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Perioperative anticoagulation

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https://www.readbyqxmd.com/read/29146276/perioperative-management-of-oral-anticoagulation-in-patients-undergoing-implantation-of-subcutaneous-implantatble-defibrillator
#1
Muhammad R Afzal, Divyesh Mehta, Christopher Evenson, Daniel Pinkhas, Auroa Badin, Dilesh Patel, Michael K Essandoh, Hemant Godara, Jaret Tyler, Mahmoud Houmsse, Zhenguo Liu, Steven J Kalbfleisch, John D Hummel, Ralph Augostini, Raul Weiss, Emile G Daoud, Toshimasa Okabe
BACKGROUND: The perioperative anticoagulation management for subcutaneous implantable cardioverter defibrillator (S-ICD) is still evolving. OBJECTIVE: To assess whether it is safe to perform S-ICD implantation with uninterrupted warfarin. METHODS: This is a single-center retrospective review of patients undergoing S-ICD implantation during 10/2012 to 6/2017. The most common indication for the implantation was primary prevention of sudden cardiac death...
November 13, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/29145278/safety-of-continuing-aspirin-therapy-during-spinal-surgery-a-systematic-review-and-meta-analysis
#2
Chenggui Zhang, Guodong Wang, Xiaoyang Liu, Yang Li, Jianmin Sun
BACKGROUND: Questions whether to continue or discontinue aspirin administration in the perioperative period of spinal surgery has not been systematically evaluated. OBJECTIVE: The present systematic review is carried out to assess the impact of continuing aspirin administration on the bleeding and cardiovascular events in perispinal surgery period. METHODS: Studies were retrieved through MEDLINE, EMBASE, and Springer Link Databases (search terms, aspirin, continue or discontinue, and spinal fusion), bibliographies of the articles retrieved, and the authors' reference files...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29138143/minimally-invasive-stand-alone-cox-maze-procedure-for-persistent-and-long-standing-persistent-atrial-fibrillation-perioperative-safety-and-5-year-outcomes
#3
Niv Ad, Sari D Holmes, Ted Friehling
BACKGROUND: Rhythm control is challenging in patients with extended atrial fibrillation (AF) duration and persistent/long-standing persistent AF. Among surgical approaches to treat AF, the Cox maze procedure performed using alternative energy sources remains superior to other beating heart techniques. We examined permanence of safety and success for the on-pump, minimally invasive, stand-alone Cox maze procedure 5 years after surgery. METHODS AND RESULTS: Stand-alone, right 5 cm minithoracotomy, Cox maze III/IV procedure for nonparoxysmal AF was conducted in 133 patients (mean follow-up=65±34 months)...
November 2017: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/29136561/calibrated-automated-thrombogram-values-in-infants-with-cardiac-surgery-before-and-after-cardiopulmonary-bypass
#4
Alessandra Rizza, Giovina Di Felice, Rosa Luciano, Ottavia Porzio, Ombretta Panizzon, Maurizio Muraca, Paola Cogo
INTRODUCTION: Impaired thrombin generation has been associated to increase bleeding after cardiac surgery with cardiopulmonary bypass (CPB), especially in children. The aim of this study was to evaluate standard coagulation assay, thrombin generation by calibrated automated thrombogram (CAT), thromboelastography (TEG) and procoagulant phospholipids (PPL) activity in infants undergoing cardiac surgery with CPB. MATERIALS AND METHODS: Prospective observational study performed in children aged <24months undergoing cardiac surgery with CPB...
September 21, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/29121841/prophylactic-inferior-vena-cava-filter-utilization-and-risk-factors-for-nonretrieval
#5
Jordan R Stern, Danielle E Cafasso, Andrew J Meltzer, Darren B Schneider, Sharif H Ellozy, Peter H Connolly
PURPOSE: Inferior vena cava filters (IVCFs) are often placed for prophylactic indications. We sought to better define the range of practice indications for placement of prophylactic IVCFs, as well as the specific retrieval rate and risk factors for nonretrieval. METHODS: A retrospective, single-institution review of patients undergoing IVCF placement over a 2-year period was performed. Patients undergoing prophylactic IVCF placement were selected from a prospectively collected database...
