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https://www.readbyqxmd.com/read/28231636/personalized-thromboprophylaxis-using-a-risk-score-for-the-management-of-pregnancies-with-high-risk-of-thrombosis-a-prospective-clinical-study
#1
Y Dargaud, L Rugeri, C Fleury, C Battie, P Gaucherand, C Huissoud, R C Rudigoz, H Desmurs-Clavel, J Ninet, M C Trzeciak
BACKGROUND: Patients with thrombophilia and/or a history of venous thromboembolism (VTE) are at risk of thrombosis during pregnancy. A risk score for pregnancies with increased risk of VTE was previously described by our group (Lyon-VTE-score). OBJECTIVES: The aim of this prospective study was to assess the efficacy and safety of our score-based prophylaxis strategy in 542 pregnancies managed between 2005 and 2015 in Lyon University Hospitals. PATIENTS/METHODS: Of 445 patients included in the study, 36 had several pregnancies during the study period...
February 23, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28230634/platelet-dysfunction-in-critically-ill-patients
#2
Travis Hase, Sarah Sirajuddin, Patrick Maluso, Raksha Bangalore, Louis DePalma, Babak Sarani
Thrombelastography Platelet Mapping (TEG-PM) allows for measurement of maximal potential clot strength (MA) and strength from stimulation of arachidonic acid (MA-AA) and adenosine disphosphate (MA-ADP) receptors. This study was conducted to assess degree of platelet dysfunction in critically ill adult patients. A retrospective study of critically ill, adult, nontrauma patients in a medical/surgical ICU was conducted from August 2013 to September 2014. All patients who underwent TEG-PM were enrolled. Patients with intracerebral hemorrhage, following cardiac surgery, or without an APACHE II score were excluded...
February 21, 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/28230248/effectiveness-of-early-administration-of-tranexamic-acid-in-patients-with-severe-trauma
#3
A Shiraishi, S Kushimoto, Y Otomo, H Matsui, A Hagiwara, K Murata
BACKGROUND: A reduction in mortality with the early use of tranexamic acid has been demonstrated in severely injured patients who are bleeding. However, the modest treatment effect with no reduction in blood transfusion has raised concerns. The aim of the present study was to estimate the effectiveness of regular use of tranexamic acid in severely injured patients. METHODS: This multicentre observational study used retrospectively collected data from consecutive injured patients (Injury Severity Score at least 16) treated in 15 Japanese academic institutions in 2012...
February 23, 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28229197/minimally-invasive-percutaneous-nephrolithotomy-vs-standard-pcnl-for-management-of-renal-stones-in-the-flank-free-modified-supine-position-single-center-experience
#4
Ahmed Sakr, Emad Salem, Mostafa Kamel, Esam Desoky, Ahmed Ragab, Mohamed Omran, Amr Fawzi, Ashraf Shahin
To assess the safety and efficacy of minimally invasive percutaneous nephrolithotomy (mPCNL) as compared to standard PCNL (sPCNL) for management of 2-3-cm renal stones in the flank-free modified supine position. Between September 2010 and December 2013, 150 patients (168 renal units) with 2-3-cm renal stones were prospectively randomized into two treatment groups; Group A (75 patients/87 renal units) treated by mPCNL and Group B (75 patients/81 renal units) treated by sPCNL. In both groups, the patients were placed in the flank-free modified supine position...
February 22, 2017: Urolithiasis
https://www.readbyqxmd.com/read/28226353/-comparison-of-complications-following-open-laparoscopic-and-robotic-gastrectomy
#5
Xin Lan, Hongqing Xi, Kecheng Zhang, Jianxin Cui, Mingsen Li, Lin Chen
OBJECTIVE: To compare clinically relevant postoperative complications after open, laparoscopic, and robotic gastrectomy for gastric cancer. METHODS: Clinical data of patients with gastric cancer who underwent gastrectomy between January 1, 2014 and October 1, 2016 at Chinese People's Liberation Army General Hospital were analyzed retrospectively. All the patients were diagnosed by upper endoscopy and confirmed by biopsy without distant metastasis. They were confirmed with R0 resection by postoperative pathology...
