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Perioperative anticoagulation guidelines

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
Mary E Westerman, Joseph A Scales, Vidit Sharma, Derek J Gearman, Johann P Ingimarsson, Amy E Krambeck
OBJECTIVE: To analyze bleeding related complications among patients on long term anticoagulation (AC) undergoing ureteroscopy (URS). Current AUA/ICUD guidelines state it is safe to continue AC in routine URS; however, these recommendations are based on small case series. PATIENTS AND METHODS: 4,799 URS procedures performed at our institution between June 2009 and February 2016 were identified. Records were then retrospectively reviewed to confirm AC use and identify periprocedural complications...
October 5, 2016: Urology
Pierre-Antoine Moulin, Anne Dutour, Patricia Ancel, Pierre-Emmanuel Morange, Thierry Bege, Olivier Ziegler, Stéphane Berdah, Corinne Frère, Bénédicte Gaborit
BACKGROUND: Venous thromboembolism (VTE) is a leading cause of death in obese patients undergoing bariatric surgery (BS), but there is neither consensus nor high-level guidelines yet on VTE prophylaxis in this specific population. OBJECTIVE: We aimed to evaluate patterns of BS perioperative thromboprophylaxis practices. SETTING: French obesity specialized care centers (CSO), which are tertiary care referral hospitals for the most severe cases of obesity METHODS: A detailed questionnaire survey (11 opened, 15 closed questions) investigating their prophylactic schemes of anticoagulation (molecule, dose, weight-adjustment, duration, associated measures, follow-up) was sent to the 37 CSO...
September 1, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
(no author information available yet)
Since 2011, data on patients exposed to direct oral anticoagulants (DOAs) while undergoing invasive procedures have accumulated. At the same time, an increased hemorrhagic risk during perioperative bridging anticoagulation without thrombotic risk reduction has been demonstrated. This has led the GIHP to update their guidelines published in 2011. For scheduled procedures at low bleeding risk, it is suggested that patients interrupt DOAs the night before irrespective of type of drug and to resume therapy six hours or more after the end of the invasive procedure...
September 19, 2016: Anaesthesia, Critical Care & Pain Medicine
Laurent Macle, John Cairns, Kori Leblanc, Teresa Tsang, Allan Skanes, Jafna L Cox, Jeff S Healey, Alan Bell, Louise Pilote, Jason G Andrade, L Brent Mitchell, Clare Atzema, David Gladstone, Mike Sharma, Subodh Verma, Stuart Connolly, Paul Dorian, Ratika Parkash, Mario Talajic, Stanley Nattel, Atul Verma
The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery...
October 2016: Canadian Journal of Cardiology
Rui Tian, Jun Gao, Alof Chen, Xinjie Bao, Jian Guan, Ming Feng, Yongning Li, Wenbin Ma, Zuyuan Ren, Renzhi Wang, Junji Wei
BACKGROUND: The requirement of postoperative bedridden and immobilization renders neurosurgical patients with higher risk of deep vein thrombosis (DVT), then more vulnerable for pulmonary thromboembolism (PTE). But silent pulmonary thromboembolism (SPTE) can be the very early stage of any typical form of PTE, its diagnosis and management is therefore critical in neurosurgical departments. However, to date, perioperative SPTE has not been attached with enough attention. METHODS: Here, we report 2 cases of perioperative SPTE in the Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China...
August 2016: Medicine (Baltimore)
Gianluca Cappelleri, Andrea Fanelli
The use of direct oral anticoagulants including apixaban, rivaroxaban, and dabigatran, which are approved for several therapeutic indications, can simplify perioperative and postoperative management of anticoagulation. Utilization of regional neuraxial anesthesia in patients receiving anticoagulants carries a relatively small risk of hematoma, the serious complications of which must be acknowledged. Given the extensive use of regional anesthesia in surgery and the increasing number of patients receiving direct oral anticoagulants, it is crucial to understand the current clinical data on the risk of hemorrhagic complications in this setting, particularly for anesthesiologists...
