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Perioperative aspirin

Paul S Myles, Julian A Smith, Andrew Forbes, Brendan Silbert, Mohandas Jayarajah, Thomas Painter, D James Cooper, Silvana Marasco, John McNeil, Jean S Bussières, Shay McGuinness, Kelly Byrne, Matthew T V Chan, Giovanni Landoni, Sophie Wallace
Background Tranexamic acid reduces the risk of bleeding among patients undergoing cardiac surgery, but it is unclear whether this leads to improved outcomes. Furthermore, there are concerns that tranexamic acid may have prothrombotic and proconvulsant effects. Methods In a trial with a 2-by-2 factorial design, we randomly assigned patients who were scheduled to undergo coronary-artery surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here...
October 23, 2016: New England Journal of Medicine
Andreas M Fichter, Lucas M Ritschl, Luisa K Robitzky, Stefan Wagenpfeil, David A Mitchell, Klaus-Dietrich Wolff, Thomas Mücke
The effects of antithrombotic drugs on random and free flap survival have been investigated in the past, but the experimental and clinical results are not in agreement. A perforator-based critical ischaemia model was used to evaluate the effects of different perioperatively administered pharmaceutical agents on tissue ischaemia and to assess the potential additional haemorheological or vasodilative effects of antithrombotics on flap microcirculation. Combined laser Doppler flowmetry and remission spectroscopy revealed an increase in certain microcirculation parameters in most groups in comparison with saline controls, and these changes correlated with flap survival...
October 21, 2016: Scientific Reports
Ozan Gökdoğan, Ilker Akyildiz, Begum Yetis Sayin, Sercan Okutucu, Ali Cevat Tanalp, Necmi Arslan
Nose bleeding is a common situation seen in otorhinolaryngological practices. One of the greatest risk factors in nose bleeding is the use of anticoagulant medicine. With the medicine developed in recent years, the risk of nose bleeding due to the frequent use of anticoagulant and antiagregant is gradually increasing.The purpose of this study is to determine the effects of especially new-generation anticoagulants on nose bleeding. In addition, the use and complications of new-generation anticoagulants and antiagregants have been compiled in light of information obtained from the literature...
October 14, 2016: Journal of Craniofacial Surgery
Yader Sandoval, Marina Zakharova, Thomas S Rector, Emmanouil S Brilakis, Todd Drexel, Edward O McFalls, Santiago Garcia
The utility of measuring cardiac troponins (cTn) in asymptomatic patients during the perioperative period has been controversial. In the present substudy of the Cardiac Remote Ischemic Preconditioning Prior to Elective Vascular Surgery Trial (NCT01558596), we hypothesized that surveillance of myocardial injury with cTnI in the perioperative period would lead to initiation or intensification of medical therapies for coronary artery disease. Increases in cTnI ≥0.01 μg/l in the perioperative period were considered clinically significant...
September 15, 2016: American Journal of Cardiology
Sleiman Sebastian Aboul-Hassan, Tomasz Stankowski, Jakub Marczak, Romuald Cichon
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether continuation of administration of preoperative aspirin until the day of coronary artery bypass grafting (CABG) could minimize postoperative mortality, prevalence of postoperative myocardial infarction (MI) with or without influence on postoperative bleeding, packed red blood cell (PRBC) transfusion and reoperation for bleeding. Altogether, 662 papers were found using the reported search, 7 of which represented the best evidence to answer the clinical question...
October 4, 2016: Interactive Cardiovascular and Thoracic Surgery
Benjamin Pradere, Benoit Peyronnet, Thomas Seisen, Zineddine Khene, Marina Ruggiero, Christophe Vaessen, Grégory Verhoest, Romain Mathieu, Morgan Roupret, Karim Bensalah
OBJECTIVE: To evaluate the impact of therapeutic anticoagulant or antiplatelet on the morbidity of robot assisted partial nephrectomy (RAPN). MATERIAL AND METHODS: From 2011 to 2015, we retrospectively analysed a prospectively maintained institutional review board-approved database of RAPN from two academic departments of urology. We evaluated the occurrence of overall complications and hemorrhagic complications (pseudoaneurysm, arterio- venous fistula, hematoma, transfusion)...
