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Perioperative aspirin

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https://www.readbyqxmd.com/read/29402422/comparison-of-outcomes-and-costs-associated-with-aspirin%C3%A2-%C3%A2-%C3%A2-clopidogrel-after-coronary-artery-bypass-grafting
#1
Ramin Ebrahimi, Sandeep Gupta, Brendan M Carr, Muath Bishawi, Faisal G Bakaeen, G Hossein Almassi, Joseph Collins, Frederick L Grover, Jacquelyn A Quin, Todd H Wagner, A Laurie W Shroyer, Brack Hattler
Optimal antiplatelet therapy after coronary artery bypass graft (CABG) surgery remains controversial. This study evaluated the role of dual antiplatelet therapy using aspirin and clopidogrel (DAPT) versus antiplatelet therapy using aspirin only (ASA) on post-CABG clinical outcomes and costs. In the Department of Veterans Affairs Randomized On/Off Bypass (ROOBY) trial, clopidogrel use after CABG was prospectively collected beginning in year 2 of this study to include 1,525 of the 2,203 original ROOBY patients who received aspirin after CABG...
January 2, 2018: American Journal of Cardiology
https://www.readbyqxmd.com/read/29389336/bleeding-frequency-of-patients-taking-ticagrelor-aspirin-clopidogrel-and-dual-antiplatelet-therapy-after-tooth-extraction-and-minor-oral-surgery
#2
Ozge Doganay, Belir Atalay, Erhan Karadag, Ugur Aga, Mehmet Tugrul
BACKGROUND: Perioperative bleeding complications of ticagrelor, a newer oral antiplatelet, has not been studied in dentistry. Studies about bleeding status after oral surgical procedures in patients receiving continued antiplatelet therapy are also limited. We investigated the effects of continuing aspirin, clopidogrel, ticagrelor, or dual antiplatelet therapy on the frequency of bleeding events in patients undergoing tooth extractions or minor oral surgery. METHODS: In this retrospective study, patient demographic characteristics, medical history, type of antiplatelet therapy, dental procedures, and perioperative bleeding associated with tooth extraction or other minor oral surgical procedures were obtained from the dental records of 222 patients...
February 2018: Journal of the American Dental Association
https://www.readbyqxmd.com/read/29383871/preoperative-platelet-transfusions-to-reverse-antiplatelet-therapy-for-urgent-non-cardiac-surgery-an-observational-cohort-study
#3
Marcel Baschin, Sixten Selleng, Astrid Hummel, Stephan Diedrich, Henry W Schroeder, Thomas Kohlmann, Antje Westphal, Andreas Greinacher, Thomas Thiele
BACKGROUND: Patients receiving antiplatelet therapy (APT) have an increased risk of perioperative bleeding and cardiac adverse events (CAE). Preoperative platelet transfusions may reduce the bleeding risk but may also increase the risk of CAE, particularly coronary thrombosis in patients after recent stent implantation. OBJECTIVES: To analyse the incidence of perioperative CAE and bleeding in patients undergoing non-cardiac surgery using a standardized management of transfusing two platelet concentrates pre-operatively and restart of APT within 24-72 hours after surgery...
January 31, 2018: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/29342431/comparison-of-access-type-on-perioperative-outcomes-after-endovascular-aortic-aneurysm-repair
#4
Jeffrey J Siracuse, Alik Farber, Jeffrey A Kalish, Douglas W Jones, Denis Rybin, Gheorghe Doros, Salvatore T Scali, Marc L Schermerhorn
OBJECTIVE: Endovascular aneurysm repair (EVAR) can be performed through percutaneous or surgical access. Our goal was to assess the difference in perioperative outcomes based on access type in a real-world setting. METHODS: The Vascular Quality Initiative (VQI) database was queried for EVAR. Univariable analysis and multivariable analysis were used to determine the independent effect of access type. RESULTS: There were 8340 (64%) and 4747 (36%) EVAR procedures performed through percutaneous and surgical access (3395 [72%] transverse and 1352 [28%] vertical incisions)...
January 13, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29234539/transurethral-bipolar-plasmakinetic-vapo-enucleation-of-the-prostate-is-it-safe-for-patients-on-chronic-oral-anticoagulants-and-or-platelet-aggregation-inhibitors
#5
Waleed El-Shaer, Ahmed Abou-Taleb, Wael Kandeel
Objectives: To assess the safety and efficacy of bipolar plasmakinetic enucleation and resection of the prostate (PKERP) for the management of benign prostatic hyperplasia (BPH) in patients on oral anticoagulant (OAC) therapy and/or platelet aggregation inhibitors (PAIs). Patients and methods: In all, 91 patients were recruited and underwent PKERP whilst they were receiving PAIs (aspirin, 56 patients; clopidogrel, three; aspirin and clopidogrel, 11). In all, 15 patients were receiving an OAC drug perioperatively, whilst another six patients were on dual PAIs and OACs...