February 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/28225801/perioperative-hemoglobin-area-under-the-curve-is-an-independent-predictor-of-renal-failure-after-cardiac-surgery-results-from-a-spanish-multicenter-retrospective-cohort-study
#6
Paula Duque-Sosa, Diego Martínez-Urbistondo, Gemma Echarri, Raquel Callejas, María Josefa Iribarren, Gregorio Rábago, Pablo Monedero
Perioperative anemia is an important risk factor for cardiac surgery-associated acute kidney injury (CSA-AKI). Nonetheless, the severity of the anemia and the time in the perioperative period in which the hemoglobin level should be considered as a risk factor is conflicting. The present study introduces the concept of perioperative hemoglobin area under the curve (pHb-AUC) as a surrogate marker of the evolution of perioperative hemoglobin concentration. Through a retrospective analysis of prospectively collected data, we assessed this new variable as a risk factor for the development of acute kidney injury after cardiac surgery in 966 adult patients who underwent cardiac surgery with cardiopulmonary bypass, at twenty-three academic hospitals in Spain...
2017: PloS One
https://www.readbyqxmd.com/read/28225743/damage-control-resuscitation-in-patients-with-severe-traumatic-hemorrhage-a-practice-management-guideline-from-the-eastern-association-for-the-surgery-of-trauma
#7
Jeremy W Cannon, Mansoor A Khan, Ali S Raja, Mitchell J Cohen, John J Como, Bryan A Cotton, Joseph J Dubose, Erin E Fox, Kenji Inaba, Carlos J Rodriguez, John B Holcomb, Juan C Duchesne
BACKGROUND: The resuscitation of severely injured bleeding patients has evolved into a multi-modal strategy termed damage control resuscitation (DCR). This guideline evaluates several aspects of DCR including the role of massive transfusion (MT) protocols, the optimal target ratio of plasma (PLAS) and platelets (PLT) to red blood cells (RBC) during DCR, and the role of recombinant activated factor VII (rVIIa) and tranexamic acid (TXA). METHODS: Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, a subcommittee of the Practice Management Guidelines (PMG) Section of EAST conducted a systematic review using MEDLINE and EMBASE...
March 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28224766/thromboelastographic-evaluation-of-coagulation-in-patients-with-liver-disease
#8
Kyung Hwa Shin, In Suk Kim, Hyun Ji Lee, Hyung Hoi Kim, Chulhun L Chang, Young Mi Hong, Ki Tae Yoon, Mong Cho
BACKGROUND: The aims of this study were to investigate the parameters of thromboelastography (TEG) for evaluating coagulopathy and to reveal an association with disease severity and/or transfusion requirement in patients with chronic liver disease (CLD) in a clinical laboratory setting. METHODS: We enrolled two groups of adult patients with cirrhotic (N=123) and non-cirrhotic liver disease (N=52), as well as 84 healthy controls. Reaction time (R), kinetic time (K), α-angle (α), maximal amplitude (MA), and coagulation index (CI) were measured with kaolin-activated citrated blood with the TEG 5000 system (Haemonetics Corporation, USA)...
May 2017: Annals of Laboratory Medicine
https://www.readbyqxmd.com/read/28222991/perioperative-clopidogrel-is-associated-with-increased-bleeding-and-blood-transfusion-at-the-time-of-lower-extremity-bypass
#9
Douglas W Jones, Marc L Schermerhorn, Benjamin S Brooke, Mark F Conrad, Philip P Goodney, Mark C Wyers, David H Stone
OBJECTIVE: Controversy persists surrounding the perceived bleeding risk associated with perioperative clopidogrel use in patients undergoing lower extremity bypass (LEB). The purpose of this study was to examine the LEB bleeding risk and clinical sequelae associated with clopidogrel. METHODS: All LEBs in the Vascular Quality Initiative (VQI) from 2008 to 2014 were studied. The exposure was perioperative clopidogrel. Primary outcomes were blood transfusion, estimated blood loss ≥500 mL, and reoperation for bleeding...
February 17, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28222649/a-randomized-control-trial-to-evaluate-the-effectiveness-of-intravenous-intra-articular-and-topical-wash-regimes-of-tranexamic-acid-in-primary-total-knee-arthroplasty
#10
Jatin Prakash, Jong-Keun Seon, Yong Jin Park, Cheng Jin, Eun-Kyoo Song
BACKGROUND: The efficacy of tranexamic acid to decrease post-operative blood loss and blood transfusion is well established in literature. However, the ideal mode of administration is debatable. Limited literature has compared all the available modes of administration including intravenous (IV), topical irrigation and retrograde through drain. We hypothesized that no difference would be present in either form of administration of tranexamic acid. METHODS: Fifty patients in four groups were enrolled for study...
