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Perioperative bridging

Christoffer C Jørgensen, Henrik Kehlet
Background - The benefit of preoperative bridging in surgical patients with continuous anticoagulant therapy is debatable, and drawing of meaningful conclusions may have been limited by mixed procedures with different thromboembolic and bleeding risks in most published studies. Patients and methods - This was an observational cohort treatment study in consecutive primary unilateral total hip and knee arthroplasty patients between January 2010 and November 2013 in 8 Danish fast-track departments. Data were collected prospectively on preoperative comorbidity and anticoagulants in patients with preoperative vitamin K antagonist (VKA) treatment...
October 19, 2016: Acta Orthopaedica
Nikhil Kumar, Christopher A Troianos, Joshua S Baisden
In this report, we present the case of a patient with biventricular noncompaction cardiomyopathy, Ebstein anomaly, and a left atrial mass who required emergent placement of a left ventricular assist device. The noncompaction cardiomyopathy complicated the left ventricular assist device implantation procedure because the thickened, trabeculated myocardium made it difficult to place the inflow cannula. We discuss our perioperative management strategy, in which transesophageal echocardiography was used, to help the surgical team identify the proper cannula placement and provide a bridge to transplantation...
October 5, 2016: A & A Case Reports
Steven L Cohn, Suparna Dutta, Barbara A Slawski, Paul J Grant, Gerald W Smetana
Recent studies have shed light on preoperative risk assessment, medical therapy to reduce postoperative cardiac complications (beta-blockers, statins, and angiotensin II receptor blockers [ARBs]), perioperative management of patients with coronary stents on antiplatelet therapy, and perioperative bridging anticoagulation.
October 2016: Cleveland Clinic Journal of Medicine
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
Ann Malley, Gary J Young
AIMS: To explore the issues and challenges of care transitions in the preoperative environment. BACKGROUND: Ineffective transitions play a role in a majority of serious medical errors. There is a paucity of research related to the preoperative arena and the multiple inherent transitions in care that occur there. DESIGN: Qualitative descriptive design was used. METHODS: Semi-structured interviews were conducted in a 975 bed academic medical center...
October 5, 2016: Journal of Clinical Nursing
Adriana D Oprea, Christopher J Noto, Thomas M Halaszynski
As a result of the aging US population and the subsequent increase in the prevalence of coronary disease and atrial fibrillation, therapeutic use of anticoagulants has increased. Perioperative and periprocedural management of anticoagulated patients has become routine for anesthesiologists, who frequently mediate communication between the prescribing physician and the surgeon and assess the risks of both thromboembolic complications and hemorrhage. Data from randomized clinical trials on perioperative management of antithrombotic therapy are lacking...
November 2016: Journal of Clinical Anesthesia
Ken Okumura, Kazutaka Aonuma, Koichiro Kumagai, Kenzo Hirao, Koichi Inoue, Masaomi Kimura, Yasushi Miyauchi, Eiki Tsushima
BACKGROUND: Catheter ablation (CA) is a common treatment for atrial fibrillation (AF). Although rivaroxaban is increasingly used as a substitute for warfarin, its safety and efficacy during CA have not been established in Japanese patients. In the present study we explored the efficacy/safety of rivaroxaban during the CA perioperative period.Methods and Results:We prospectively enrolled Japanese AF patients scheduled for CA who had received either rivaroxaban (rivaroxaban cohort, JACRE-R) or warfarin (warfarin cohort, JACRE-W) during the perioperative period...
September 29, 2016: Circulation Journal: Official Journal of the Japanese Circulation Society
(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
P Nadziakiewicz, J Pacholewicz, M Zakliczynski, T Niklewski, J Borkowski, T Hrapkowicz, M Zembala
BACKGROUND: Mechanical circulatory support is increasingly used in patients with heart failure as a bridge to transplant or recovery. Results of use the Polish POLVAD MEV pulsatile circulatory support system and its comparison with novel devices never was done. We compared the course of patients with left ventricular circulatory support (left ventricular assist device [LVAD]) supported by POLVAD MEV or continuous flow devices Heart Mate II (HM II) and Heart Ware (HW) in single-center cohort...
June 2016: Transplantation Proceedings
Kenta Okitsu, Takeshi Iritakenishi, Sho Carl Shibata, Keitaro Domae, Koichi Toda, Yoshiki Sawa, Yuji Fujino
Left ventricular assist device (LVAD) implantation is increasingly being used as a bridging therapy to heart transplantation. Infection is a major complication in patients with implanted LVADs, and it is associated with short- and long-term mortality. Surgical management for infection control is sometimes necessary; however, providing pain management during the surgical procedures is challenging. Anesthesiologists may be able to contribute to better pain management during surgical interventions to treat LVAD infections...
July 26, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Megan E Barra, John Fanikos, Marie D Gerhard-Herman, Deepak L Bhatt
BACKGROUND: Patients who have undergone intracoronary stent implantation often require surgery within the first year after the procedure. Planned or emergent surgical intervention requires interruption of antiplatelet therapy and is associated with an increased risk of stent thrombosis. Eptifibatide, an intravenous glycoprotein IIb/IIIa inhibitor (GPIIb/IIIa), can be considered for antiplatelet bridging of high-risk patients in the periprocedural period. OBJECTIVES: The aim of this report is to describe the management of antiplatelet therapy and outcomes of patients who were bridged with eptifibatide perioperatively within 1 year of intracoronary stent implantation...
September 2016: Critical Pathways in Cardiology
Roman Steckiewicz, Dariusz A Kosior, Marek Rosiak, Elżbieta Świętoń, Przemysław Stolarz, Marcin Grabowski
INTRODUCTION: The vast majority of cardiac implantable electronic device (CIED) recipients require transvenous lead insertion, which may be hindered by the presence of venous anomalies. The aim of this study was to determine the prevalence and variations of persistent left superior vena cava (PLSVC) and to conduct subsequent outpatient follow-up in terms of device function and the clinical condition of the recipients using data from CIED placement procedures conducted over a 12-year period...
