal injury). Within 90 days following discharge from traumatic injury, 60.6% resumed VKA (median age = 80, CHA2DS2-VASc = 4, HAS-BLED = 2), 16.7% resumed NOAC (median age = 81, CHA2DS2-VASc = 4, HAS-BLED = 2), and 22.7% did not resume OAC treatment (median age = 81, CHA2DS2-VASc = 4, HAS-BLED = 3). Switch from VKA to NOAC occurred among 9.5%. Since 2009, the trend in OAC resumption increased (P-value <0.0001), in particular with NOACs (P-value <0.0001). Follow-up started 90 days after discharge, and time-varying multiple Cox regression analyses were used for comparisons. Compared with non-resumption, VKA and NOAC resumption were associated with lower hazard [95% confidence interval (CI)] of all-cause mortality [hazard ratio (HR) 0.48 (0.42-0.53) and HR 0.55 (0.47-0.66), respectively] and ischaemic stroke [HR 0.56 (0.43-0.72) and HR 0.54 (0.35-0.82), respectively], increased major bleeding hazard [HR 1.30 (1.03-1.64) and HR 1.15 (0.81-1.63), respectively], and similar hazard of recurrent traumatic injury [HR 0.93 (0.73-1.18) and HR 0.87 (0.60-1.27), respectively].. AF patients resuming VKA and NOAC treatment following traumatic injury have lower hazard of all-cause mortality and ischaemic stroke, increased hazard of major bleeding but without additional hazards of recurrent traumatic injury. Withholding OAC following a traumatic injury in AF patients may not be warranted.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Cause of Death; Female; Hemorrhage; Humans; Male; Recurrence; Registries; Retrospective Studies; Risk Factors; Stroke; Thrombosis; Vitamin K; Wounds and Injuries

Since 2013, prothrombin complex concentrate (PCCs) have been approved in the United States for the reversal of anticoagulation induced by vitamin K antagonists. However, there has been limited investigation into their use in trauma and acute-care surgery (ACS).. To investigate the role that 4-factor PCC may have in reversing anticoagulation in the setting of trauma and ACS.. All trauma and ACS patients who presented between March 14, 2014, and August 1, 2015, were included in this retrospective descriptive analysis. Patients receiving 4-factor PCC were compared with patients receiving fresh frozen plasma (FFP) alone. The following data were collected from medical records: age, sex, race, international normalized ratio (INR) at admission (baseline) and after reversal, blood products given, dosing of medication, injury severity score, length of stay, thromboembolic event, death during admission, and death within 90 days after admission.. There were 188 trauma and ACS patients who required reversal of anticoagulation. Of these, 98 patients received FFP and 90 received PCC. Patients who received PCC were at increased risk for death during admission (20% vs 9.2% for FFP group) or within 90 days (39% vs 15%, respectively). Patients in the PCC group had a higher median baseline INR (2.9 vs 2.5 in the FFP group) and a lower postintervention INR (1.4 vs 1.8); consequently, the decrease in INR was greater in the PCC group than in the FFP group (1.5 vs 0.7, respectively). The number of total units of packed red blood cells transfused was significantly higher in patients receiving PCC.. Patients receiving PCC had worse outcomes than those who received FFP. Given that these differences may have resulted from baseline differences between groups, these results mandate further prospective analysis of the use of PCC in trauma and ACS patients.

Topics: Adult; Aged; Anticoagulants; Blood Coagulation Disorders; Blood Coagulation Factors; Female; Hemorrhage; Humans; International Normalized Ratio; Male; Middle Aged; Plasma; Retrospective Studies; Treatment Outcome; Vitamin K; Wounds and Injuries

