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Perioperative coagulation

Owain Thomas, Hampus Rein, Karin Strandberg, Ulf Schött
BACKGROUND: The risk of spinal haematoma in patients receiving epidural catheters is estimated using routine coagulation tests, but guidelines are inconsistent in their recommendations on what to do when results indicate slight hypocoagulation. Postoperative patients are prone to thrombosis, and thromboelastometry has previously shown hypercoagulation in this setting. We aimed to better understand perioperative haemostasis by comparing results from routine and advanced tests, hypothesizing that patients undergoing major upper gastrointestinal surgery would be deficient in vitamin K-dependent coagulation factors because of malnutrition, or hypocoagulative because of accumulation of low molecular weight heparin (LMWH)...
2016: Perioperative Medicine
Yi Cheng, Mu Jin, Xiuhua Dong, Lizhong Sun, Jing Liu, Rong Wang, Yanwei Yang, Peirong Lin, Siyu Hou, Yuehua Ma, Yuefeng Wang, Xudong Pan, Jiakai Lu, Weiping Cheng
BACKGROUND: Stanford type-A acute aortic dissection (AAD) is a severe cardiovascular disease demonstrating the characteristics of acute onset and rapid development, with high morbidity and mortality. The available evidence shows that preoperative acute lung injury (ALI) induced by Stanford type-A AAD is a frequent and important cause for a number of untoward consequences. However, there is no study assessing the incidence of preoperative ALI and its independent determinants before Standford type-A AAD surgery in Chinese adult patients...
October 2016: Medicine (Baltimore)
Julie L Huffmyer, Lucas G Fernandez, Cyrus Haghighian, Abdullah S Terkawi, Danja S Groves
BACKGROUND: The Quantra Hemostasis Analyzer is a novel diagnostic device that uses an ultrasound-based technology, sonic estimation of elasticity via resonance (SEER) sonorheometry, to characterize the dynamic changes in viscoelastic properties of a blood sample during coagulation. Cardiac surgery utilizing cardiopulmonary bypass (CPB) is associated with a significant impact on the coagulation system and can result in perioperative coagulopathy. The aim of this study was to correlate SEER sonorheometry results to corresponding rotational thromboelastometry (ROTEM) and laboratory parameters obtained before, during, and after CPB...
October 4, 2016: Anesthesia and Analgesia
Thomas M Halaszynski
Oral health care providers are concerned with how to manage patients prescribed coagulation-altering therapy during the perioperative/periprocedural period for dental and oral surgery interventions. Management and recommendation can be based on medication pharmacology and the clinical relevance of coagulation factor levels/deficiencies. Caution should be used with concurrent use of medications that affect other components of the clotting mechanisms; prompt diagnosis and any necessary intervention to optimize outcome is warranted...
November 2016: Oral and Maxillofacial Surgery Clinics of North America
M Clerc, J Prothet, T Rimmelé
Composite tissue allotransplantation (CTA) is a complex procedure requiring a multidisciplinary collaboration between surgeons, anesthetists, and transplantation specialists. We will describe the perioperative management of a bilateral forearm allograft performed at our facility. A 40-year-old man who lost both forearms was registered on the transplant waiting list; a suitable graft was available 11months later. Anesthesia required planning for vascular access, hemodynamic monitoring, fluid therapy management and prevention of deep vein thrombosis...
June 2016: Hand Surgery and Rehabilitation
Sathappan Karuppiah, Christopher Mckee, Ashley Hodge, Mark Galantowicz, Joseph Tobias, Aymen Naguib
Over the years, there has been a growing recognition of the potential negative sequelae of allogeneic blood products on postoperative outcomes following cardiac surgery. In addition, followers of the Jehovah's Witness (JW) faith have a religious restriction against receiving blood or blood components. Advances in perioperative care, cardiopulmonary bypass (CPB), and surgical technique have minimized the need for allogeneic blood products. Specific blood conservation strategies include maximizing the preoperative hematocrit and coagulation function as well as intraoperative strategies, such as acute normovolemic hemodilution and adjustments of the technique of CPB...
September 2016: Journal of Extra-corporeal Technology
C Raspé, L Flöther, R Schneider, M Bucher, P Piso
Due to the significantly improved outcome and quality of life of patients with different tumor entities after cytoreductive surgery (CRS) and HIPEC, there is an increasing number of centers performing CRS and HIPEC procedures. As this procedure is technically challenging with potential high morbidity and mortality, respectively, institutional experience also in the anesthetic and intensive care departments is essential for optimal treatment and prevention of adverse events. Clinical pathways have to be developed to achieve also good results in more comorbid patients with border line indications and extensive surgical procedures...
