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Thoracic surgery, anticoagulant

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
Andreas Vötsch, Wolfgang Weihs, Martin Asslaber, Otto Dapunt
Until now, to our knowledge no case of bioprosthetic valvular thrombosis after implantation of the sutureless Sorin Perceval valve has been reported. Although sutureless aortic valve replacement has become a powerful tool in our daily practice, recent guidelines from the European Society of Cardiology, the European Association for Cardio-Thoracic Surgery, the American College of Cardiology, and the American Heart Association do not give specific recommendations on postoperative anticoagulation therapy. We report the first case of valve dysfunction resulting from thrombosis 12 months after implantation with a possible link to postoperative cortisole therapy...
October 2016: Annals of Thoracic Surgery
Kenta Okitsu, Takeshi Iritakenishi, Mitsuo Iwasaki, Tatsuyuki Imada, Yuji Fujino
OBJECTIVE: This study aimed to determine the risk of hematoma associated with thoracic paravertebral block (TPVB) in patients undergoing cardiovascular surgery. DESIGN: Retrospective analysis. SETTING: Single university hospital. PARTICIPANTS: The study comprised 141 patients who underwent cardiovascular surgery with TPVB to relieve postoperative pain. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Three patients were excluded and of the remaining 138, TPVB was performed in 135, ages 11 to 96 years, who either had a clotting abnormality or were on anticoagulant or antiplatelet therapy...
June 3, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Samuel L Chen, Isabella J Kuo, Roy M Fujitani, Nii-Kabu Kabutey
INTRODUCTION: Acute aortic symptomatology is an unusual manifestation of Brucella melitensis infection. We present a rare case of acute multifocal thoracic and abdominal aortic ruptures arising from Brucellosis aortitis managed exclusively with endovascular surgery. METHODS: A 71 year-old Hispanic male with a history of atrial fibrillation and prior stroke on chronic anticoagulation, presented with shortness of breath and malaise. In addition, he had been treated approximately one year previously in Mexico for Brucella melitensis bacteremia after eating fresh unpasteurized cheese...
August 20, 2016: Annals of Vascular Surgery
E Anne Russell, Robert A Baker, Jayme S Bennetts, Alex Brown, Christopher M Reid, Robert Tam, Lavinia Tran, Warren F Walsh, Graeme P Maguire
BACKGROUND: In Australia it has been suggested that heart valve surgery, particularly for rheumatic heart disease (RHD), should be consolidated in higher volume centres. International studies of cardiac surgery suggest large volume centres have superior outcomes. However the effect of site and surgeon case load on longer term outcomes for valve surgery has not been investigated. METHODS: The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed...
October 15, 2016: International Journal of Cardiology
J B Larsen, T D Christensen, C L Hvas, A M Hvas
INTRODUCTION: Recent research has focused on the complement system in cancer, including the lectin pathway of complement activation. Mannose-binding lectin (MBL), a key activator of the lectin pathway, can bind to tumor cell surfaces in vitro, and lectin pathway activation is increased in several types of cancer. The exact role of the complement system in cancer is currently discussed. However, one possible consequence of the increased complement activation could be contribution to the increased thrombosis risk which cancer patients experience...
April 2016: Thrombosis Research
Thomas A Schwann, Robert H Habib, Rakesh M Suri, J Matthew Brennan, Xia He, Vinod H Thourani, Milo Engoren, Gorav Ailawadi, Brian R Englum, Mark R Bonnell, James S Gammie
BACKGROUND: Anticoagulation with warfarin following bioprosthetic mitral valve replacement (BMVR) is recommended by multiple practice guidelines. We assessed practice variability and patient characteristics associated with warfarin prescription following BMVR. METHODS: We analyzed 7,637 patients in the Society of Thoracic Surgeons Database (January 1, 2008 to June 30, 2011) who were discharged following isolated primary nonemergent BMVR. Patients requiring preoperative warfarin, those with preoperative atrial fibrillation, or those with a contraindication to warfarin were excluded...
