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Clotting time correction for surgery

Jerrold H Levy, Kamrouz Ghadimi, Quintin J Quinones, Raquel R Bartz, Ian Welsby
Patients who are critically ill following surgical or traumatic injury often present with coagulopathy as a component of the complex multisystem dysfunction that clinicians must rapidly diagnose and treat in the intensive care environment. Failure to recognize coagulopathy while volume resuscitation with crystalloid or colloid takes place, or an unbalanced transfusion strategy focused on packed red blood cell transfusion can all significantly worsen coagulopathy, leading to increased transfusion requirements and poor outcomes...
October 2017: Transfusion Medicine Reviews
Lily A Whitehurst, Bhaskar K Somani
INTRODUCTION: With the broadening indications of ureteroscopy (URS) for complex stones and high-risk patients, more URS is being performed and hence there is an increasing risk of major potentially life-threatening complications. We wanted to define the incidence, predisposing factors, management, and long-term sequelae for post-URS perirenal hematoma (PRH). MATERIAL AND METHODS: We conducted a systematic review of literature according to Cochrane and preferred reporting items for systematic reviews and meta-analysis guidelines for all studies reporting on post-URS PRH from 1980 to September 2016...
May 2017: Journal of Endourology
J W Simmons, M F Powell
Acute Traumatic Coagulopathy occurs immediately after massive trauma when shock, hypoperfusion, and vascular damage are present. Mechanisms for this acute coagulopathy include activation of protein C, endothelial glycocalyx disruption, depletion of fibrinogen, and platelet dysfunction. Hypothermia and acidaemia amplify the endogenous coagulopathy and often accompany trauma. These multifactorial processes lead to decreased clot strength, autoheparinization, and hyperfibrinolysis. Furthermore, the effects of aggressive crystalloid administration, haemodilution from inappropriate blood product transfusion, and prolonged surgical times may worsen clinical outcomes...
December 2016: British Journal of Anaesthesia
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...
December 0: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Bhiken I Naik, Marcel E Durieux, Anne Knisely, Juhee Sharma, Vivien C Bui-Huynh, Bhavana Yalamuru, Abdullah S Terkawi, Edward C Nemergut
BACKGROUND: Sonic estimation of elasticity via resonance (SEER) sonorheometry is a novel technology that uses acoustic deformation of the developing clot to measure its viscoelastic properties and extract functional measures of coagulation. Multilevel spine surgery is associated with significant perioperative blood loss, and coagulopathy occurs frequently. The aim of this study was to correlate SEER sonorheometry results with those of equivalent rotation thromboelastometry (ROTEM) and laboratory parameters obtained during deformity correction spine surgery...
December 2016: Anesthesia and Analgesia
Omer Dzemali, Michael T Ganter, Alicja Zientara, Kirk Graves, Renate Behr, Michele Genoni, Christoph K Hofer
BACKGROUND: Sonoclot is used to measure kaolin-based activated clotting time (kACT) for heparin management. Apart from measuring kACT, the device assesses the patient's coagulation status by glass bead-activated tests (gbACTs; measuring also clot rate [CR] and platelet function [PF]). Recently, a new version of the Sonoclot has been released, and the redesign may result in performance changes. The aim of this study was to evaluate and compare the performance of the new (S2) and the previous (S1) Sonoclot...
January 2017: Clinical and Applied Thrombosis/hemostasis
Suna Kang, Hoi Soo Yoon, Eun Hye Lee
The objective of this study is to analyze the major causes of abnormal findings seen in the preoperative coagulation tests of asymptomatic pediatric patients and to discuss the usefulness of coagulation tests prior to minor surgery. Among patients who received minor surgery in Kyung Hee University Medical Center from March 2008 to April 2015, a total of 7114 pediatric patients (ages 1-18) were included in our study. Of these, 226 (3.1%) were referred to the pediatrics hematology-oncology department because of abnormal preoperative coagulation tests...