March 2016: Hellenic Journal of Cardiology: HJC, Hellēnikē Kardiologikē Epitheōrēsē
Pınar Türker Duyuler, Serkan Duyuler, Ekrem Şahan, Şeref Alp Küçüker
Acute fulminant myocarditis is a life-threatening inflammatory disease of the myocardium characterized by the rapid deterioration of the hemodynamic status of the affected individual. With prompt recognition and appropriate management, complete recovery of ventricular function is likely within a few weeks. We introduce a 28-year-old man with acute fulminant myocarditis, who experienced circulatory collapse following acute angina and dyspnea. The patient had high troponin levels with low ejection fraction and normal coronary arteries...
January 13, 2016: Journal of Tehran Heart Center
V Maus, P Kurz, C M Sommer, A Massmann, A Hatopp, S Erpenbach, K Thomas, T Saalmüller, H Meißner, T Hupp, G M Richter
PURPOSE: The aim of this study was to evaluate the technical feasibility and short-time patency rate of iliac side branch devices based on the authors' institution's experience. MATERIALS AND METHODS: Data of 17 patients (all men) with an aortoiliac aneurysm (median age 72.5 years) who underwent endovascular repair between October 2013 and June 2015 (20 months) at our institution was analyzed retrospectively. Primary endpoint was primary technical success, defined as adequate implantation of the iliac branch device with patency of the hypogastric side branch without the need of further re-interventions within 30 days...
August 2016: RöFo: Fortschritte Auf Dem Gebiete der Röntgenstrahlen und der Nuklearmedizin
Minoru Ono, Yoshiki Sawa, Takeshi Nakatani, Ryuji Tominaga, Yoshiro Matsui, Kenji Yamazaki, Yoshikatsu Saiki, Hiroshi Niinami, Goro Matsumiya, Hirokuni Arai
BACKGROUND: The HeartMate II (HMII) continuous-flow LVAD was approved for Japanese health insurance coverage in April 2013 as a bridge to transplantation (BTT). We report on post-approval Japanese multicenter outcomes, and a comparison between patients with low and high body surface area (BSA). METHODS AND RESULTS: HMII LVAD was implanted in 104 consecutive patients at 15 Japanese centers between April 2013 and July 2014. Perioperative data were submitted to the Japanese Registry for Mechanically Assisted Circulatory Support...
August 25, 2016: Circulation Journal: Official Journal of the Japanese Circulation Society
Lukas Pollert, Zuzana Prikrylova, Jan Berousek, Frantisek Mosna, Robert Lischke
BACKGROUND: Lung transplantation is considered an established treatment for patients with end-stage chronic respiratory failure. Patients with acute respiratory failure requiring respiratory support with invasive mechanical ventilation while awaiting lung transplantation are at high risk of death. Extracorporeal membrane oxygenation (ECMO) has been proposed as an alternative bridging strategy to mechanical ventilation. The shear stress created by the mechanical pumps causes changes in the hematological system in almost all patients treated with ECMO...
2016: Therapeutics and Clinical Risk Management
Bantayehu Sileshi, Brian K O'Hara, Mary E Davis, Nicholas A Haglund, Xu Meng, Robert Deegan, John M Stulak, Sudhir S Kushwaha, Andrew Shaw, Simon Maltais
As ventricular-assist devices (VADs) are increasingly employed in heart failure management, a leading cause of mortality, new literature is consistently published on less-invasive implantation techniques. Although early perioperative outcomes have been shown to be favorable with minimally invasive left thoracotomy (LT) approaches compared with conventional sternotomy (CS), studies comparing long-term outcomes are lacking. We set out to evaluate long-term follow up between LT and CS approach. In a single center, retrospective review, data on patients with similar demographic profiles were collected...
September 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Cigdem Benlice, Meagan Costedio, Luca Stocchi, Maher A Abbas, Emre Gorgun
BACKGROUND: Perioperative outcomes of patients who underwent hand-assisted colorectal laparoscopic (HALS) vs open colectomy were compared using recently released procedure-targeted database. METHODS: Review was conducted using the 2012 colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database. Patients were classified into 2 groups according to final surgical approach: HALS vs open (planned). Groups were matched (1:1) based on age, gender, body mass index, surgical procedure, diagnosis, American Society of Anesthesiologists score, and wound classification...
May 7, 2016: American Journal of Surgery
Roland Tilz, Serge Boveda, Jean-Claude Deharo, Dan Dobreanu, Kristina H Haugaa, Nikolaos Dagres
The aim of this EP Wire was to assess the management, indications, and techniques for implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) device replacement in Europe. A total of 24 centres in 14 European countries completed the questionnaire. All centres were members of the European Heart Rhythm Association Electrophysiology Research Network. Replacement procedures were performed by electrophysiologists in 52% of the centres, by cardiologists in 33%, and both in the remaining centres...
June 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Karam Ayoub, Ramez Nairooz, Ahmed Almomani, Meera Marji, Hakan Paydak, Waddah Maskoun
BACKGROUND: Patients with atrial fibrillation (AF) often require temporary interruption of warfarin for an elective operation or invasive procedure. However, the safety and efficacy of periprocedural bridging anticoagulation with unfractionated heparin (UH) or low-molecular-weight heparin (LMWH) are still unclear. We evaluated the safety of periprocedural heparin bridging in AF patients requiring temporary interruption of oral anticoagulation. METHODS: We searched the literature for trials that compared heparin bridging with no bridging in AF patients for whom warfarin was temporarily interrupted...
September 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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