September 2016: Chest
D Oladokun, B O Patterson, J Sobocinski, A Karthikesalingam, I Loftus, M M Thompson, P J Holt
OBJECTIVE/BACKGROUND: The growth rates of thoracic aortic aneurysms (TAAs) and factors influencing their expansion are poorly understood. This study aimed to review systematically published literature describing TAA expansion and examine factors that may be associated with this. METHODS: A comprehensive search of MEDLINE and Embase databases was performed until 30 April 2015. Studies describing rates of TAA growth were identified and systematically reviewed. Outcomes of interest were TAA growth rates and associated factors...
May 2016: European Journal of Vascular and Endovascular Surgery
Michael B Streiff, Giancarlo Agnelli, Jean M Connors, Mark Crowther, Sabine Eichinger, Renato Lopes, Robert D McBane, Stephan Moll, Jack Ansell
This guidance document focuses on the diagnosis and treatment of venous thromboembolism (VTE). Efficient, cost effective diagnosis of VTE is facilitated by combining medical history and physical examination with pre-test probability models, D dimer testing and selective use of confirmatory imaging. Clinical prediction rules, biomarkers and imaging can be used to tailor therapy to disease severity. Anticoagulation options for acute VTE include unfractionated heparin, low molecular weight heparin, fondaparinux and the direct oral anticoagulants (DOACs)...
January 2016: Journal of Thrombosis and Thrombolysis
Wilhelm Haverkamp, Thomas Hachenberg
PURPOSE OF REVIEW: This article reviews and summarizes the pathophysiology, risk factors, and the management of arrhythmias in patients undergoing noncardiac thoracic surgery. RECENT FINDINGS: Cardiac arrhythmias are common findings in the perioperative period, particularly with increasing age. They often complicate the course of the patient's recovery after operation. The most common postoperative arrhythmia is atrial fibrillation. It requires either a rate or rhythm control strategy, and the need for anticoagulation has to be assessed depending on the duration of the arrhythmia and risk factors...
February 2016: Current Opinion in Anaesthesiology
Akihiko Maeda, Sho C Shibata, Kenta Okitsu, Tatsuyuki Imada, Ayako Takahashi, Akinori Uchiyama, Takahiko Kamibayashi, Yuji Fujino
OBJECTIVE: We report a case of perioperative management of a single-ventricle patient with Fontan-associated liver disease undergoing hepatectomy. CASE REPORT: A 12-year-old boy with Fontan circulation was scheduled for partial hepatectomy to remove a liver mass in segment 6. He received stent implantation to relieve conduit stenosis 6 months before the operation. The operation was performed under general anesthesia and with a bilateral thoracic paravertebral block (PVB)...
November 2015: Regional Anesthesia and Pain Medicine
Alessandro Landi, Fabrizio Gregori, Nicola Marotta, Roberto Delfini
INTRODUCTION: Accurate hemostasis in surgical practice is critical. The need for optimal atraumatic hemostasis has become compelling in neurosurgery. A simple and safe gelified hemostatic matrix is often used. This prospective study evaluates two different hemostatics, FloSeal (Baxter Healthcare, Deerfield, Illinois, United States) and Surgiflo (Ethicon, Somerville, New Jersey, United States), for bleeding control during spine surgery, considering their efficacy, safety, and ease of use...
March 2016: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Philip D Hewes, Krista J Hachey, Xue Wei Zhang, Yorghos Tripodis, Pamela Rosenkranz, Michael I Ebright, David McAneny, Hiran C Fernando, Virginia R Litle
BACKGROUND: Patients undergoing esophagectomy for cancer are in the highest-risk group for venous thromboembolism, with a 7.3% incidence reported by the National Surgical Quality Improvement Program. Venothromboembolism (VTE) doubles esophagectomy mortality. The Caprini risk assessment model (RAM) is a method to stratify postoperative thromboembolism risk for consideration of prolonged preventive anticoagulation in higher-risk patients. Our aim was to examine the potential use of this model for reducing the VTE incidence in esophagectomy patients...