September 23, 2016: Urology
Faraz Khan Luni, Haris Riaz, Abdur Rahman Khan, Talha Riaz, Muhammad Husnain, Irbaz Bin Riaz, Muhammad Shahzeb Khan, Mohammed Taleb, Yusuf Kanjwal, Christopher J Cooper, Sadik A Khuder
BACKGROUND: Postoperative state is characterized by increased thrombotic risk by virtue of platelet activation. Whether aspirin ameliorates this risk in patients with established coronary artery disease undergoing cardiac or noncardiac surgery is unknown. We conducted a systematic review and meta-analysis to compare the risk of major adverse cardiac events (MACE) and the risk of bleeding in patients with early (3-5 or more days before surgery) vs. late discontinuation(<3-5 days)/no discontinuation of aspirin...
September 24, 2016: Catheterization and Cardiovascular Interventions
John W Eikelboom, Clive Kearon, Gordon Guyatt, Daniel I Sessler, Salim Yusuf, Deborah Cook, James Douketis, Ameen Patel, Andrea Kurz, Rene Allard, Philip M Jones, Rodolfo J Dennis, Thomas W Painter, Sergio D Bergese, Kate Leslie, Duminda N Wijeysundera, Kumar Balasubramanian, Emmanuelle Duceppe, Scott Miller, Johan Diedericks, P J Devereaux
BACKGROUND: The PeriOperative ISchemia Evaluation-2 (POISE-2) trial compared aspirin with placebo after noncardiac surgery. METHODS: The authors randomly assigned 10,010 patients undergoing noncardiac surgery to receive 200 mg aspirin or placebo 2 to 4 h before surgery and then 100 mg aspirin daily or placebo daily for up to 30 days after surgery. Herein, the authors report the effect of aspirin on venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, as well as an updated pooled analysis of randomized trials of antiplatelet therapy for VTE prevention in noncardiac surgery patients...
September 14, 2016: Anesthesiology
David Schweer, Jonathon J Carmouche, Daniel Jupiter, Timothy Ball, J Randolph Clements
The interrelationship between diabetes mellitus and cardiovascular disease is well-documented, and, secondary to the latter, is the use of antiplatelet therapy. Although diabetes and the associated vascular manifestations are driving forces behind lower extremity amputations, few data are available on the risks of perioperative antiplatelet therapy with foot and ankle amputations. The goal of the present study was to address the surgical effect of continuing or discontinuing antiplatelet therapy before foot and/or ankle amputation...
September 7, 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Rahel Meier, Regula Marthy, Christoph H Saely, Markus S Kuster, Karlmeinrad Giesinger, Hans Rickli
INTRODUCTION: Preoperative discontinuation of aspirin (acetylsalicylic acid) can reduce bleeding risk but may increase the risk of perioperative cardiovascular events. MATERIALS AND METHODS: We retrospectively assessed the impact of preoperative continuation versus discontinuation of aspirin compared with a control group in a cohort of 739 consecutive patients undergoing total hip (THA) (n = 396) or knee arthroplasty (TKA) (n = 343) at a tertiary hospital. Bleeding risk, local complications, orthopaedic outcome, and cardiac and cerebral complications were assessed...
September 9, 2016: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Austin A Woolard, Jesse M Ehrenfeld, Susan S Eagle, Jonathan P Wanderer
STUDY OBJECTIVE: To evaluate perioperative dual antiplatelet therapy management in patients with previously placed coronary stents. DESIGN: Retrospective medical record review. SETTING: Academic medical center. PATIENTS: A total of 1891 surgical cases performed at Vanderbilt University Medical Center in 2012 were evaluated using a perioperative database. Of these, 161 had complete data records that were evaluated using 2 evidence-based and expert opinion-supported protocols...
September 2016: Journal of Clinical Anesthesia
Maria Kamenova, Katharina Lutz, Sabine Schaedelin, Javier Fandino, Luigi Mariani, Jehuda Soleman
BACKGROUND: Antiplatelet therapy in patients with chronic subdural hematoma (cSDH) presents significant neurosurgical challenges. Given the lack of guidelines regarding perioperative management with antiplatelet therapy, it is difficult to balance the patient's increased cardiovascular risk and prevalence of cSDH. OBJECTIVE: To better understand the risk and recurrence rates related to resuming low-dose acetylsalicylic acid (ASA) by evaluating our patients' resumption of low-dose ASA at various times after burr-hole drainage of the hematoma...
August 16, 2016: Neurosurgery
Jorge A Belardi, Mariano Albertal
During the pre-procedural (medication) phase, the use of bivalirudin monotherapy is associated with the lowest rate of bleeding in patients with Non-ST elevation myocardial infarction (Non-STEMI) undergoing an early invasive strategy. Monotherapy with either bivalirudin or unfractionated heparin (UFH) appear interchangeable in this setting. The use of GPI upstream with either drug should be discouraged due to an increased risk of bleeding and net adverse events. The use of low dose aspirin plus potent P2Y12 inhibitors followed by a transradial approach with implantation of drug-eluting coronary stents with fluorinated polymers represents an strategy that may help limit perioperative ischemic and hemorrhagic complications in these individuals...
