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Cirrhosis anticoagulation

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https://www.readbyqxmd.com/read/28091770/relevance-of-surgery-in-patients-with-non-variceal-upper-gastrointestinal-bleeding
#1
S Dango, T Beißbarth, E Weiss, A Seif Amir Hosseini, D Raddatz, V Ellenrieder, J Lotz, B M Ghadimi, A Beham
INTRODUCTION: Upper GI bleeding remains one of the most common emergencies with a substantial overall mortality rate of up to 30%. In severe ill patients, death does not occur due to failure of hemostasis, either medical or surgical, but mainly from comorbidities, treatment complications, and decreased tolerated blood loss. Management strategies have changed dramatically over the last two decades and include primarily endoscopic intervention in combination with acid-suppressive therapy and decrease in surgical intervention...
January 14, 2017: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/28073690/citrate-pathophysiology-and-metabolism
#2
REVIEW
Mehran Monchi
By chelating ionized calcium, citrate allows extracorporeal circuit anticoagulation without a bleeding risk for the patient. Citrate anticoagulation is also associated with a reduced activation of leucocytes and platelets. Citrate clearance by citric acid cycle (Krebs cycle) is not modified by renal failure, but is reduced by about 50% in patients with cirrhosis. Toxic effects of citrate result from a decrease in plasma ionized calcium of the patient. The first side effect is a prolongation of the QT interval...
December 30, 2016: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/28029598/perioperative-outcome-of-laparoscopic-sleeve-gastrectomy-for-high-risk-patients
#3
Yves Borbély, Olivier Juilland, Julia Altmeier, Dino Kröll, Philipp C Nett
BACKGROUND: Morbidly obese patients with excessive concomitant disease carry a significantly increased perioperative risk. Although they may benefit most from a bariatric intervention, they are often denied surgery. Laparoscopic sleeve gastrectomy (LSG), as it is less complication-prone than other bariatric procedures, suits the needs of those patients. OBJECTIVE: To review the short-term outcome of LSG for high-risk patients SETTING: University hospital, Switzerland...
August 26, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/28026110/reversal-of-direct-oral-anticoagulants-for-liver-transplantation-in-cirrhosis-a-step-forward
#4
N M Intagliata, H Maitland, S Pellitier, S H Caldwell
No abstract text is available yet for this article.
December 27, 2016: Liver Transplantation
https://www.readbyqxmd.com/read/28009449/the-efficacy-and-safety-of-direct-oral-anticoagulants-vs-traditional-anticoagulants-in-cirrhosis
#5
Justine Hum, Joseph J Shatzel, Janice H Jou, Thomas G Deloughery
INTRODUCTION: The coagulopathy of cirrhosis is complex, placing patients at risk for both bleeding and thrombosis. Direct oral anticoagulants (DOACs) have equivalent or superior efficacy and safety as compared to vitamin K antagonists (VKA); however, their efficacy and safety in liver cirrhosis has not been studied. To better define this, we evaluated outcomes of cirrhotic patients prescribed DOACS compared to other anticoagulants at our center. METHODS: Retrospective cohort study of cirrhotic patients prescribed therapeutic anticoagulation over a 3 year period for thrombosis or prevention of stroke in patients with atrial fibrillation...
December 23, 2016: European Journal of Haematology
https://www.readbyqxmd.com/read/27912035/failure-to-rescue-after-infectious-complications-in-a-statewide-trauma-system
#6
Elinore J Kaufman, Emily Earl-Royal, Philip S Barie, Daniel N Holena
BACKGROUND: The failure to rescue (FTR) rate, the rate of death after a complication, measures a center's ability to identify and manage complications by "rescuing" vulnerable patients. Infectious complications are common after trauma, but risk factors for death after infection are not established. We hypothesized that risk factors would differ for FTR after infectious complications, development of infections, and for development of and death after non-infectious complications. PATIENTS AND METHODS: We analyzed trauma registry data for adult patients admitted to all 30 level I and II Pennsylvania trauma centers, 2011-2014...
