Acute Management of Hemostasis in Patients With Neurological Injury

Area of Science:

• Neurology
• Hematology
• Critical Care Medicine

Background:

• Neurological injuries, including traumatic brain injury (TBI) and stroke (ischemic or hemorrhagic), involve complex hemostasis and thrombosis.
• Current treatments aim to control bleeding or restore blood flow, but effective therapies remain a challenge.

Purpose of the Study:

• To review hemostatic and thrombolytic therapies for neurological injuries.
• To evaluate the impact of these therapies on clinical outcomes in patients with stroke and TBI.

Main Methods:

• A comprehensive literature review was conducted using MEDLINE and EMBASE databases.
• Search terms included neurological disorders and hemostatic therapies, focusing on English-language studies of adult human subjects.

Main Results:

• Intravenous thrombolytic therapy with recombinant tissue plasminogen activator improves outcomes in ischemic stroke patients treated within 4.5-5 hours.
• No hemostatic therapies have proven effective in improving clinical outcomes for hemorrhagic stroke or TBI.
• Reversal agents for anticoagulants in hemorrhagic stroke and platelet transfusions in TBI/hemorrhagic stroke with antiplatelet use showed no clinical benefit or potential harm.
• Tranexamic acid reduced rebleeding in subarachnoid hemorrhage but did not improve clinical outcomes; its role in TBI is under investigation.

Conclusions:

• Thrombolytic therapy is beneficial for acute ischemic stroke within a specific time window.
• Current hemostatic therapies for hemorrhagic stroke and TBI primarily affect laboratory parameters, not clinical recovery.
• Further research, particularly on tranexamic acid, is needed, with a focus on clinical outcome measures in future trials.