January 2017: Journal of Orthopaedic Surgery
https://www.readbyqxmd.com/read/28222238/thrombolysis-with-intravenous-recombinant-tissue-plasminogen-activator-during-early-postpartum-period-a-review-of-the-literature
#11
Munetoshi Akazawa, Makoto Nishida
Thromboembolic events are one of the leading causes of maternal death during the postpartum period. Postpartum thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) is controversial because the treatment may lead to massive bleeding. Data centralization may be beneficial for analyzing the safety and effectiveness of systemic thrombolysis during the early postpartum period. We performed a computerized MEDLINE and EMBASE search. We collected data for 13 cases of systemic thrombolytic therapy during the early postpartum period, when limiting the early postpartum period to 48 hours after delivery...
February 21, 2017: Acta Obstetricia et Gynecologica Scandinavica
https://www.readbyqxmd.com/read/28221207/aprotinin-vs-tranexamic-acid-in-isolated-coronary-artery-bypass-surgery-a-large-multicentre-observational-study
#12
Elsa Deloge, Julien Amour, Sophie Provenchère, Bertrand Rozec, Bruno Scherrer, Alexandre Ouattara
BACKGROUND: Aprotinin appears to be more efficacious than lysine analogues to reduce bleeding and transfusion of blood products in high-transfusion-risk cardiac surgical patients. However, in isolated coronary artery bypass graft (CABG) surgery, the results from head-to-head trials remain less conclusive. OBJECTIVE: Our objective was to compare the efficacies and safety of aprotinin and tranexamic acid (TXA) in patients undergoing isolated on-pump CABG. DESIGN: A large multicentre before-and-after study pooling individual data from published trials and unpublished data from three other databases...
February 17, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28220499/three-year-follow-up-of-implementation-of-evidence-based-transfusion-practice-in-a-tertiary-hospital
#13
A Norgaard, J Stensballe, T H de Lichtenberg, J O White, A Perner, M Wanscher, J Hillingsø, M L Holm, M Mau-Sørensen, H Sillesen, L Kjeldsen, C Bäck, J Nielsen, J Seeberg, M B Hansen, P I Johansson
BACKGROUND AND OBJECTIVES: Traditionally, Denmark has had a high rate of allogeneic red blood cell transfusion caused by a liberal transfusion practice despite the existence of restrictive guidelines. We established a Patient Blood Management programme in a tertiary hospital and report the results of the implementation of evidence-based transfusion practice. MATERIALS AND METHODS: Red blood cell transfusion quality indicators were compared with the evidence-based guideline at hospital and department level...
February 20, 2017: Vox Sanguinis
https://www.readbyqxmd.com/read/28219665/comparison-of-hospital-outcome-of-transcatheter-versus-surgical-aortic-valve-replacement-in-patients-with-diabetes-mellitus-from-the-nationwide-inpatient-sample
#14
Tomo Ando, Emmanuel Akintoye, Tesfaye Telila, Alexandros Briasoulis, Hisato Takagi, David P Slovut, Theodore Schreiber, Cindy L Grines, Luis Afonso
The comparative outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in diabetes mellitus (DM) patients are scarce. We aimed to assess and compare the outcomes of TAVR versus SAVR in DM patients using the Nationwide Inpatient Sample database from 2011 to 2013. A complete case analysis was performed for the multivariate analysis and cases with missing data were excluded. The primary end point was in-patient all-cause mortality and secondary outcomes were perioperative complications...
January 25, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28219635/direct-oral-anticoagulant-or-warfarin-related-major-bleeding-characteristics-reversal-strategies-and-outcomes-from-a-multi-center-observational-study
#15
Yan Xu, Sam Schulman, Dar Dowlatshahi, Anne M Holbrook, Christopher S Simpson, Lois E Shepherd, Philip S Wells, Antonio Giulivi, Tara Gomes, Muhammad Mamdani, Wayne Khuu, Eliot Frymire, Ana P Johnson
BACKGROUND: Direct oral anticoagulants (DOACs) have expanded the armamentarium for antithrombotic therapy. While DOAC-related major bleeds were associated with favourable outcomes compared to warfarin in clinical trials, warfarin was reversed in <40% of cases, raising concerns about the generalizability of this finding. METHODS: Consecutive patients ≥66 years presenting to five tertiary care hospitals across three cities in Ontario, Canada with diagnoses that included hemorrhage from October 2010 to March 2015...