August 2016: Journal of Clinical Anesthesia
Jean-Claude Deharo, Elena Sciaraffia, Christophe Leclercq, Walid Amara, Michael Doering, Maria G Bongiorni, Jian Chen, Nicolaus Dagres, Heidi Estner, Torben B Larsen, Jens B Johansen, Tatjana S Potpara, Alessandro Proclemer, Laurent Pison, Caroline Brunet, Carina Blomström-Lundqvist
The European Snapshot Survey on Procedural Routines for Electronic Device Implantation (ESS-PREDI) was a prospective European survey of consecutive adults who had undergone implantation/surgical revision of a cardiac implantable electronic device (CIED) on chronic antithrombotic therapy (enrolment March-June 2015). The aim of the survey was to investigate perioperative treatment with oral anticoagulants and antiplatelets in CIED implantation or surgical revision and to determine the incidence of complications, including clinically significant pocket haematomas...
May 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Salome Weiss, Roman Bühlmann, Regula S von Allmen, Vladimir Makaloski, Thierry P Carrel, Jürg Schmidli, Thomas R Wyss
OBJECTIVE: Floating aortic thrombus is an underrecognized source of systemic emboli and carries a life-threatening risk of stroke when located in the aortic arch. Optimal treatment is not established in available guidelines. We report our experience in managing floating thrombi in the aortic arch. METHODS: Consecutive patients diagnosed with a floating aortic arch thrombus at a tertiary referral center between January 2008 and December 2014 were reviewed. Perioperative and midterm outcomes were assessed...
September 2016: Journal of Thoracic and Cardiovascular Surgery
Yuji Shindo, Satohiro Matsumoto, Hiroyuki Miyatani, Yukio Yoshida, Hirosato Mashima
AIM: To evaluate the risk factors for postoperative bleeding after gastric endoscopic submucosal dissection (ESD) based on the latest guidelines. METHODS: A total of 262 gastric neoplasms were treated by ESD at our center during a 2-year period from October 2012. We analyzed the data of these cases retrospectively to identify the risk factors for post-ESD bleeding. RESULTS: Of the 48 (18.3%) cases on antithrombotic treatment, 10 were still receiving antiplatelet drugs perioperatively, 13 were on heparin replacement after oral anticoagulant withdrawal, and the antithrombotic therapy was discontinued perioperatively in 25 cases...
April 10, 2016: World Journal of Gastrointestinal Endoscopy
Ramsin M Benyamin, Ricardo Vallejo, Victor Wang, Nitesh Kumar, David L Cedeño, Anobel Tamrazi
BACKGROUND: Perioperative management of patients on anticoagulant therapy prior to interventional pain procedures creates a challenge when balancing the risk of bleeding against thromboembolic events. CASE REPORT: We report a case of epidural hematoma formation in the cervical spine following interlaminar epidural steroid injection in an elderly woman with chronic neck and arm pain, who was on clopidogrel therapy. CONCLUSIONS: This is the first reported case of hematoma formation immediately following an epidural steroid injection possibly associated with clopidogrel, even though established guidelines on the timing of the discontinuation of clopidogrel prior to the procedure were exceeded...
May 2016: Regional Anesthesia and Pain Medicine
C F Munson, A J Reid
Novel oral anticoagulants (NOACs) have emerged as a good alternative to warfarin in the prevention of stroke for patients with atrial fibrillation. NOAC use is increasing rapidly; therefore, greater understanding of their use in the perioperative period is important for optimal care. Studies and reviews that reported on the use of NOACs were identified, with particular focus on the perioperative period. PubMed was searched for relevant articles published between January 2000 and August 2015. The inevitable rise in the use of NOACs such as rivaroxaban (Xarelto™), apixaban (Eliquis™), edoxaban (Lixiana™) and dabigatran (Pradaxa™) may present a simplified approach to perioperative anticoagulant management due to fewer drug interactions, rapidity of onset of action and relatively short half-lives...
May 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Edward W Chu, Artur Chernoguz, Celia M Divino
BACKGROUND: The perioperative safety profile of clopidogrel, a potent antiplatelet agent used in the management of cardiovascular disease, is unknown, and there are no evidence-based guidelines recommending for either its interruption or continuation at this time. The aim of this study was to determine whether patients who are maintained on clopidogrel before general surgical procedures are at increased risk of perioperative bleeding complications. METHODS: Patients receiving clopidogrel at the time of elective general surgery were randomized to either discontinue clopidogrel 1 week before surgery (group A) or continue clopidogrel into surgery (group B)...