Outpatient anticoagulation in the geriatric trauma patient is a challenging clinical problem. The aim of this study is to determine clinical outcomes associated with class of preinjury anticoagulants (PA) used by this population. This is a multicenter retrospective cohort study among four Level II trauma centers. A total of 1642 patients were evaluated; 684 patients were on anticoagulation and 958 patients were not. Patients on PA were compared with those who were not. Drug classes were divided into thromboxane A2 inhibitors, vitamin K factor-dependent inhibitors, antithrombin III activation, platelet P2Y12 inhibitors, and thrombin inhibitors. Multivariate regression was used to adjust for age, gender, race, mechanism of injury, and Injury Severity Score. No single or combination of anticoagulation agents had a significant association with mortality; however, there were positive trends toward increased mortality were noted for all antiplatelet groups involving thromboxane A2 inhibitors and platelet P2Y12 inhibitors classes. The likelihood of complications was significantly higher with platelet P2Y12 inhibitors adjusted odds ratio (aOR) 2.39 [95% confidence interval (CI) 1.32, 4.3]. The likelihood of blood transfusion was increased with vitamin K inhibitors aOR 2.89 (95% CI 1.3, 6.5), P2Y12 inhibitors aOR 2.76 (95% CI 1.12, 6.76), and combined thromboxane A2 and P2Y12 inhibitors aOR 2.89 (95% CI 1.13, 7.46). P2Y12 inhibitors were also more likely associated with traumatic brain injury aOR 2.16 (95% CI 1.01, 4.6). All classes of PA were associated with solid organ injury. There were no significant differences in the use of antiplatelet agents between patients with major indications for PA and those without major indications. Geriatric trauma patients on outpatient anticoagulants have a higher likelihood of developing complications, packed red blood cell transfusions, traumatic brain injury, and solid organ injury. Attention should be paid to patients on platelet P2Y12 inhibitors, vitamin K inhibitors, and thromboxane A2 inhibitor agents combined with platelet P2Y12 inhibitors. Opportunities exist to address the use of antiplatelet agents among patients without major indications to improve patient outcomes.

Topics: Aged; Aging; Anticoagulants; Antithrombin III; Brain Injuries; Female; Florida; Geriatric Assessment; Geriatrics; Hemostatics; Humans; Inpatients; Male; Outpatients; Platelet Aggregation Inhibitors; Purinergic P2Y Receptor Antagonists; Retrospective Studies; Risk Factors; Thrombin; Thromboxane-A Synthase; Trauma Centers; Treatment Outcome; Vitamin K; Vitamins; Wounds and Injuries

Reversal of warfarin-induced coagulopathy after traumatic injury may be done exclusively with prothrombin complex concentrates (PCCs). No direct comparisons between different PCC regimens exist to guide clinical decision-making. Our institution has used 2 distinct PCC strategies for warfarin reversal; a 3-Factor PCC (Profilnine) combined with activated Factor VII (3F-PCC+rVIIa), and a 4-Factor PCC (Kcentra) given without additional factor supplementation.. Retrospective review of all PCC administrations to trauma patients with acute bleeding who were taking warfarin before injury. Primary endpoints were international normalized ratio (INR) reduction, in-hospital mortality, and diagnosis of deep venous thrombosis (DVT).. Eighty-seven patients were identified from 2011 to 2015. Fifty-three were treated with 3F-PCC+rVIIa and 34 with 4F-PCC. Patient demographics, injury severity, and presenting laboratory data were similar. The 3F-PCC+rVIIa produced a lower median (IQR) INR postreversal compared with 4F-PCC (.75 (.69, 1.00) vs 1.28 (1.13, 1.36), P<.001). Both regimens were able to obtain an INR lower than 1.5 immediately after administration (3F+rVIIA 93.9% vs 4F 97.1%, P =.51). In the 4F-PCC group, there was a significant decrease in the incidence of DVT (2.9% vs 22.6%), P < .01), and a nonsignificant reduction in mortality (2.9% vs 17.0%, P = .08).. Use of 4F-PCC for warfarin reversal after traumatic hemorrhage is associated with a less severe decrease in INR, a significant reduction in DVT rates and a trend toward reduced mortality when compared with similar patients treated with 3F-PCC+rVIIa.