January 1, 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29121664/does-preoperative-mechanical-prophylaxis-have-additional-effectiveness-in-preventing-postoperative-venous-thromboembolism-in-elderly-patients-with-hip-fracture-retrospective-case-control-study
#6
Ji-Hoon Nam, Dae-Hwan Kim, Je-Hyun Yoo, Ji-Hyo Hwang, Jun-Dong Chang
BACKGROUND: Elderly patients undergoing hip fracture surgery (HFS) are at increased risk of postoperative venous thromboembolism (VTE). To reduce this risk, combined postoperative mechanical and chemical thromboprophylaxis has been routinely performed after HFS in these patients. This retrospective case-control study was conducted to evaluate the additional effectiveness of preoperative mechanical thromboprophylaxis for the prevention of VTE following HFS in elderly patients. METHODS: Of 539 consecutive patients aged 70 years or older undergoing HFS, 404 (control group) did not receive preoperative mechanical thromboprophylaxis, while 135 (study group) received mechanical thromboprophylaxis using an intermittent pneumatic compression device and graduated compression stockings from the time of admission until surgery...
2017: PloS One
https://www.readbyqxmd.com/read/29117993/an-update-on-the-bleeding-risks-associated-with-doacs
#7
(no author information available yet)
The direct oral anticoagulants (DOACs), also referred to as novel (or non-vitamin K antagonist) oral anticoagulants (NOACs), represent a major development in anticoagulation therapy due to their rapid onset of action, predictable dose-response with fixed doses and limited interactions with food and drugs.(1,2) However, these agents have been in widespread clinical use for less than a decade and, compared with extensive experience with warfarin, there is uncertainty relating to optimal laboratory monitoring of anticoagulation, perioperative management and treatment of bleeding...
November 2017: Drug and Therapeutics Bulletin
https://www.readbyqxmd.com/read/29112549/european-guidelines-on-perioperative-venous-thromboembolism-prophylaxis-patients-with-preexisting-coagulation-disorders-and-after-severe-perioperative-bleeding
#8
Aamer Ahmed, Sibylle Kozek-Langenecker, François Mullier, Sue Pavord, Cedric Hermans
: In patients with inherited bleeding disorders undergoing surgery, we recommend assessment of individual risk for venous thromboembolism, taking into account the nature of the surgery and anaesthetic, type and severity of bleeding disorder, age, BMI, history of thrombosis, the presence of malignancy and other high-risk comorbidities. Venous thromboembolism risk should be balanced against the increased bleeding risk associated with anticoagulant use in patients with known bleeding disorders (Grade 1C). In these patients undergoing major surgery, we recommend against routine postoperative use of pharmacological thromboprophylaxis, especially for patients with haemophilia A and B (Grade 1B)...
November 6, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29112547/european-guidelines-on-perioperative-venous-thromboembolism-prophylaxis-chronic-treatments-with-antiplatelet-agents
#9
Juan V Llau, Pieter Kamphuisen, Pierre Albaladejo
: Antiplatelet agents (APA) are considered first-line therapy in preventing cardiovascular thrombotic events, but they are of limited value in the prophylaxis of venous thromboembolism (VTE) during the perioperative period. Consequently, many patients should receive both an APA and an anticoagulant. This combination can increase the bleeding risk and it is necessary to make some recommendations to minimise that risk. In patients receiving APA chronically, if the risk of VTE outweighs the risk of bleeding, we suggest pharmacological prophylaxis (grade 2C)...
