ANTICOAGULATION  PEARLS

  • Utilizing regional or systemic anticoagulation will be on a case-by-case basis. Systemic anticoagulation is the ideal method, but may not be possible with high-risk concomitant injuries such as traumatic brain injury, non-operative blunt solid organ injury, etc. If contraindications for systemic anticoagulation exist, regional anticoagulation is advised.
  • Antiplatelet therapy with aspirin is recommended post-operatively for arterial repairs, interposition grafts (autologous or prosthetic) and bypass grafts (autologous or prosthetic) unless concomitant injuries stated above contraindicate its use.
  • Systemic anticoagulation is achieved with 50 u/kg of IV heparin with 1000 u repeated at 1 hr; repeat doses are not recommended given the propensity for bleeding in wartime injury.
  • “Regional anticoagulation” is the use of heparin saline flush in the inflow/outflow vessels.
  • Heparin saline is typically 10000u/liter (10U Heparin/1cc of Saline), although other mixtures with or without papaverine are acceptable; there is no evidence that other ‘vein solutions’ offer any advantage.
  • The use of recombinant factor VII is no longer recommended.