The natural history

of these patients is unclear, as they are generally on anticoagulants, but we can glean some estimate of risk from studies that have evaluated temporarily discontinuing anticoagulation after intracranial hemorrhage. It appears safe to discontinue anticoagulation for brief periods of time [14, 15]. Most of this work has been BMN 673 in vitro conducted in patients with spontaneous intracranial hemorrhage. It is possible that traumatic hemorrhage is a different entity, as injured patients are more hypercoaguable than then general population. Our data represents an important adjunct to these studies, in that we have demonstrated that early reintroduction of anticoagulation can be safely accomplished. There are limitations of this study worth noting. We did not have a protocolized approach to management of anticoagulation. Rather, we consulted with the neurosurgeons on a daily basis and we started anticoagulation when their clinical judgment indicated it was safe to do so. As such, we are likely dealing with a highly select patient population. Additionally, our sample size is limited. It is possible that we would have yielded different results with a larger sample size. Finally, some of our patients received anticoagulation for Erismodegib clinical trial uncomplicated

PE rather than the extreme examples listed in this discussion. This does not detract from our results demonstrating safety of anticoagulation, however. In conclusion, selected patients with brain injury may safely be anticoagulated to prevent the propagation of thrombotic Monoiodotyrosine complications. Our data does not provide definitive evidence of the safety profile. Rather, this manuscript provides initial evidence that suggests that traditional beliefs about anticoagulation

in patients with brain injuries may be incorrect. Our data should be used a springboard to develop further study on this issue, so that the specific groups that would most benefit from anticoagulation could be defined. References 1. Geerts WH, Code KI, Jay RM, Chen E, Szalai JP: A prospective study of venous thromboembolism after major trauma. N Engl J Med 1994,331(24):1601–1606.PubMedCrossRef 2. Norwood SH, Berne JD, Rowe SA, Villarreal DH, Ledlie JT: Early venous thromboembolism prophylaxis with enoxaparin in patients with blunt traumatic brain injury. J Trauma 2008,65(5):1021–1026. discussion 6–7PubMedCrossRef 3. Bates SM, Ginsberg JS: Clinical practice. Treatment of deep-vein thrombosis. N Engl J Med 2004,351(3):268–277.PubMedCrossRef 4. Geerts WH, Heit JA, Clagett GP, Pineo GF, Colwell CW, Anderson FA, et al.: Prevention of venous thromboembolism. Chest 2001,119(1 Suppl):132S-175S.PubMedCrossRef 5. Knudson MM, Morabito D, Paiement GD, Shackleford S: Use of low molecular weight heparin in preventing thromboembolism in trauma patients. J Trauma 1996,41(3):446–459.PubMedCrossRef 6.