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Antithrombotics in trauma: management strategies in the older patients

Authors Wong H, Lovett N, Curry N, Shah K, Stanworth SJ

Received 30 June 2017

Accepted for publication 25 August 2017

Published 4 October 2017 Volume 2017:8 Pages 165—174


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Martin Bluth

Henna Wong,1,2 Nicola Lovett,3 Nicola Curry,1 Ku Shah,2 Simon J Stanworth1,2,4

1Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, 2Radcliffe Department of Medicine, University of Oxford, Oxford BRC Haematology Theme, 3Department of Geratology, Oxford University Hospitals NHS Foundation Trust, 4Department of Haematology, NHS Blood and Transplant, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

Abstract: The ageing population has resulted in a change in the demographics of trauma, and older adult trauma now accounts for a growing number of trauma admissions. The management of older adult trauma can be particularly challenging, and exhibits differences to that of the younger age groups affected by trauma. Frailty syndromes are closely related with falls, which are the leading cause of major trauma in older adults. Comorbid disease and antithrombotic use are more common in the older population. Physiological changes that occur with ageing can alter the expected clinical presentation of older persons after injury and their susceptibility to injury. Following major trauma, definitive control of hemorrhage remains essential for improving outcomes. In the initial assessment of an injured patient, it is important to consider whether the patient is taking anticoagulants or antiplatelets and if measures to promote hemostasis such as reversal are indicated. After hemostasis is achieved and bleeding has stopped, longer-term decisions to recommence antithrombotic agents can be challenging, especially in older people. In this review, we discuss one aspect of management for the older trauma patients in greater detail, that is, acute and longer-term management of antithrombotic therapy. As we consider the health needs of an ageing population, rise in elderly trauma and increasing use of antithrombotic therapy, the need for research in this area becomes more pressing to establish best practice and evidence-based care.

Keywords: injury, elderly, anticoagulation, antiplatelet, antithrombotic

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