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Lead Neurosurgery Nurse Practitioner Receives Doctor of Nursing Practice Degree for Research on Blood Thinning Medication Following Brain Injury

As an Advanced Practice Provider, specializing in neurotrauma, Andrea Thomas, now DNP, saw patients in follow-up clinic after they left the hospital. In those visits, she noticed that patients who had suffered an acute traumatic brain injury, who were also on antiplatelet or anticoagulation medications had varying reactions. 
Andrea Thomas at graduationHistorically, providers tell their patients that they cannot resume taking medications to thin the blood until 14 days after they have experienced a head injury. Providers are concerned that if the medications are resumed too soon the patient could have a hemorrhage. However, the risk of delaying the resumption of medication increases the chances that the patient may form a blood clot.  Based on the anecdotal observations Thomas made in clinic, she thought the 14-day rule may be too long putting the patient at greater risk of clotting.

As she pursued her Doctor of Nursing Practice, the highest degree in the field of nursing, Thomas chose to study the prevailing 2-week rule to not resume antiplatelet or anticoagulation medications, to determine if there was a better way. “After witnessing first-hand the effect of holding antithrombotic medications (blood thinners) for an extended period of time I knew it was time to evaluate if our current practice is the best, most up-to-date practice for our patients," says Thomas.

As part of her thesis, Thomas developed a risk stratification model that providers can use to determine if the benefits outweigh the risks if they re-start blood thinning medications before 14 days had elapsed. “This protocol helps us look at each patient's individualized risk factors to make a determination if earlier medication resumption is needed and allows an easy way to communicate the plan of care to all providers across the hospital system," explains Thomas.
Prior to the new protocol all patients were resuming their medication on or after day 14, but using the risk stratification model, some patients resumed their medications earlier, and not one f them had increased intracranial hemorrhages or thrombotic events. "Given these results we know we need to continue risk stratifying patients and collecting data," concludes Thomas.
Andrea Thomas making presentationWith the collaboration of neurosurgeon, Laura Ngwenya, MD, PhD, at University of Cincinnati multi institutional discussions are on the way and research is continuing.
Thomas will be making a poster presentation of her research in March 2022 in Phoenix, AZ at the annual conference of American Association of Neuroscience Nursing.

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