Timing of Agent Resumption and Therapeutic Targets in the Pathophysiology of Traumatic Brain Injuries

An estimated 69 million people worldwide suffer from traumatic brain injuries each year. Direct head trauma can cause traumatic brain hemorrhage, which can be life-threatening if not treated quickly. Current studies suggest the use of antithrombotic therapy for treatment, but the optimal duration of such therapy in neurosurgery remains controversial. This article critically reviews recommendations regarding the ideal timing of antiplatelet and anticoagulant therapy for diseases such as subarachnoid hemorrhage, subdural hematoma, skull fractures, brain contusions, and diffuse axonal injury. . Additionally, the role of these agents in the context of prosthetic valves and stents will be examined, and their effects on bleeding time and platelet aggregation will be evaluated. This review highlights possible directions for future research in this area and highlights the limitations inherent in the current literature. In the case of hemorrhage in TBI, the standard of care is to resume appropriate AAT at intervals to reduce the risk of ICH, but timing and treatment vary among clinicians. Various studies have shown that restarting AAT reduces the long-term risk of thrombotic events and ischemic stroke. However, this benefit should be weighed against the risk of her developing ICH if AAT is restarted too soon. Timing of resumption of AAT should be determined based on multidisciplinary risk stratification considering patient risk factors and comorbidities that may predispose to thromboembolic complications due to prolonged discontinuation of AAT cessation.