December 2, 2016: Surgical Infections
https://www.readbyqxmd.com/read/27899521/venous-thrombotic-events-after-liver-transplantation
#7
Annabel Blasi, Virginia Hernandez, Javier Fernandez, Jordi Colmenero, Joan Beltran, Juan Carlos Garcia-Valdecasas, Joan Carles Reverter
Thromboprophylaxis is not well defined after liver transplantation (LT). The aim of this study was to evaluate the incidence of splanchnic vein thrombosis (SVT) and nonsplanchnic vein thrombosis (NSVT) after LT. Liver transplantations performed between 2009 and 2013 in our institution were reviewed. Demographic, intraoperative, and postoperative data were recorded. Low-molecular-weight heparin was only administered postoperatively if intraoperative thrombectomy was performed or in patients preoperatively anticoagulated...
November 28, 2016: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/27880998/recurrent-acute-portal-vein-thrombosis-in-liver-cirrhosis-treated-by-rivaroxaban
#8
Hyeyoung Yang, Seo Ree Kim, Myeong Jun Song
Cirrhosis can occur with the development of portal vein thrombosis (PVT). PVT may aggravate portal hypertension, and it can lead to hepatic decompensation. The international guideline recommends for anticoagulation treatment to be maintained for at least 3 months in all patients with acute PVT. Low-molecular-weight-heparin and changing to warfarin is the usual anticoagulation treatment. However, warfarin therapy is problematic due to a narrow therapeutic window and the requirement for frequent dose adjustment, which has prompted the development of novel oral anticoagulants for overcoming these problems...
December 2016: Clinical and Molecular Hepatology
https://www.readbyqxmd.com/read/27778440/antithrombotic-treatment-with-direct-acting-oral-anticoagulants-in-patients-with-splanchnic-vein-thrombosis-and-cirrhosis
#9
Andrea De Gottardi, Jonel Trebicka, Christoph Klinger, Aurélie Plessier, Susana Seijo, Benedetta Terziroli, Lorenzo Magenta, David Semela, Elisabetta Buscarini, Philippe Langlet, Jan Görtzen, Angela Puente, Beat Müllhaupt, Carmen Navascuès, Filipe Nery, Pierre Deltenre, Fanny Turon, Cornelius Engelmann, Rupen Arya, Karel Caca, Markus Peck-Radosavljevic, Frank W G Leebeek, Dominique Valla, Juan Carlos Garcia-Pagan
BACKGROUND: Direct-acting oral anticoagulants (DOACs) are used in patients with splanchnic vein thrombosis (SVT) and cirrhosis, but evidence for safety and efficacy in this setting is limited. Our aim was to identify indications and reasons for starting or switching to DOACs and to report adverse effects, complications and short-term outcome. METHODS: Data collection including demographic information, laboratory values, treatment and complications through the Vascular Liver Disease Interest Group Consortium...
October 25, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/27740524/portal-vein-thrombosis-in-patients-with-cirrhosis-just-a-common-finding-or-a-predictor-of-poor-outcome
#10
Omar D Borjas-Almaguer, Carlos A Cortez-Hernández, Emmanuel I González-Moreno, Francisco J Bosques-Padilla, José A González-González, Aldo A Garza, Juan A Martínez-Segura, Diego García-Compean, Juan V Alejandre-Loya, Jesús García-García, Guillermo Delgado-García, Héctor J Maldonado-Garza
:  Background & Aims. It is unclear whether portal vein thrombosis (PVT) unrelated to malignancy is associated with reduced survival or it is an epiphenomenon of advanced cirrhosis. The objective of this study was to assess clinical outcome in cirrhotic patients with PVT not associated with malignancy and determine its prevalence. MATERIAL AND METHODS: Retrospective search in one center from June 2011 to December 2014. RESULTS: 169 patients, 55 women and 114 men, median age 54 (19-90) years...