November 6, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29112546/european-guidelines-on-perioperative-venous-thromboembolism-prophylaxis-surgery-in-the-obese-patient
#10
Linas Venclauskas, Almantas Maleckas, Juan I Arcelus
: A systematic literature search was performed and patients were selected as obese patients undergoing bariatric surgery or obese patients undergoing nonbariatric surgical procedures. In addition, patients were stratified according to low risk of venous thromboembolism and high risk of venous thromboembolism (age >55 years, BMI >55 kg m, history of venous thromboembolism, venous disease, sleep apnoea, hypercoagulability or pulmonary hypertension). Prophylaxis of venous thromboembolism was analysed depending on the type of modality: compression devices of the lower extremities (including intermittent pneumatic compression and graduated compression stockings), pharmacological prophylaxis or inferior vena cava filters...
November 6, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29112545/european-guidelines-on-perioperative-venous-thromboembolism-prophylaxis-intensive-care
#11
Jacques Duranteau, Fabio Silvio Taccone, Peter Verhamme, Walter Ageno
: Venous thromboembolism is a common and potentially life-threatening complication that occurs in 4 to 15% of patients admitted to ICUs despite the routine use of pharmacological prophylaxis. We therefore recommend an institution-wide protocol for the prevention of venous thromboembolism (Grade 1B). The routine use of ultrasonographic screening for deep vein thrombosis is not recommended when thromboprophylactic measures are in place (Grade 1B), as the detection of asymptomatic deep vein thrombosis may prompt therapeutic anticoagulation that may increase bleeding risk but has no proven reduction of clinically significant thrombotic events...
November 6, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29112543/european-guidelines-on-perioperative-venous-thromboembolism-prophylaxis-surgery-during-pregnancy-and-the-immediate-postpartum-period
#12
Anne-Sophie Ducloy-Bouthors, Andrea Baldini, Rezan Abdul-Kadir, Jacky Nizard
: Thromboembolic events in the pregnant and postpartum patient remain rare but potentially fatal complications. The aim of this section was to analyse the few prospective studies addressing the issue of thromboprophylaxis following a surgical procedure during and immediately after pregnancy, as well as national guidelines, and to propose European guidelines on this specific condition. Thromboprophylaxis is broadly recommended due to the combined risks of surgery and pregnancy or the postpartum period, regardless of the mode of delivery...
November 6, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29100876/preoperative-antiplatelet-and-statin-use-does-not-affect-outcomes-after-carotid-endarterectomy
#13
Brianna M Krafcik, Alik Farber, Robert T Eberhardt, Jeffrey A Kalish, Denis Rybin, Gheorghe Doros, Steven L Pike, Jeffrey J Siracuse
OBJECTIVE: The use of statin and antiplatelet medications has been advocated in patients with cerebrovascular disease as primary medical therapy and as an adjunct to carotid endarterectomy (CEA). Our goal was to assess the prevalence of preoperative statin and antiplatelet use and its effect on perioperative outcomes after CEA. METHODS: The American College of Surgeons National Surgical Quality Improvement Program targeted CEA database was queried for patients undergoing CEA between 2011 and 2014...
October 31, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29095764/oral-surgery-in-patients-under-antithrombotic-therapy-perioperative-bleeding-as-a-significant-risk-factor-for-postoperative-hemorrhage
#14
Amanda L Rocha, Alessandra F Souza, Maria A P Martins, Marina G Fraga, Denise V Travassos, Ana C B Oliveira, Daniel D Ribeiro, Tarcília A Silva
: To investigate perioperative and postoperative bleeding, complications in patients under therapy with anticoagulant or antiplatelet drugs submitted to oral surgery. To evaluate the risk of bleeding and safety for dental surgery, a retrospective chart review was performed. Medical and dental records of patients taking oral antithrombotic drugs undergoing dental surgery between 2010 and 2015 were reviewed. Results were statistically analyzed using Fisher's exact test, t test or the χ test. One hundred and seventy-nine patients underwent 293 surgical procedures...