Topics: Aged; Aged, 80 and over; Blood Coagulation Factors; Chi-Square Distribution; Cohort Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Combinations; Emergencies; Factor IX; Factor VII; Factor X; Female; Follow-Up Studies; Hemorrhage; Humans; International Normalized Ratio; Male; Middle Aged; Prothrombin; Retrospective Studies; Risk Assessment; Severity of Illness Index; Statistics, Nonparametric; Treatment Outcome; Vitamin K; Warfarin; Wounds and Injuries

Optimal dosing of prothrombin complex concentrate (PCC) has yet to be defined and varies widely due to concerns of efficacy and thrombosis. We hypothesized a dose of 15 IU/kg actual body weight of a three-factor PCC would effectively correct coagulopathy in acute care surgery patients. Retrospective review of 41 acute care surgery patients who received 15 IU/kg (± 10%) actual body weight PCC for correction of coagulopathy. Demographics, laboratory results, PCC dose, blood and plasma transfusions, and thrombotic complications were analyzed. We performed subset analyses of trauma patients and those taking warfarin. Mean age was 69 years (18-94 years). Thirty (73%) trauma patients, 8 (20%) emergency surgery patients, 2 (5%) burns, and 1 (2%) nontrauma neurosurgical patient were included. Mean PCC dose was 1305.4 IU (14.2 IU/kg actual body weight). Mean change in INR was 2.52 to 1.42 (p 0.00004). Successful correction (INR <1.5) was seen in 78 per cent. Treatment failures had a higher initial INR (4.3 vs 2.03, p 0.01). Mean plasma transfusion was 1.46 units. Mean blood transfusion was 1.61 units. Patients taking prehospital warfarin (n = 29, 71%) had higher initial INR (2.78 vs 1.92, p 0.05) and received more units of plasma (1.93 vs 0.33, p 0.01) than those not taking warfarin. No statistical differences were seen between trauma and nontrauma patients. One thrombotic event occurred. Administration of low-dose PCC, 15 IU/kg actual body weight, effectively corrects coagulopathy in acute care surgery patients regardless of warfarin use, diagnosis or plasma transfusion.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Antifibrinolytic Agents; Blood Coagulation Disorders; Blood Coagulation Factors; Blood Transfusion; Body Weight; Burns; Drug Dosage Calculations; Emergencies; Humans; International Normalized Ratio; Middle Aged; Plasma; Retrospective Studies; Surgical Procedures, Operative; Thrombosis; Vitamin K; Warfarin; Wounds and Injuries; Young Adult

An increasing number of patients routinely undergo long-term anticoagulation with warfarin or other pharmacological agents. There is little evidence and no consensus documents in the literature regarding the appropriateness and relative risk of their participation in wilderness activities. We present a case report, conduct an analysis of the limited literature that is available, and make recommendations for wilderness medicine practitioners and screening personnel.

Topics: Anticoagulants; Drug Interactions; Hemorrhage; Humans; Practice Patterns, Physicians'; Risk Factors; Sports; Vitamin K; Warfarin; Wilderness; Wounds and Injuries

The use of international normalized ratio (INR) to diagnose vitamin K-dependent coagulation factor (VitK-CF) deficiency in trauma has limitations (inability to predict bleeding and long turnaround times). Thromboelastography (TEG) assesses the entire coagulation process. With TEG, reaction time (TEG-R) is used to assess global coagulation factor activity and takes less than 10 minutes. We assessed the ability of TEG-R to detect VitK-CF deficiency in trauma, compared to the INR.. A total of 219 trauma patients with INR, TEG, and all VitK-CF measured at admission were included. Demographics and laboratory tests, drugs, blood transfusions, and severity scores were analyzed. Specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of INR (≥1.3 and ≥1.5) and TEG-R (>8 min) to diagnose VitK-CF deficits (≤50%) were calculated. Secondary outcomes included time to INR and TEG results.. Overall, TEG-R performed worse than INR. TEG-R had a sensitivity of 33% (95% CI, 16%-55%), specificity of 95% (95% CI, 91%-98%), PPV of 47% (95% CI, 23%-72%), and NPV of 92% (95% CI, 87%-95%). An INR of 1.5 or greater had a sensitivity of 67% (95% CI, 45%-84%), specificity of 98% (95% CI, 96%-99.7%), PPV of 84% (95% CI, 60%-97%), and NPV of 96% (95% CI, 92%-98%). An INR of 1.3 or greater also had better sensitivity, PPV, and NPV. For patients on warfarin, the times to INR results and TEG completion were 58 (±23) and 92 (±40) minutes (p=0.07), respectively. TEG-R was abnormal in only one patient on warfarin.. Our study suggests that TEG-R is not superior at identifying VitK-CF deficiency compared to INR in trauma.