September 28, 2016: European Journal of Surgical Oncology
Fuat H Saner, Carmen Kirchner
BACKGROUND: Patients with end-stage liver disease (ESLD) are assumed to be at high risk of bleeding when undergoing any kind of invasive intervention (any kind of operation, including transplantation or minimally invasive interventions). Both bleeding and thrombosis are associated with a poor outcome. METHODS: A selective literature research was conducted with the following key words: 'cirrhosis', 'coagulation', 'bleeding', 'INR' (international normalized ratio), 'aPTT' (activated partial thromboplastin time), and 'thrombocytopenia'...
August 2016: Visc Med
Brianne Bordes, David Martin, Brian Schloss, Allan Beebe, Walter Samora, Jan Klamar, David Stukus, Joseph D Tobias
When hemodynamic or respiratory instability occurs intraoperatively, the inciting event must be determined so that a therapeutic plan can be provided to ensure patient safety. Although generally uncommon, one cause of cardiorespiratory instability is anaphylactic reactions. During anesthetic care, these most commonly involve neuromuscular blocking agents, antibiotics, or latex. Floseal is a topical hemostatic agent that is frequently used during orthopedic surgical procedures to augment local coagulation function and limit intraoperative blood loss...
July 2016: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
S H Cui, Y X Zhi, K Zhang, L D Zhang, L N Shen, Y N Gao
Objective: To investigate the value of temporary balloon occlusion of the abdominal aorta in the treatment of complete placenta previa with placenta accreta. Methods: From January 2015 to February 2016, 24 cases of complete placenta previa with placenta accreta were treated with temporary balloon occlusion of the abdominal aorta(the study group)before cesarean, and 24 cases of complete placenta previa with placenta accreta did not receive balloon occlusion(the control group). The operation time, intraoperative blood loss, intraoperative blood transfusion volume, the perioperative hemoglobin level, the hysterectomy rate and the related complications were compared retrospectively...
September 25, 2016: Zhonghua Fu Chan Ke za Zhi
Claudia L Côté, Alexandra M Yip, Jeffrey B MacLeod, Bill O'Reilly, Joshua Murray, Maral Ouzounian, Craig D Brown, Rand Forgie, Marc P Pelletier, Ansar Hassan
BACKGROUND: Evidence regarding the safety and efficacy of intraoperative cell salvage (ICS) in transfusion reduction during cardiac surgery remains conflicting. We sought to evaluate the impact of routine ICS on outcomes following cardiac surgery. METHODS: We conducted a retrospective analysis of patients who underwent nonemergent, first-time cardiac surgery 18 months before and 18 months after the implementation of routine ICS. Perioperative transfusion rates, postoperative bleeding, clinical and hematological outcomes, and overall cost were examined...
September 2016: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Richard Holtby, Monique Christakis, Eran Maman, Joy C MacDermid, Tim Dwyer, George S Athwal, Kenneth Faber, John Theodoropoulos, Linda J Woodhouse, Helen Razmjou
BACKGROUND: Increased interest in using platelet-rich plasma (PRP) as an augment to rotator cuff repair warrants further investigation, particularly in smaller rotator cuff tears. PURPOSE: To examine the effectiveness of PRP application in improving perioperative pain and function and promoting healing at 6 months after arthroscopic repair of small- or medium-sized rotator cuff tears. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1...
September 2016: Orthopaedic Journal of Sports Medicine
Hendrika C A M Hazendonk, Marieke J H A Kruip, Ron A A Mathôt, Marjon H Cnossen
A 29-year-old man with severe haemophilia A and end-stage renal disease underwent a renal transplantation. To prevent bleeding, patient was treated with replacement therapy using factor VIII (FVIII) concentrate, according to National guidelines. Bayesian analysis was performed by combining observed FVIII concentrations with a population pharmacokinetic (PK) model for patients with severe haemophilia A in a perioperative setting. Application of Bayesian analysis led to accurate prediction of observed concentrations after prescribing dosing advice...