October 31, 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/29088960/acute-subdural-hematoma-in-patients-on-oral-anticoagulant-therapy-management-and-outcome
#15
Sae-Yeon Won, Daniel Dubinski, Markus Bruder, Adriano Cattani, Volker Seifert, Juergen Konczalla
OBJECTIVE Isolated acute subdural hematoma (aSDH) is increasing in older populations and so is the use of oral anticoagulant therapy (OAT). The dramatic increase of OAT-with direct oral anticoagulants (DOACs) as well as with conventional anticoagulants-is leading to changes in the care of patients who present with aSDH while receiving OAT. The purpose of this study was to determine the management and outcome of patients being treated with OAT at the time of aSDH presentation. METHODS In this single-center, retrospective study, the authors analyzed 116 consecutive cases involving patients with aSDH treated from January 2007 to June 2016...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29088950/neurosurgical-applications-of-viscoelastic-hemostatic-assays
#16
Svetlana Kvint, James Schuster, Monisha A Kumar
Patients taking antithrombotic agents are very common in neurosurgical practice. The perioperative management of these patients can be extremely challenging especially as newer agents, with poorly defined laboratory monitoring and reversal strategies, become more prevalent. This is especially true with emergent cases in which rapid reversal of anticoagulation is required and the patient's exact medical history is not available. With an aging patient population and the associated increase in diseases such as atrial fibrillation, it is expected that the use of these agents will continue to rise in coming years...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29064875/perioperative-patient-blood-management-to-improve-outcomes
#17
Neel Desai, Nick Schofield, Toby Richards
Anemia is common in elective surgery and is an independent risk factor for morbidity and mortality. Historical management of anemia has focused on the use of allogeneic blood transfusion but this in itself is not without risk. It too has been independently associated with morbidity and mortality, let alone the costs and relative shortage of this resource. In recognition of this, patient blood management (PBM) shifts the focus from the product to the patient and views the patient's own blood as a resource that should be conserved and managed appropriately as a standard of care...
October 19, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29054780/safe-burr-hole-surgery-for-chronic-subdural-hematoma-using-dabigatran-with-idarucizumab
#18
Nobuhiko Arai, Yutaka Mine, Hiroshi Kagami, Michiyuki Maruyama, Jun Daiko, Makoto Inaba
BACKGROUND: Chronic subdural hematoma (CSDH) is a common intracranial hematoma. The number of patients who undergo anticoagulant therapy including a direct oral anticoagulant (DOAC) is expected to increase. Recently, idarucizumab, the antidote for dabigatran, which is a DOAC, has been developed. We successfully treated CSDH with dabigatran using emergency burr hole surgery and idarucizumab. CASE DESCRIPTION: A 79-year-old Japanese man severely hit his head and visited the emergency room (ER)...
October 17, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29049708/two-staged-hybrid-ablation-of-non-paroxysmal-atrial-fibrillation-clinical-outcomes-and-functional-improvements-after-1%C3%A2-year
#19
Petr Budera, Pavel Osmancik, David Talavera, Anna Kraupnerova, Richard Fojt, Jana Zdarska, Tomas Vanek, Zbynek Straka
OBJECTIVES: Hybrid ablation of atrial fibrillation (AF) is a promising treatment strategy; however, data regarding its efficacy and safety are still limited. METHODS: Patients with non-paroxysmal AF were enrolled. First, a thoracoscopic, epicardial isolation of pulmonary veins and the left atrial posterior wall ('box lesion') was performed; a novel unipolar/bipolar radiofrequency device was used. Moreover, in 12 patients enrolled thereafter, the left atrial appendage was occluded...
July 31, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29046768/smartphones-and-e-tablets-in-perioperative-medicine
#20
REVIEW
Frederic Michard
Smartphones and electronic tablets (e-tablets) have become ubiquitous devices. Their ease of use, smartness, accessibility, mobility and connectivity create unique opportunities to improve quality of surgical care from prehabilitation to rehabilitation. Before surgery, digital applications (Apps), serious games and text messaging may help for a better control of risk factors (hypertension, overweight), for smoking cessation, and for optimizing adherence to preoperative recommendations (e.g., regarding anticoagulation or antihypertensive treatments)...
October 2017: Korean Journal of Anesthesiology
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