December 2017: Arab Journal of Urology
https://www.readbyqxmd.com/read/29227173/changes-in-platelet-function-with-inflammation-in-patients-undergoing-vascular-surgery
#6
Bartosz Olechowski, Vikram Khanna, Mark Mariathas, Alexander Ashby, Richard T Dalton, Ian Nordon, Nicola Englyst, Scott Harris, Zoe Nicholas, Kala Thayalasamy, Michael Mahmoudi, Nick Curzen
The role of platelets in ischaemic events is well established. Aspirin represents the default antiplatelet and blocks the metabolism of arachidonic acid (AA) at the cyclo-oxygenase enzyme (COX). AA is commonly used as a test of response to aspirin, but recent data raise uncertainty about the validity of this approach. Specifically, in some patients AA-induced clotting is not suppressed, but the level of COX-dependent AA metabolite, thromboxane B2 (TXB2) is negligible. Furthermore, AA-induced whole blood clotting varies dynamically in individuals, who are aspirin responsive according to TXB2 levels...
December 11, 2017: Platelets
https://www.readbyqxmd.com/read/29224638/predictors-of-perioperative-major-bleeding-in-patients-who-interrupt-warfarin-for-an-elective-surgery-or-procedure-analysis-of-the-bridge-trial
#7
RANDOMIZED CONTROLLED TRIAL
Nathan P Clark, James D Douketis, Vic Hasselblad, Sam Schulman, Andrei L Kindzelski, Thomas L Ortel
BACKGROUND: The use of low-molecular weight heparin bridge therapy during warfarin interruption for elective surgery/procedures increases bleeding. Other predictors of bleeding in this setting are not well described. METHODS: BRIDGE was a randomized, double-blind, placebo-controlled trial of bridge therapy with dalteparin 100 IU/kg twice daily in patients with atrial fibrillation requiring warfarin interruption. Bleeding outcomes were documented from the time of warfarin interruption until up to 37 days postprocedure...
January 2018: American Heart Journal
https://www.readbyqxmd.com/read/29217437/carotid-endarterectomy-performed-before-the-weekend-is-associated-with-increased-length-of-stay
#8
Thomas W Cheng, Alik Farber, Jeffrey A Kalish, Douglas W Jones, Myriam Castagne, Denis Rybin, Stephen J Raulli, Jeffrey J Siracuse
OBJECTIVE: Length of stay (LOS) is commonly used to gauge hospital resource utilization and can affect hospital profit margin. Other fields of surgery have showed that operations performed close to the weekend have longer LOS and higher patient morbidity. Our goal was to investigate whether asymptomatic patients undergoing elective carotid endarterectomy (CEA) earlier in the week had a shorter LOS and improved clinical outcomes compared to those treated before the weekend. METHODS: The Vascular Quality Initiative database was queried for elective weekday CEAs performed for asymptomatic carotid stenosis from 2005 to 2017...
December 5, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29205497/the-use-of-preoperative-aspirin-in-cardiac-surgery-a-systematic-review-and-meta-analysis
#9
REVIEW
Sleiman Sebastian Aboul-Hassan, Tomasz Stankowski, Jakub Marczak, Maciej Peksa, Marcin Nawotka, Ryszard Stanislawski, Bartosz Kryszkowski, Romuald Cichon
BACKGROUND: Despite the fact that aspirin is of benefit to patients following coronary artery bypass grafting (CABG), continuation or administration of preoperative aspirin before CABG or any cardiac surgical procedure remains controversial. Therefore, we performed a systematic review and meta-analysis to assess the influence of preoperative aspirin administration on patients undergoing cardiac surgery. MATERIALS AND METHODS: Medline database was searched using OVID SP interface...
