Coagulopathy Reversal Approaches & DVT Protocols for Trauma Patients-Video

Video Transcription

Video Summary

In this video, Dr. Joshua Meadow and Dr. Christopher Zacco discuss coagulopathy reversal and deep vein thrombosis (DVT) prevention for patients with traumatic brain injury. They discuss a case of an 86-year-old female who developed a cerebellar hemorrhage and had abnormal PTT levels. The patient initially did well but later became confused and lethargic, requiring surgery for evacuation of blood. The doctors discuss the coagulation cascade and various reversal strategies for different factors that contribute to coagulopathy. They also discuss the use of different medications for preventing DVT and the guidelines for prophylaxis in patients undergoing abdominal, spinal, and cranial surgeries. The doctors also present a quality improvement initiative conducted at the University of Wisconsin, where they implemented a protocol for chemoprophylaxis using heparinoids for neuro-ICU patients. The results showed no acute hemorrhages after starting chemoprophylaxis, but there were some limitations in the study. The doctors conclude that while DVT may not be entirely preventable in trauma patients, it is better to use prophylactic anticoagulants to prevent the risk of a significant pulmonary embolism. IVC filter placement is not recommended for prevention, but may be useful if a DVT is already present. They emphasize the importance of changing behavior towards DVT prophylaxis to optimize prevention.

Keywords

coagulopathy reversal

deep vein thrombosis prevention

traumatic brain injury

cerebellar hemorrhage

PTT levels

coagulation cascade

reversal strategies