2016: BMJ Case Reports
M Durila, J Schützner, T Vymazal
UNLABELLED: Warfarin overdose with unmeasurable values of the prothrombin time (PT-INR) is a significant problem in the preoperative preparation of the patient for acute invasive surgery. In contrast to conventional blood clotting assays, rotational thromboelastometry (ROTEM) evaluates the coagulation profile of the whole blood and provides a more complex view of the coagulation status of the patient. Thromboelastometry results are available within about 10 minutes and help us to provide targeted "bedside" therapy of coagulopathy in a bleeding patient...
2016: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Jens Meier
Despite impressive progress in surgical technique, aortic surgery is still associated with relatively high morbidity and mortality. One of the most important contributors to this phenomenon is the triad of bleeding, anemia, and transfusion. All three factors are known to influence the outcome of aortic surgery to a great extent. However, over the last few years a multidisciplinary, multimodal concept has been established, which enables the physician to avoid bleeding, anemia, and transfusion as much as possible...
September 2016: Best Practice & Research. Clinical Anaesthesiology
Brittney Williams, John McNeil, Andrew Crabbe, Kenichi A Tanaka
Achieving hemostasis after complex cardiovascular and transplant surgical procedures is one of the greatest challenges anesthesiologists face. Preoperative coagulation disturbances due to underlying disease or antithrombotic therapy are common, and they are worsened by intraoperative blood loss and fluid replacement. The coagulation reactions in vivo are incredibly complex interactions among blood cells, proteins, and vasculature, standing in sharp contrast to rather simple treatment options including transfusion of platelets, plasma, and cryoprecipitate...
August 27, 2016: Transfusion Medicine Reviews
Nilesh Kurwale, Kanwaljeet Garg, Amit Arora, Poodipedi Sarat Chandra, Manjari Tripathi
Valproic acid (VPA) has been associated with coagulation factors deficiency, platelet dysfunction and hemorrhagic complications. We investigated 169 patients with drug resistant epilepsy (DRE), who underwent surgery, to look for clinical implications of VPA associated bleeding problems. All patients had normal preoperative coagulation profile. VPA was a part of polytherapy in 54% of patients (Group A), however 46% patients were not on VPA (Group B). The groups were comparable with mean age of 17.3±10.3years...
September 4, 2016: Epilepsy Research
Ngoh C Liew, Gina V Alemany, Pantep Angchaisuksiri, Soo M Bang, Gordon Choi, Deidre A De Silva, Ji M Hong, Limi Lee, Yong J Li, Ganesan N Rajamoney, John Suviraj, Thiam C Tan, Eric Tse, Li T Teo, Julie Jvisperas, Raymond S Wong, Lai H Lee
The Asian venous thromboembolism (VTE) prophylaxis guidelines was first published in 2012. Since its first edition, the Asian Venous Thrombosis Forum (AVTF) working group have updated the Asian VTE epidemiology and reviewed issues that were not addressed in the previous guidelines. The authors noted that the rising incidence of VTE across Asia may be attributable to aging population, dietary changes, and increasing incidence of obesity and diabetes. The new additions in the guideline include role of thrombophilia in VTE, bleeding risk in Asians, individual risk assessment, updates in the prevention of VTE in medically ill, bariatric surgery, cancer, orthopaedic and trauma patients...
September 8, 2016: International Angiology: a Journal of the International Union of Angiology
Xinliang Guan, Jiachen Li, Ming Gong, Feng Lan, Hongjia Zhang
Coagulopathy is still a frequent complication in the surgical treatment of acute aortic dissection. However, the physiopathology of surgically induced coagulopathy has never been systematically and comprehensively studied in patients with acute aortic dissection. The aim of the present study was to describe the perioperative hemostatic system in patients with acute aortic dissection.The 87 patients who underwent aortic arch surgery for acute Stanford type A aortic dissection from January 2013 to September 2015 were enrolled in this study...
September 2016: Medicine (Baltimore)
Xiaopeng Guo, Lu Gao, Wei Lin, Yue Wu, Qiang Wang, Bing Xing, Zhiqin Xu
BACKGROUND: Antiepileptic drugs (AEDs) are increasingly used prophylactically during the perioperative period to prevent epilepsy in patients undergoing craniotomy. Evidence concerning the use of AEDs and the incidence, extent and risk factors of hyperammonemia induced by different types of AEDs is lacking. METHODS: Patients were divided into groups with 3 different AED regimens, levetiracetam, valproate and carbamazepine regimens, and the blood ammonia concentration and liver and coagulation functions were assessed during the perioperative period...
November 1, 2016: Clinica Chimica Acta; International Journal of Clinical Chemistry
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