Topics: Adult; Aged; Aged, 80 and over; Blood Coagulation; Blood Coagulation Factors; Blood Proteins; Female; Humans; International Normalized Ratio; Male; Middle Aged; Thrombelastography; Vitamin K; Wounds and Injuries; Young Adult

Topics: Blood Coagulation Factors; Blood Proteins; Female; Humans; Male; Vitamin K; Wounds and Injuries

Topics: Anticoagulants; Hemorrhage; Humans; Thrombocytopenia; Thrombosis; Vitamin K; Wounds and Injuries

To describe the characteristics, management and outcomes of patients with major trauma who were taking warfarin; explore the use of rapid anticoagulation reversal; and assess the effect of reversal on outcomes.. Retrospective cohort analysis of prospective data extracted from the trauma registries and patient charts of the two adult trauma referral hospitals with neurosurgical units in Western Australia, 2000 to 2005. Inclusion criteria were: major trauma (injury severity score > 15); first international normalised ratio (INR) after injury > 1.4; and documented (in registry or chart) warfarin use.. Eighty patients were identified. Their mean age was 76.8 years. Forty-six were men; 34 were transferred from another hospital; 28 died; and the functional outcomes of 58 were worse at discharge from hospital than before injury. Intracranial haemorrhage (ICH) occurred in 62, of whom 25 died; the difference in mortality between those with ICH and those without ICH was insignificant. Warfarin reversal started 17.4 hours (mean) after injury and the documented period between injury and completion of reversal was 54.2 hours (mean). Multiple logistic regression models, controlling for age, sex, on-scene Glasgow Coma Scale (GCS), initial INR and progressive ICH, showed no independent survival benefit for rapid reversal. Factors associated with mortality were age (22% increase per year [95% CI, 17%-34%]) and progressive ICH on computed tomography scan (24 of the 36 patients with progressive ICH died v one of the 26 patients with stable ICH died). Every point increase in on-scene GCS > 8 increased survival likelihood by 215% (95% CI, 119%-388%).. Patients with major trauma taking warfarin at the time of injury have high mortality rates, poor functional outcomes and long delays to initiation and completion of anticoagulation reversal. Rapid, appropriate warfarin reversal was rarely performed and was not independently associated with survival. Age, low on-scene GCS and progressive ICH were strongly associated with mortality, but presenting INR, ICH v no ICH, and sex were not.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Blood Coagulation Factors; Causality; Cohort Studies; Factor VIII; Female; Fibrinogen; Hemorrhage; Humans; Intracranial Hemorrhages; Male; Middle Aged; Plasma; Registries; Treatment Outcome; Vitamin K; Warfarin; Western Australia; Wounds and Injuries

Topics: Administration, Oral; Anticoagulants; Blood Coagulation; Blood Coagulation Disorders; Cohort Studies; Drug Administration Schedule; Female; Humans; Injections, Intravenous; Male; Orthopedic Procedures; Preoperative Care; Thrombosis; Treatment Outcome; Vitamin K; Warfarin; Wounds and Injuries