November 2016: Annals of Hepatology
https://www.readbyqxmd.com/read/27716978/influence-of-successful-chronic-hepatitis-c-virus-treatment-with-ledipasvir-sofosbuvir-on-warfarin-dosing-requirements-in-four-veterans
#11
Sara R Britnell, Amy E Willets, Adam J Vanderman, Catherine L Woodard, Rachel B Britt
STUDY OBJECTIVE: To describe international normalized ratio (INR) trends and warfarin dosage adjustments required for four veterans who were receiving warfarin therapy and started treatment for hepatitis C virus (HCV) with ledipasvir/sofosbuvir with or without ribavirin. DESIGN: Case series. SETTING: Pharmacist-led anticoagulation clinic in a Veterans Affairs Health Care System. PATIENTS: Four patients aged 59-66 years who were receiving warfarin and had stable, therapeutic INRs and started ledipasvir/sofosbuvir therapy with or without ribavirin for HCV infection...
October 7, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27683637/thromboelastographic-reference-ranges-for-a-cirrhotic-patient-population-undergoing-liver-transplantation
#12
Lesley De Pietri, Marcello Bianchini, Gianluca Rompianesi, Elisabetta Bertellini, Bruno Begliomini
AIM: To describe the thromboelastography (TEG) "reference" values within a population of liver transplant (LT) candidates that underline the differences from healthy patients. METHODS: Between 2000 and 2013, 261 liver transplant patients with a model for end-stage liver disease (MELD) score between 15 and 40 were studied. In particular the adult patients (aged 18-70 years) underwent to a first LT with a MELD score between 15 and 40 were included, while all patients with acute liver failure, congenital bleeding disorders, and anticoagulant and/or antiplatelet drug use were excluded...
September 24, 2016: World Journal of Transplantation
https://www.readbyqxmd.com/read/27470055/coagulation-parameters-in-patients-with-cirrhosis-and-portal-vein-thrombosis-treated-sequentially-with-low-molecular-weight-heparin-and-vitamin-k-antagonists
#13
Armando Tripodi, Massimo Primignani, Simon Braham, Veena Chantarangkul, Marigrazia Clerici, Marco Moia, Flora Peyvandi
BACKGROUND/AIMS: Information on coagulation for cirrhotics on anticoagulants is scanty. We investigated plasma from 23 cirrhotics treated with low-molecular-weight-heparin (LMWH) followed by vitamin K antagonists (VKA). METHODS: On days 1-4 patients received full-dose LMWH. On day-5 VKA was started and LMWH was terminated when INR therapeutic-interval was reached. Blood was collected at peak and trough during LMWH, LMWH+VKA and VKA. Non-cirrhotics on VKA were included as controls...
October 2016: Digestive and Liver Disease
https://www.readbyqxmd.com/read/27416950/increased-soluble-gpvi-levels-in-cirrhosis-evidence-for-early-in-vivo-platelet-activation
#14
Karl Egan, Audrey Dillon, Eimear Dunne, Barry Kevane, Zita Galvin, Patricia Maguire, Dermot Kenny, Stephen Stewart, Fionnuala Ni Ainle
Cirrhosis is a consequence of prolonged liver injury and is characterised by extensive tissue fibrosis: the deposition of collagen-rich extracellular matrix. The haemostatic balance is disordered in cirrhosis and coagulation activation appears to promote fibrosis. In spite of recent studies demonstrating a role for anticoagulant therapy in preventing cirrhosis progression, there has not been a change in clinical practice, suggesting that physicians are reluctant to anticoagulate patients with cirrhosis due to bleeding risks...
July 14, 2016: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/27375806/axillobifemoral-bypass-for-aortitis-syndrome-in-a-living-donor-liver-transplant-patient
#15
Naoto Fukunaga, Kenji Uryuhara, Tadaaki Koyama
A 64-year-old female patient with aortitis syndrome presented with progressive intermittent claudication for 6 months. Her medical history was notable for living-donor liver transplantation for primary biliary cirrhosis 4-years prior and chronic immunosuppressive therapy. Evaluation included normal laboratory examination, and contrast-enhanced computed tomography angiography which demonstrated severely calcified descending aorta with high-grade stenosis below the diaphragm. The patient was treated by axillobifemoral bypass using an 8-mm ringed expanded polytetrafluoroethylene graft under general anesthesia...
