Dabigatran etixilate and traumatic brain injury: Evolving anticoagulants require evolving care plans

AIM: To investigate the outcomes of trauma patients with traumatic brain injury(TBI) on Dabigatran Etexilate(DE). METHODS: Following IRB approval, all patients taking DE who were admitted to our level 1 trauma service were enrolled in the study. Injury complexity, length of stay(LOS), intensive care length of stay, operative intervention, therapeutic interventions and outcomes were analyzed retrospectively. RESULTS: Twenty-eight of 4310 admissions were taking DE. Eleven patients were excluded on concurrent antiplatelet therapy. Average age was 77.14 years(64-94 years), and average LOS was 4.7 d(1-35 d). Thirty-two percent were admitted with intracranial hemorrhage. Eighteen percent received factor Ⅶ, and 22% received dialysis in attempts to correct coagulopathy. Mortality was 21%.CONCLUSION: The low incidence, absence of reversal agents, and lack of practice guidelines makes managing patients with TBI taking DE frustrating and provider specific. Local practice guidelines may be helpful in managing such patients.

Lipocalin-2 and intestinal diseases

Dysfunction of the intestinal barrier is a prevalent phenomenon observed across a spectrum of diseases,encompassing conditions such as mesenteric artery dissection,inflammatory bowel disease,cirrhosis,and sepsis.In these pathological states,the integrity of the intestinal barrier,which normally serves to regulate the selective passage of substances between the gut lumen and the bloodstream,becomes compromised.This compromised barrier function can lead to a range of adverse consequences,including increased permeability to harmful substances,the translocation of bacteria and their products into systemic circulation,and heightened inflammatory responses within the gut and beyond.Understanding the mechanisms underlying intestinal barrier dysfunction in these diverse disease contexts is crucial for the development of targeted therapeutic interventions aimed at restoring barrier integrity and ameliorating disease progression.Lipocalin-2(LCN2)expression is significantly upregulated during episodes of intestinal inflammation,making it a pivotal indicator for gauging the extent of such inflammatory processes.Notably,however,LCN2 derived from distinct cellular sources,whether intestinal epithelial cells or immune cells,exhibits notably divergent functional characteristics.Furthermore,the multifaceted nature of LCN2 is underscored by its varying roles across different diseases,sometimes even demonstrating contradictory effects.

Massive transfusion:An update for the anesthesiologist

Exsanguination from trauma, gastrointestinal bleeding,and obstetric hemorrhage remains a major source of mortality across the planet. Continued research into resuscitation strategies and evolving technology and blood product storage has allowed for patient to undergo very large volume transfusions, even to the point of replacing a patient's blood volume several times over. As massive transfusions have become more common, more studies have been performed delineating the exact patient population that would benefit, start-and stop-points of transfusions, complications and avoidance of the same. We discuss these points and provide information and strategies for massive transfusion.