December 3, 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/29189290/period-dependent-associations-between-hypotension-during-and-for-4-days-after-noncardiac-surgery-and-a-composite-of-myocardial-infarction-and-death-a-substudy-of-the-poise-2-trial
#10
Daniel I Sessler, Christian S Meyhoff, Nicole M Zimmerman, Guangmei Mao, Kate Leslie, Skarlet M Vásquez, Packianathaswamy Balaji, Jesús Alvarez-Garcia, Alexandre B Cavalcanti, Joel L Parlow, Prashant V Rahate, Manfred D Seeberger, Bruno Gossetti, S A Walker, Rajendra K Premchand, Rikke M Dahl, Emmanuelle Duceppe, Reitze Rodseth, Fernando Botto, P J Devereaux
BACKGROUND: The relative contributions of intraoperative and postoperative hypotension to perioperative morbidity remain unclear. We determined the association between hypotension and a composite of 30-day myocardial infarction and death over three periods: 1) intraoperative; 2) remaining day of surgery; and 3) during the initial four postoperative days. METHODS: This was a substudy of POISE-2, a 10,010-patient factorial-randomized trial of aspirin and clonidine for prevention of myocardial infarction...
November 21, 2017: Anesthesiology
https://www.readbyqxmd.com/read/29163956/eversion-endarterectomy-under-full-prasugrel-treatment
#11
Thomas Kotsis, Panagitsa Christoforou, Nikolaos Asaloumidis, Erifyli Argyra
The third-generation thienopyridine prasugrel has much stronger antiplatelet effect compared to other current antiplatelet inhibitors and exhibits practically zero resistance in healthy people. Prasugrel is used as a pre- and post-treatment in percutaneous coronary or neurovascular interventions with parallel aspirin regime. However, as there is a higher reported bleeding with intraluminal interventions and meticulous technique is recommended, there is nearly non-existent international experience of open surgery under full prasugrel treatment...
2017: SAGE Open Medical Case Reports
https://www.readbyqxmd.com/read/29145278/safety-of-continuing-aspirin-therapy-during-spinal-surgery-a-systematic-review-and-meta-analysis
#12
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/29132159/aspirin-in-patients-with-previous-percutaneous-coronary-intervention-undergoing-noncardiac-surgery
#13
Michelle M Graham, Daniel I Sessler, Joel L Parlow, Bruce M Biccard, Gordon Guyatt, Kate Leslie, Matthew T V Chan, Christian S Meyhoff, Denis Xavier, Alben Sigamani, Priya A Kumar, Marko Mrkobrada, Deborah J Cook, Vikas Tandon, Jesus Alvarez-Garcia, Juan Carlos Villar, Thomas W Painter, Giovanni Landoni, Edith Fleischmann, Andre Lamy, Richard Whitlock, Yannick Le Manach, Meylin Aphang-Lam, Juan P Cata, Peggy Gao, Nicolaas C S Terblanche, Pamidimukkala V Ramana, Kim A Jamieson, Amal Bessissow, Gabriela R Mendoza, Silvia Ramirez, Pierre A Diemunsch, Salim Yusuf, P J Devereaux
Background: Uncertainty remains about the effects of aspirin in patients with prior percutaneous coronary intervention (PCI) having noncardiac surgery. Objective: To evaluate benefits and harms of perioperative aspirin in patients with prior PCI. Design: Nonprespecified subgroup analysis of a multicenter factorial trial. Computerized Internet randomization was done between 2010 and 2013. Patients, clinicians, data collectors, and outcome adjudicators were blinded to treatment assignment...
November 14, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29122431/nonsurgical-strategies-to-reduce-mortality-in-patients-undergoing-cardiac-surgery-an-updated-consensus-process
#14
Giovanni Landoni, Vladimir Lomivorotov, Simona Silvietti, Caetano Nigro Neto, Antonio Pisano, Gabriele Alvaro, Ludmilla Abrahao Hajjar, Gianluca Paternoster, Hynek Riha, Fabrizio Monaco, Andrea Szekely, Rosalba Lembo, Nesrin A Aslan, Giovanni Affronti, Valery Likhvantsev, Cristiano Amarelli, Evgeny Fominskiy, Martina Baiardo Redaelli, Alessandro Putzu, Massimo Baiocchi, Jun Ma, Giuseppe Bono, Valentina Camarda, Remo Daniel Covello, Nora Di Tomasso, Miriam Labonia, Carlo Leggieri, Rosetta Lobreglio, Giacomo Monti, Paolo Mura, Anna Mara Scandroglio, Daniela Pasero, Stefano Turi, Agostino Roasio, Carmine D Votta, Emanuela Saporito, Claudio Riefolo, Chiara Sartini, Luca Brazzi, Rinaldo Bellomo, Alberto Zangrillo
OBJECTIVE: A careful choice of perioperative care strategies is pivotal to improve survival in cardiac surgery. However, there is no general agreement or particular attention to which nonsurgical interventions can reduce mortality in this setting. The authors sought to address this issue with a consensus-based approach. DESIGN: A systematic review of the literature followed by a consensus-based voting process. SETTING: A web-based international consensus conference...