Trauma patients are at risk of developing an acute coagulopathy of trauma (ACT) related to tissue injury, shock, and hemodilution. ACT is incompletely understood, but is similar to disseminated intravascular coagulation (DIC) and is associated with poor outcome.. Thrombin generation assays were used to evaluate plasma hemostasis in 42 trauma patients, 25 normal subjects, and 45 patients on warfarin and in laboratory-prepared factor reduced plasma.. Prolonged prothrombin time (PT), more than 18 seconds, or an international normalized ratio of greater than 1.5 was present in 15 trauma patients indicating possible ACT. Native thrombin generation (no activator added, contact activation blocked) showed that Trauma with ACT patients had lag times 68% shorter and peak thrombin generation threefold higher than normal patients indicating the presence of circulating procoagulants capable of initiating coagulation systemically. Trauma patients had lower platelet counts and fibrinogen and Factor (F)II levels putting them at increased risk of bleeding. In laboratory-prepared isolated factor-reduced samples and in patients with vitamin K-dependent factor deficiency due to warfarin, thrombin generation decreased in direct proportion to FII levels. In contrast, in diluted plasma and in trauma patients with reduced factor levels, thrombin generation was increased and associated with slower inhibition of thrombin generation (prolonged termination time) and decreased antithrombin levels (43% of normal in Trauma with ACT).. Thrombin generation studies indicate that Trauma with ACT patients show dysregulated hemostasis characterized by excessive non-wound-related thrombin generation due to a combination of circulating procoagulants capable of activating coagulation systemically and reduced inhibitor levels allowing systemic thrombin generation to continue once started.

Topics: Adult; Anticoagulants; Antithrombins; Disseminated Intravascular Coagulation; Female; Hemostasis; Humans; Male; Middle Aged; Plasma; Prothrombin; Prothrombin Time; Thrombin; Thromboplastin; Vitamin K; Warfarin; Wounds and Injuries

Therapeutic effect of "Aekol" preparation (artificial sea-buckthorn oil) has been studied in the process of treatment of 41 victims and patients with open injuries of limb segments, pyo-necrotic complications of skeletal trauma, investing tissue necrosis following cavitary and cutaneoplastic operative interventions, tropic disturbances of investing tissue integrity. "Aeko" preparation efficiency has been compared with the efficiency of prototype preparation (natural sea-buckthorn oil) and with the efficiency of remedies, traditionally applied for the II phase of the wound process. On the basis of clinical observations, wound surface planimetry, investigation of wound surface bioptats and study of dynamics of some biochemical components in the blood serum in the process of wound healing the authors concluded that the clinical efficiency of "Aekol" preparation in open injure treatment is comparable with the efficiency of natural sea-buckthorn oil and considerably exceeds the efficiency of the traditional would healing remedies.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Drug Combinations; Female; Fractures, Open; Humans; Male; Middle Aged; Plant Oils; Vitamin A; Vitamin E; Vitamin K; Wound Healing; Wounds and Injuries

The author presents the data of her own experimental studies devoted to the investigation of specific wound-healing effect of the new medicinal preparation "Aekol". The author proves that like its prototype, native, sea-buckthorn oil, aekol is indicated for application at the second stage of the wound process as a stimulant of reparative processes. Besides, the drug possesses antiinflammatory effect. Objectivization of the principal points of the article was performed by means of numeral moterial obtained in immunological, biochemical and morphological experimental studies.

Topics: Animals; Anti-Inflammatory Agents; Drug Combinations; Drug Evaluation, Preclinical; Plants, Medicinal; Plants, Toxic; Rats; Rhamnus; Vitamin A; Vitamin E; Vitamin K; Wound Healing; Wounds and Injuries

Topics: Aminocaproates; Animals; Blood Coagulation; Hemorrhage; Hemostatics; Peptide Hydrolases; Rats; Snakes; Thromboplastin; Venoms; Vitamin K; Wounds and Injuries

Topics: Accidents, Traffic; Adult; Anticoagulants; Craniocerebral Trauma; Female; Heparin; Humans; Thromboembolism; Tibial Fractures; Vitamin K; Wounds and Injuries

Topics: Humans; Penicillins; Vitamin A; Vitamin K; Vitamins; Wounds and Injuries