June 2016: American Journal of Surgery
Pierre Fontana, Helia Robert-Ebadi, Henri Bounameaux, Françoise Boehlen, Marc Righini
In recent years, small oral compounds that specifically block activated coagulation factor X (FXa) or thrombin (FIIa) have become alternatives to the anticoagulants that had been used for several decades. As of today, these direct oral anticoagulants (DOACs) include dabigatran etexilate (thrombin inhibitor) and apixaban, edoxaban and rivaroxaban (inhibitors of FXa). While there is no doubt that DOACs represent a major step forward in the management of patients with venous thromboembolic disease and atrial fibrillation, new challenges have arisen...
2016: Swiss Medical Weekly
Andrew C T Ha, Cyril David Mazer, Subodh Verma, Bobby Yanagawa, Atul Verma
PURPOSE OF REVIEW: Postoperative atrial fibrillation (POAF) occurs commonly after cardiac surgery and is associated with a number of adverse outcomes. This article will review the available evidence on the prevention and treatment of atrial fibrillation after cardiac surgery. Using this knowledge, we propose a conceptual framework on the management of patients with POAF during various phases after cardiac surgery. RECENT FINDINGS: Perioperative β-blockade is the cornerstone in preventing POAF after cardiac surgery...
March 2016: Current Opinion in Cardiology
Sabeen Dhand, S David Stulberg, Lalit Puri, Jennifer Karp, Robert K Ryu, Robert J Lewandowski
INTRODUCTION: Some patients undergoing total joint arthroplasty are at increased risk for venous thromboembolism (VTE). The aim of the present study was to evaluate the safety and efficacy of prIVCF in preventing PE in patients undergoing joint replacement surgery who are at high-risk for VTE. MATERIALS AND METHODS: In this prospective, IRB-approved study, prIVCF were placed in consecutive patients who met specific high-risk criteria (history of VTE or hypercoaguable state) prior to total joint arthroplasty...
December 2015: Journal of Clinical and Diagnostic Research: JCDR
Allison E Burnett, Charles E Mahan, Sara R Vazquez, Lynn B Oertel, David A Garcia, Jack Ansell
Venous thromboembolism (VTE) is a serious medical condition associated with significant morbidity and mortality, and an incidence that is expected to double in the next forty years. The advent of direct oral anticoagulants (DOACs) has catalyzed significant changes in the therapeutic landscape of VTE treatment. As such, it is imperative that clinicians become familiar with and appropriately implement new treatment paradigms. This manuscript, initiated by the Anticoagulation Forum, provides clinical guidance for VTE treatment with the DOACs...
January 2016: Journal of Thrombosis and Thrombolysis
Claire M McCarthy, Orfhlaith E O'Sullivan, Barry A O'Reilly
The use of novel orally administered anticoagulant agents (NOACs) provides new challenges to clinicians in the perioperative care of patients undergoing urogynaecological surgery. We aimed to assess evidence for managing patients taking NOACs before and after urogynaecological surgery. We conducted a literature search in CINAHL, MEDLINE, CENTRAL, Cochrane Library and PubMed for original research articles in the English language on this topic. However, despite initially identifying 556 articles, no articles pertained to the use of NOACs in urogynaecological surgery...
April 2016: International Urogynecology Journal
Adam J Rose, Arthur L Allen, Tracy Minichello
Because of the recent publication of several important studies, there has been a major change in how we think about perioperative management of anticoagulation. Because of these changes, existing consensus guidelines are suddenly out of date and can no longer be used as is, particularly the 2012 American College of Chest Physicians Antithrombotic Guidelines, version 9. We estimate that well over 90% of patients receiving warfarin therapy should not receive bridging anticoagulation during periprocedural interruptions of therapy, except under unusual circumstances and with appropriate justification...
January 2016: Circulation. Cardiovascular Quality and Outcomes
Benjamin Maslin, Erin Springer, Richard Zhu, Vijay Kodumudi, Nalini Vadivelu
BACKGROUND: Warfarin is the most widely prescribed oral anticoagulant frequently encountered in the patients presenting for both elective and emergent surgery. Maintaining therapeutic levels of warfarin therapy may increase the risk of blood loss and procedural complications, including complications from neuraxial and regional anesthetic techniques. However, in some vulnerable patient groups, discontinuing therapy may result in negative thromboembolic consequences. OBJECTIVE: To review the published guidelines and supporting data from clinical studies addressing the safe and coordinated management of patients on warfarin therapy who present for perioperative care...
2016: Current Drug Safety
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