June 7, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29112548/european-guidelines-on-perioperative-venous-thromboembolism-prophylaxis-aspirin
#15
Jean-Yves Jenny, Ingrid Pabinger, Charles Marc Samama
: There is a good rationale for the use of aspirin in venous thromboembolism prophylaxis in some orthopaedic procedures, as already proposed by the 9th American College of Chest Physicians' guidelines (Grade 1C). We recommend using aspirin, considering that it may be less effective than or as effective as low molecular weight heparin for prevention of deep vein thrombosis and pulmonary embolism after total hip arthroplasty, total knee arthroplasty and hip fracture surgery (Grade 1C). Aspirin may be less effective than or as effective as low molecular weight heparins for prevention of deep vein thrombosis and pulmonary embolism after other orthopaedic procedures (Grade 2C)...
February 2018: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29112547/european-guidelines-on-perioperative-venous-thromboembolism-prophylaxis-chronic-treatments-with-antiplatelet-agents
#16
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)...
February 2018: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29107032/the-effect-of-continued-low-dose-aspirin-therapy-in-patients-undergoing-percutaneous-nephrolithotomy
#17
Brandon J Otto, Russell S Terry, Forat G Lutfi, Jamil Syed, Harold C Hamann, Mohit Gupta, Vincent G Bird
PURPOSE: Aspirin is often stopped prior to percutaneous nephrolithotomy due to concern about the surgical bleeding risk. There is evidence that discontinuing aspirin perioperatively increases thromboembolic events and continuing it may be safe. We assessed the effect of continuing low dose aspirin through percutaneous nephrolithotomy and its effect on surgical and safety outcomes. MATERIALS AND METHODS: We retrospectively reviewed the records of 285 consecutive percutaneous nephrolithotomies performed between 2012 and 2015 at our institution...
October 26, 2017: Journal of Urology
https://www.readbyqxmd.com/read/29071156/bipolar-vs-monopolar-resection-of-bladder-tumours-of-3%C3%A2-cm-in-patients-maintained-on-low-dose-aspirin-a-randomised-clinical-trial
#18
Mohamed M Hashad, Hussein M Abdeldaeim, Ahmed Moussa, Akram Assem, Tamer M Abou Youssif
OBJECTIVE: To compare the safety and efficacy of bipolar vs monopolar transurethral resection of bladder tumour (TURBT) in patients maintained on low-dose aspirin with tumours >3 cm. PATIENTS AND METHODS: A prospective randomised single-centre study was performed including 200 patients with bladder tumours of >3 cm, as measured by ultrasonography. All patients were using low-dose aspirin (81 mg/day), which was not stopped in the perioperative period. Patients were randomised into two groups: Group A, monopolar TURBT (M-TURBT); Group B, bipolar TURBT (B-TURBT)...
September 2017: Arab Journal of Urology
https://www.readbyqxmd.com/read/29016553/bleeding-and-neurologic-complications-in-58-000-interventional-pain-procedures
#19
Nafisseh S Warner, W Michael Hooten, Matthew A Warner, Tim J Lamer, Jason S Eldrige, Halena M Gazelka, Daryl J Kor, Bryan C Hoelzer, William D Mauck, Susan M Moeschler
BACKGROUND AND OBJECTIVES: Interventional pain procedures are commonly performed on patients receiving antiplatelet therapy. However, there is limited evidence to support or refute the safety of this practice. The goal of this investigation was to assess the rate of bleeding complications in a large cohort of patients undergoing intermediate- and low-risk pain procedures, with a specific focus on antiplatelet and anticoagulant medication use and baseline coagulation abnormalities. METHODS: This is a retrospective cohort study of adult patients undergoing low- and intermediate-risk pain procedures from 2005 through 2014 by the division of pain medicine at a single academic tertiary care center...
November 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28927346/deep-venous-thrombosis-prophylaxis-in-anterior-cruciate-ligament-reconstructive-surgery-what-is-the-current-state-of-practice
#20
Robert A Keller, Vasilios Moutzouros, Joshua S Dines, Charles A Bush-Joseph, Orr Limpisvasti
BACKGROUND: Venous thromboembolism (VTE) is a significant perioperative risk with many common orthopaedic procedures. Currently, there is no standardized recommendation for the use of VTE prophylaxis during anterior cruciate ligament (ACL) reconstruction. This study sought to evaluate the current prophylactic practices of fellowship-trained sports medicine orthopaedic surgeons in the United States. HYPOTHESIS: Very few surgeons use perioperative VTE prophylaxis for ACL reconstructive surgery...
September 1, 2017: Sports Health
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