February 17, 2017: Chest
https://www.readbyqxmd.com/read/28217301/risk-factors-for-perineal-wound-infection-after-abdominoperineal-resection-of-advanced-lower-rectal-cancer
#16
Takatoshi Nakamura, Takeo Sato, Kazushige Hayakawa, Yoko Takayama, Masanori Naito, Takahiro Yamanashi, Atsuko Tsutsui, Hirohisa Miura, Masahiko Watanabe
PURPOSE: Abdominoperineal resection (APR) of advanced lower rectal cancer carries a high incidence of perineal wound infection. The aim of this study was to retrospectively evaluate risk factors for perineal wound infection after APR. METHODS: The study group comprised 154 patients who underwent APR for advanced lower rectal cancer in our department from January 1990 through December 2012. The following 15 variables were studied as potential risk factors for perineal wound infection: sex, age, body-mass index, American Society of Anesthesiologists score, diabetes mellitus, preoperative albumin level, preoperative hemoglobin level, neoadjuvant chemoradiotherapy(NCRT), surgical procedure (open surgery vs...
March 2017: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/28213888/transfusion-in-critical-care-a-uk-regional-audit-of-current-practice
#17
J O M Plumb, M G Taylor, E Clissold, M P W Grocott, R Gill
A consistent message within critical care publications has been that a restrictive transfusion strategy is non-inferior, and possibly superior, to a liberal strategy for stable, non-bleeding critically ill patients. Translation into clinical practice has, however, been slow. Here, we describe the degree of adherence to UK best practice guidelines in a regional network of nine intensive care units within Wessex. All transfusions given during a 2-month period were included (n = 444). Those given for active bleeding or within 24 h of major surgery, trauma or gastrointestinal bleeding were excluded (n = 148)...
February 18, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28210867/management-and-outcome-of-gastrointestinal-bleeding-in-patients-taking-oral-anticoagulants-or-antiplatelet-drugs
#18
Sven Pannach, Julia Goetze, Sandra Marten, Thomas Schreier, Luise Tittl, Jan Beyer-Westendorf
BACKGROUND: Non-vitamin K dependent oral anticoagulants (NOACs) significantly decrease overall major bleeding rates compared with vitamin K antagonists (VKAs) but there is conflicting evidence regarding the relative risk of gastrointestinal bleeding. Since data regarding the types, the management, and the outcome of NOAC-associated gastrointestinal bleeding are scarce, we aimed to fill this gap by comparing cases of gastrointestinal bleeding associated with NOAC, VKA, or antiplatelet therapy...
February 16, 2017: Journal of Gastroenterology
https://www.readbyqxmd.com/read/28210010/evaluation-and-treatment-of-anemia-in-premature-infants
#19
Edo Hasanbegovic, Nermana Cengic, Snijezana Hasanbegovic, Jasmina Heljic, Ismail Lutolli, Edin Begic
INTRODUCTION: Anemia in preterm infants is the pathophysiological process with greater and more rapid decline in hemoglobin compared to the physiological anemia in infants. There is a need for transfusions and administration of human recombinant erythropoietin. AIM: To determine the frequency of anemia in premature infants at the Pediatric Clinic, University Clinical Center Sarajevo, as well as parameter values in the blood count of premature infants and to explore a relationship between blood transfusions with the advent of intraventricular hemorrhage (determine treatment outcome in preterm infants)...
December 2016: Medical Archives
https://www.readbyqxmd.com/read/28205386/nonvariceal-upper-gastrointestinal-bleeding-in-the-elderly-clinical-outcomes-and-prognostic-factors
#20
Josè Alberto González-González, Roberto Monreal-Robles, Diego García-Compean, Jonathan Paz-Delgadillo, Martín Wah-Suárez, Héctor Jesús Maldonado-Garza
AIM: To analyze the clinical characteristics, outcomes and prognostic factors in elderly patients with acute nonvariceal upper gastrointestinal bleeding (UGIB). METHODS: From a database prospectively collected from 2006 to 2013, the clinical characteristics and outcomes of patients aged 75 years or older consecutively admitted with acute nonvariceal UGIB undergoing upper gastrointestinal endoscopy were compared with those younger than 75 years. RESULTS: There were1136 patients included in the study; 276 (24...
February 16, 2017: Journal of Digestive Diseases
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