May 2016: Pediatric Hematology and Oncology
Brian J Santin, Joanne M Lohr, Thomas W Panke, Patrick M Neville, Melissa M Felinski, Brian A Kuhn, Matthew H Recht, Patrick E Muck
OBJECTIVE: Superficial venous reflux disease has been treated with endovenous ablation techniques for more than 15 years. Thrombi discovered in the postoperative period are referred to as endovenous heat-induced thrombi (EHIT). In spite of the few studies of the ultrasound differentiation between EHIT and deep vein thrombi (DVT), there remains a paucity of literature regarding the evaluation of ultrasound examination and pathologic differentiation. METHODS: Six Yorkshire cross swine underwent femoral vein thrombosis by suture ligation or endovenous radiofrequency ablation...
April 2015: Journal of Vascular Surgery. Venous and Lymphatic Disorders
B V V Srinivas, N Rupa, K V Halini Kumari, A Rajender, M Narendra Reddy
Periodontal plastic surgery is the branch of periodontology that is focused mainly on the correction or elimination of mucogingival problems associated with lack of attached gingiva, a shallow vestibule and aberrant frenum. Various mucogingival surgical procedures are used to halt the progression of the gingival recession and to correct poor esthetic appearance. Free gingival autograft is one of the most common techniques used for a gingival recession in areas of inadequate attached gingiva in the mandibular anterior region...
August 2015: Journal of Pharmacy & Bioallied Sciences
Bobby K W Ng, W W Chau, Alec L H Hung, Anna Cn Hui, Tze Ping Lam, Jack C Y Cheng
BACKGROUND: Many reports had been received on the application of antifibrinolytic medications on spinal corrective surgery and the surgical outcome evaluations of its efficacy on reducing blood loss. This study aimed to assess the efficacy of tranexamic acid (TXA) in reducing operative blood loss during posterior spinal fusion for the treatment of severe adolescent idiopathic scoliosis (AIS). METHODS: A retrospective cohort study was carried out on 90 (TXA = 55, Control = 35) AIS girls undergoing posterior spinal surgery...
2015: Scoliosis
A Boban, C Lambert, C Hermans
INTRODUCTION: Continuous infusion (CI) of clotting factors has facilitated surgical procedures and intensive replacement therapy in haemophilia patients. This procedure could, however, be further optimized by using a short-term central venous catheter (CVCs) instead of via peripheral venous access. AIM: In this paper, we present our results on using a short-term CVC in haemophilia patients during major surgical operations. METHODS: In total, 40 patients with haemophilia A or B (37 and 3, respectively), aged 21-81 years, underwent 67 surgeries with 65 CVCs...
September 2015: Haemophilia: the Official Journal of the World Federation of Hemophilia
Rachel Curtis, Alexandra Schweitzer, Janet van Vlymen
PURPOSE: Patients treated with warfarin for therapeutic anticoagulation present a challenge for the perioperative management of urgent and emergent surgery. Anticoagulation must be reversed prior to most surgical procedures to prevent intraoperative bleeding. The purpose of this module is to review the options for urgent reversal of warfarin anticoagulation and the indications for each reversal agent. Selection of the appropriate agent is important to reduce unnecessary complications of treatment and to achieve optimal reversal of anticoagulation...
June 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Tomas L Lindahl, Maria Wallstedt, Kerstin M Gustafsson, Egon Persson, Andreas Hillarp
The number of patients on antithrombotic treatment due to atrial fibrillation and venous thromboembolism is increasing fast due to an aging population. A growing proportion will be treated with novel oral anticoagulants, the first in clinical use was the direct oral thrombin inhibitor dabigatran (Pradaxa®). A small percentage of the patients on dabigatran will experience serious bleeding or be in need of urgent surgery. The aim of this study was to test the effects of different hemostatic agents in potentially reversing the anticoagulant effects in vitro in blood or platelet-rich plasma (PRP) spiked with dabigatran...
March 2015: Thrombosis Research
Susan E Rowell, Ronald R Barbosa, Tori C Lennox, Kelly A Fair, Abigail J Rao, Samantha J Underwood, Martin A Schreiber
BACKGROUND: The management of severe traumatic brain injury (TBI) frequently involves invasive intracranial monitoring or cranial surgery. In our institution, intracranial procedures are often deferred until an international normalized ratio (INR) of less than 1.4 is achieved. There is no evidence that a moderately elevated INR is associated with increased risk of bleeding in patients undergoing neurosurgical intervention (NI). Thrombelastography (TEG) provides a functional assessment of clotting and has been shown to better predict clinically relevant coagulopathy compared with INR...