August 2016: Catheterization and Cardiovascular Interventions
Akihiro Inoue, Kanehisa Kohno, Shinya Fukumoto, Saya Ozaki, Satoko Ninomiya, Hitomi Tomita, Kenji Kamogawa, Kensho Okamoto, Haruhisa Ichikawa, Shinji Onoue, Hajime Miyazaki, Bungo Okuda, Shinji Iwata
INTRODUCTION: We report a patient treated successfully via endovascular surgery within 24h after intravenous thrombolysis using recombinant tissue plasminogen activator for acute cervical internal carotid artery occlusion. PRESENTATION OF CASE: A 68-year-old man was admitted to our hospital. Neurological examination revealed severe left-sided motor weakness. Magnetic resonance imaging showed no cerebral infarction, but magnetic resonance angiography revealed complete occlusion of the right internal carotid artery...
2016: International Journal of Surgery Case Reports
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
David S Strosberg, Todd Corbey, Jon C Henry, Jean E Starr
BACKGROUND: This study examined the outcomes of patients holding or continuing clopidogrel during the preoperative period. METHODS: We reviewed all patients taking clopidogrel who underwent one of 72 different Current Procedural Terminology code procedures, representing major emergency and elective general thoracic and vascular operations from 2009-2012 at a single institution. Demographics, comorbidities, aspirin use, details of coronary stents, and perioperative events were collected...
October 2016: Surgery
Nuno Carvalho Guerra, Mathieu Pernot, Georgios Nesseris, Mohammed Al-Yamani, Xavier Roques, Jean-Benoît Thambo, Bernard Kreitmann, François Roubertie
BACKGROUND: Scimitar syndrome may be corrected using different techniques. Repair using an extracardiac conduit has rarely been performed. This study assessed the intermediate-term outcomes of this technique in adults. METHODS: From January 2000 to June 2011, 7 adult patients underwent correction with a ringed polytetrafluoroethylene conduit used to connect the scimitar vein (SV) to the left atrium, posterior to the inferior vena cava (IVC). Preoperative and perioperative data were reviewed retrospectively...
July 14, 2016: Annals of Thoracic Surgery
Timothy Ito, Ithaar H Derweesh, Serge Ginzburg, Philip H Abbosh, Omer A Raheem, Hossein Mirheydar, Zachary Hamilton, David Y T Chen, Marc C Smaldone, Richard E Greenberg, Rosalia Viterbo, Alexander Kutikov, Robert G Uzzo
OBJECTIVE: We evaluated the risk of bleeding complications in patients undergoing partial nephrectomy (PN) in whom perioperative anti-platelet (AP) therapy was continued, as AP therapy is increasingly utilized and hemorrhage is a significant concern in PN. METHODS: Two-center retrospective analysis of 1097 patients undergoing PN between 2000-2014. The cohort was split into three groups: Perioperative continuation of AP therapy (Group-1, n=67), AP therapy stopped preoperatively (Group-2, n=254), and no chronic AP therapy (Group-3, n=776)...
July 11, 2016: Journal of Urology
Wilson W L Li, Laurens W Wollersheim, Wim J Morshuis
No abstract text is available yet for this article.
July 7, 2016: New England Journal of Medicine
Roberta Rossini, Dominick J Angiolillo, Giuseppe Musumeci, Davide Capodanno, Maddalena Lettino, Daniela Trabattoni, Annarita Pilleri, Paolo Calabria, Paola Colombo, Paola Bernabò, Marco Ferlini, Marco Ferri, Giuseppe Tarantini, Stefano De Servi, Stefano Savonitto
OBJECTIVES: The aim of the present study was to define the feasibility and clinical impact of complying with national consensus recommendations on perioperative management of antiplatelet therapy in patients with coronary stents undergoing cardiac and noncardiac surgery. BACKGROUND: There are limited evidence-based recommendations on the perioperative management of antiplatelet therapy in stented patients undergoing surgery. METHODS: The recommendations provided by the national consensus document were applied in a multicenter, prospective registry of consecutive patients with prior coronary stenting undergoing any type of surgery at 19 hospitals in Italy...
July 12, 2016: Catheterization and Cardiovascular Interventions
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