2016: Annals of Vascular Diseases
https://www.readbyqxmd.com/read/27302378/preserved-hemostatic-status-in-patients-with-non-alcoholic-fatty-liver-disease
#16
Wilma Potze, Mohammad S Siddiqui, Sherry L Boyett, Jelle Adelmeijer, Kalyani Daita, Arun J Sanyal, Ton Lisman
BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of thrombosis. However, it remains unclear if hypercoagulability contributes to this risk. We, therefore, determined an in-depth hemostatic profile in a cohort of well-defined patients with NAFLD. METHODS: We drew blood samples from 68 patients with biopsy-proven NAFLD (simple steatosis n=24, NASH n=22, and NASH cirrhosis n=22), 30 lean controls, 30 overweight controls (body mass index (BMI) >25kg/m(2)), and 15 patients with alcoholic (ASH) cirrhosis, and performed in-depth hemostatic profiling...
November 2016: Journal of Hepatology
https://www.readbyqxmd.com/read/27289254/medical-complications-following-splenectomy
#17
R Buzelé, L Barbier, A Sauvanet, B Fantin
Splenectomy is attended by medical complications, principally infectious and thromboembolic; the frequency of complications varies with the conditions that led to splenectomy (hematologic splenectomy, trauma, presence of portal hypertension). Most infectious complications are caused by encapsulated bacteria (Meningococcus, Pneumococcus, Hemophilus). These occur mainly in children and somewhat less commonly in adults within the first two years following splenectomy. Post-splenectomy infections are potentially severe with overwhelming post-splenectomy infection (OPSI) and this justifies preventive measures (prophylactic antibiotics, appropriate immunizations, patient education) and demands prompt antibiotic management with third-generation cephalosporins for any post-splenectomy fever...
August 2016: Journal of Visceral Surgery
https://www.readbyqxmd.com/read/27264036/clinical-history-and-antithrombotic-treatment-of-incidentally-detected-splanchnic-vein-thrombosis-a-multicentre-international-prospective-registry
#18
Nicoletta Riva, Walter Ageno, Sam Schulman, Jan Beyer-Westendorf, Rita Duce, Alessandra Malato, Rita Santoro, Daniela Poli, Peter Verhamme, Ida Martinelli, Pieter Kamphuisen, Francesco Dentali
BACKGROUND: Little information is available about the clinical history of patients with incidentally detected splanchnic vein thrombosis and its therapeutic management remains controversial. The aim of this study was to assess the risk factors, therapeutic strategies, and long-term outcomes of incidentally detected splanchnic vein thrombosis. METHODS: We analysed data from patients with incidentally detected splanchnic vein thrombosis who were enrolled in an international, multicentre, prospective cohort study of splanchnic vein thrombosis between 2008 and 2012...
June 2016: Lancet Haematology
https://www.readbyqxmd.com/read/27246107/evidence-based-clinical-practice-guidelines-for-liver-cirrhosis-2015
#19
REVIEW
Hiroshi Fukui, Hidetsugu Saito, Yoshiyuki Ueno, Hirofumi Uto, Katsutoshi Obara, Isao Sakaida, Akitaka Shibuya, Masataka Seike, Sumiko Nagoshi, Makoto Segawa, Hirohito Tsubouchi, Hisataka Moriwaki, Akinobu Kato, Etsuko Hashimoto, Kojiro Michitaka, Toshikazu Murawaki, Kentaro Sugano, Mamoru Watanabe, Tooru Shimosegawa
The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system...
July 2016: Journal of Gastroenterology
https://www.readbyqxmd.com/read/27221722/possible-association-between-the-methylenetetrahydrofolate-reductase-gene-c677t-polymorphism-and-preexisting-portal-vein-thrombosis-in-liver-transplant-recipients
#20
Hideya Kamei, Taro Nakamura, Shunji Nagai, Masatoshi Ishigami, Nobuyuki Hamajima
OBJECTIVES: Liver transplant in patients with preexisting portal vein thrombosis involves complicated surgical procedures and increased blood loss, indicating the need for further surgical innovations to overcome these difficulties. Patients who are at high risk of developing portal vein thrombosis may benefit from prophylactic anticoagulant therapy while on the transplant wait list. Homozygosity for C677T polymorphism in the methylenetetrahydrofolate reductase gene has been associated with a high plasma homocysteine concentration, which is a risk factor for venous thrombosis...
2016: Experimental and Clinical Transplantation
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