December 2014: Journal of Trauma and Acute Care Surgery
Ariane Sümnig, Anne Grotevendt, Antje Westphal, Michael Fiene, Andreas Greinacher, Thomas Thiele
BACKGROUND: Direct oral anticoagulants (DOACs) were recently introduced and are being increasingly prescribed. Most DOACs alter the values of traditional coagulation tests, such as the international normalized ratio (INR) or the activated partial thromboplastin time (aPTT). Although vitamin K antagonists raise the INR value to an extent that mirrors their anticoagulant effect, DOACs do not, in general, alter standard clotting values in any consistent way. Thus, there is a risk that abnormal INR and aPTT values can be misinterpreted...
May 9, 2014: Deutsches Ärzteblatt International
Rik H G Olde Engberink, Gerhardus J A J M Kuiper, Rick J H Wetzels, Patty J Nelemans, Marcus D Lance, Erik A M Beckers, Yvonne M C Henskens
OBJECTIVES: In the present study, the authors have investigated whether rotational thromboelastometry (ROTEM) could predict thrombocytopenia and hypofibrinogenemia in cardiac surgery using the clot amplitude after 5 minutes (A5). Another parameter, PLTEM, in which the contribution of fibrinogen is eliminated by subtracting a fibrin-specific ROTEM test (FIBTEM) from an extrinsically-activated ROTEM test (EXTEM), was investigated. Furthermore, the turnaround time of ROTEM was compared to conventional laboratory tests...
April 2014: Journal of Cardiothoracic and Vascular Anesthesia
Cornelia Czembirek, Wolfgang Paul Poeschl, Christina Eder-Czembirek, Michael Bernhard Fischer, Christos Perisanidis, Philip Jesch, Kurt Schicho, Angel Dong, Rudolf Seemann
OBJECTIVES: This study examines a cohort of patients who suffered bleeding requiring hemostatic intervention after oral surgery. The reasons for bleeding and the interval between surgery and onset of bleeding are investigated. MATERIALS AND METHODS: Between 1998 and 2009, 1,819 cases were eligible for this retrospective study. Factors (independent parameters) influencing the interval (dependent variable) were analyzed using negative binomial count regression models (NegBin II)...
July 2014: Clinical Oral Investigations
Yulia Djabir, Hayley L Letson, Geoffrey P Dobson
INTRODUCTION: No drug therapy has demonstrated improved survival following cardiac arrest (CA) of cardiac or noncardiac origin. In an effort to translate the cardiorescue properties of Adenocaine (adenosine and lidocaine) and magnesium sulfate (ALM) from cardiac surgery and hemorrhagic shock to resuscitation, we examined the effect of ALM on hemodynamic rescue and coagulopathy following asphyxial-induced CA in the rat. METHODS: Nonheparinized animals (400-500 g, n = 39) were randomly assigned to 0...
September 2013: Shock
Hiram Rivas-Perez, Mark Wewers
SESSION TYPE: Airway Cases IIPRESENTED ON: Tuesday, October 23, 2012 at 11:15 AM - 12:30 PMINTRODUCTION: Aorto-bronchial fistulae secondary to thoracic aortic repair has only been reported fifteen times in literature. Massive hemoptysis can occur and prompt recognition of a fistula improves survival.CASE PRESENTATION: An 88 year old man with history of hypertension and a thoracic aorta aneurysm, repaired with a surgical graft placement 7 years earlier, presented to the hospital with massive hemoptysis. Chest X rays and computerized tomography (CT) showed no lesion on parenchyma...
October 1, 2012: Chest
C Solomon, C Hagl, N Rahe-Meyer
BACKGROUND: There is currently a contrast between the demonstrated benefits of fibrinogen concentrate in correcting bleeding and reducing transfusion, and its perceived thrombogenic potential. This analysis evaluates the effects of fibrinogen concentrate on coagulation up to 12 days after administration during aortic surgery. METHODS: We performed a post hoc analysis of a prospective, randomized, double-blind, controlled trial of fibrinogen concentrate as first-line haemostatic therapy in aortic surgery...
June 2013: British Journal of Anaesthesia
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