December 2015: Annals of Thoracic Surgery
Mathew Thomas, K Robert Shen
Coagulopathy and bleeding in thoracic surgery may be compounded by the chronic use of anticoagulants and antiplatelet agents. Timely preoperative cessation and postoperative resumption of these antithrombotic drugs are critical in reducing the risks of perioperative major bleeding and thromboembolism. This article describes the various strategies for the optimal perioperative management of antithrombotics based on individual assessment of each patient and the most recent multisociety guidelines.
August 2015: Thoracic Surgery Clinics
Marcello Di Nisio, Frank Peinemann, Ettore Porreca, Anne W S Rutjes
BACKGROUND: Cardiac and thoracic surgery are associated with an increased risk of venous thromboembolism (VTE). The safety and efficacy of primary thromboprophylaxis in patients undergoing these types of surgery is uncertain. OBJECTIVES: To assess the effects of primary thromboprophylaxis on the incidence of symptomatic VTE and major bleeding in patients undergoing cardiac or thoracic surgery. SEARCH METHODS: The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched May 2014) and CENTRAL (2014, Issue 4)...
2015: Cochrane Database of Systematic Reviews
Carolina Chic Acevedo, Francisco Velasco, Concepción Herrera
Rivaroxaban is a once-daily oral anticoagulant currently indicated for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. It is also indicated for the prevention and treatment of venous or pulmonary thromboembolism. Despite the known advantages of rivaroxaban over standard therapy, this treatment is not exempt from bleeding. We present the case of a 51-year-old woman with arterial hypertension and paroxysmal atrial fibrillation anticoagulated with rivaroxaban 20 mg o...
September 2015: Future Cardiology
Wezi Sendama, Mark Shipley
Chylothorax is a rare entity characterised by leakage of lymphatic fluid into the pleural cavity from the thoracic duct. We present a case of traumatic chylothorax following a traumatic fracture of the L1 vertebra. An 84-year-old lady presented to the emergency department after being found collapsed at home. She gave a preceding history of one day of diarrhoea. Chest X-ray showed a rightsided effusion. Drainage of the effusion yielded a cloudy, off-white fluid that settled in layers in the drainage container...
2015: Respiratory Medicine Case Reports
Cameron C Trenor, Jeremy G Fisher, Faraz A Khan, Eric A Sparks, Juliann Duzan, Kathy Harney, Brian Dillon, Matthew Menard, Biren P Modi
OBJECTIVE: To review the presentation, management, and outcomes of Paget-Schroetter syndrome (PSS) in children and propose a multidisciplinary treatment algorithm involving pediatric and vascular surgery, interventional radiology, and hematology. STUDY DESIGN: Patients with PSS presenting between 2003 and 2013 were reviewed. Demographics, symptoms, therapies, and functional outcomes were noted. Data from early patients informed the development of a multidisciplinary treatment algorithm applied to later patients...
June 2015: Journal of Pediatrics
Hiromitsu Domen, Kichizo Kaga, Yasuhiro Hida, Naotake Honma, Reiko Kubota, Yuki Yagi, Yoshiro Matsui
BACKGROUND: According to the aging in Japan, surgery of lung cancer with cardiovascular disease is increasing. Among them, the merger of the heart and large blood vessel disease would be expected to be directly linked to the perioperative management. MATERIALS AND METHODS: We conducted a retrospective analysis of 1,005 patients who had undergone surgical resection of primary lung adenocarcinoma between January 1997 and June 2014 at Hokkaido University Hospital. Among them, 81 patients had more than one cardiovascular disease...
April 2015: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Hironori Ishibashi, Katsutoshi Seto, Masatsugu Kobayashi, Kenichi Okubo
UNLABELLED: In patients with preoperative cardiac complications such as myocardial ischemia, arrhythmia, or congestive heart failure, it is important to offer any necessary medical treatments, such as anticoagulation therapy, prior to surgery. This study investigated the perioperative results of surgical treatment for primary lung cancer in patients with cardiac complications. Data relating to 467 patients who underwent lung resection for lung cancer between April 2010 and March 2014 were collected...
April 2015: Kyobu Geka. the Japanese Journal of Thoracic Surgery
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