833 results match your criteria Perioperative Anticoagulation Management


Management of oral anticoagulants prior to emergency surgery or with major bleeding: A survey of perioperative practices in North America: Communication from the Scientific and Standardization Committees on Perioperative and Critical Care Haemostasis and Thrombosis of the International Society on Thrombosis and Haemostasis.

Res Pract Thromb Haemost 2020 May 2;4(4):562-568. Epub 2020 Mar 2.

Department of Medicine, Anticoagulation and Clinical Thrombosis Services Northwell Health at Lenox Hill Hospital New York New York.

Background: There is limited information on real-world practice versus current clinical practice guidelines for oral anticoagulant reversal before emergency surgery.

Objective: To identify current practice/knowledge gaps for oral anticoagulant reversal emergency surgery among anesthesiologists.

Methods: A 22-question survey covering aspects of clinical practice relating to oral anticoagulant reversal was sent to American Society of Anesthesiology members with weekly reminders during data collection from October to December 2018. Read More

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http://dx.doi.org/10.1002/rth2.12320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292675PMC

Anticoagulation management during pulmonary endarterectomy with cardiopulmonary bypass and deep hypothermic circulatory arrest.

Perfusion 2020 Jun 10:267659120928682. Epub 2020 Jun 10.

Department of Cardio-Thoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VU University, Amsterdam, The Netherlands.

Introduction: Pulmonary endarterectomy requires cardiopulmonary bypass and deep hypothermic circulatory arrest, which may prolong the activated clotting time. We investigated whether activated clotting time-guided anticoagulation under these circumstances suppresses hemostatic activation.

Methods: Individual heparin sensitivity was determined by the heparin dose-response test, and anticoagulation was monitored by the activated clotting time and heparin concentration. Read More

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http://dx.doi.org/10.1177/0267659120928682DOI Listing

Periprocedural Management of Oral Anticoagulation.

Med Clin North Am 2020 Jul 12;104(4):709-726. Epub 2020 May 12.

Department of Medicine, Division of General Internal Medicine, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L4N 4A6, Canada; Department of Medicine, Division of Hematology and Thromboembolism, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L4N 4A6, Canada. Electronic address:

Decisions surrounding periprocedural anticoagulation management must balance thromboembolic and procedural bleed risk. The interruption of both warfarin and DOACs requires consideration of anticoagulant pharmacokinetics, procedural bleed risk and patient characteristics. There is a diminishing role for periprocedural bridging LMWH overall and no role for bridging LMWH for the procedural interruption of DOACs. Read More

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http://dx.doi.org/10.1016/j.mcna.2020.02.005DOI Listing

High-intensity focused ultrasound ablation of muscle in an anticoagulated swine model.

Minim Invasive Ther Allied Technol 2020 Jun 3:1-5. Epub 2020 Jun 3.

Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Image-guided non-invasive high-intensity focused ultrasound (HIFU) has been gaining recognition in treating musculoskeletal tumors and desmoids. However, there is no consensus on the appropriate perioperative management for patients on ongoing anticoagulation who undergo HIFU ablation. Image-guided HIFU treatment was performed in swine on an ongoing oral anticoagulation protocol ( = 5) in two treatment sessions seven days apart. Read More

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http://dx.doi.org/10.1080/13645706.2020.1760301DOI Listing

Perioperative antithrombotic management of patients who receive direct oral anticoagulants during gastroenterological surgery.

Ann Gastroenterol Surg 2020 May 1;4(3):301-309. Epub 2020 Apr 1.

Department of Surgery Kokura Memorial Hospital Kitakyushu Japan.

Aim: We investigated the effect of perioperative management of direct oral anticoagulants (DOACs) on bleeding and thromboembolic complications during gastroenterological (GE) surgery.

Methods: A total of 334 patients receiving anticoagulants and undergoing elective GE surgery between 2012 and 2018 were enrolled. The patients were divided into three groups: patients receiving warfarin (WF, n = 231), patients receiving DOACs with heparin bridging (DOAC-HB, n = 34), and patients receiving DOAC without heparin bridging (DOAC-NHB, n = 69). Read More

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http://dx.doi.org/10.1002/ags3.12328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7240147PMC

Scientific and Standardization Committee Communication: Clinical Guidance on the Diagnosis, Prevention and Treatment of Venous Thromboembolism in Hospitalized Patients with COVID-19.

J Thromb Haemost 2020 May 27. Epub 2020 May 27.

Department of Medicine, McMaster University, Hamilton, ON, Canada.

The novel coronavirus disease of 2019 (COVID-19) pandemic, as declared by the World Health Organization, is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). Cardiovascular disease and, in particular, venous thromboembolism (VTE) has emerged as an important consideration in the management of hospitalized patients with COVID-19. The diagnosis of VTE using standardized objective testing is problematic in these patients, given the risk of infecting non-COVID-19 hospitalized patients and hospital personnel, coupled with the usual challenges of performing diagnostic testing in critically-ill patients. Read More

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http://dx.doi.org/10.1111/jth.14929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283841PMC

Direct-acting Oral Anticoagulants in Dermatologic Surgery.

Actas Dermosifiliogr 2020 May 14. Epub 2020 May 14.

Servicio de Dermatología, Hospital Universitario Vall d'Hebron, Barcelona, España.

Direct-acting oral anticoagulants (DOACs) have emerged as safer, easier-to-manage alternatives to traditional vitamin K antagonists and are used increasingly because they require no monitoring, have a wider therapeutic window, and react less with other drugs. However, there is little consensus on optimal perioperative management when these drugs are used in dermatologic surgery. This article describes the characteristics of DOACs and reviews current evidence on their use in this setting. Read More

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http://dx.doi.org/10.1016/j.ad.2019.10.002DOI Listing

Partnering with Palliative Care: A Case Report of Severe Pain in Critical Limb Ischemia Treated Successfully with a Continuous Popliteal Nerve Catheter.

Case Rep Anesthesiol 2020 6;2020:1054521. Epub 2020 Apr 6.

Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1 St SW, Rochester, MN 55904, USA.

Background: Critical limb ischemia (CLI) is limb pain occurring at rest or impending limb loss as a result of lack of blood flow to the affected extremity. CLI pain is challenging to control despite multimodal pharmacologic analgesia and surgical intervention. We described the successful use of a continuous local anesthetic infusion via a popliteal nerve catheter to control severe refractory ischemic lower limb pain in a patient who failed surgical intervention and performed a brief narrative literature review on regional anesthesia for ischemic pain. Read More

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http://dx.doi.org/10.1155/2020/1054521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7166256PMC

Concomitant Aspirin and Anticoagulation Is Associated With Increased Risk for Major Bleeding in Surgical Patients Requiring Postoperative Intensive Care.

Crit Care Med 2020 Jul;48(7):985-992

Division of Critical Care, Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, MN.

Objectives: Critically ill surgical patients may receive concomitant aspirin and therapeutic anticoagulation postoperatively, yet the safety of this practice remains unknown. We evaluated the risk of major bleeding with concomitant therapy compared with anticoagulation alone.

Design: Observational cohort study. Read More

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http://dx.doi.org/10.1097/CCM.0000000000004350DOI Listing

TEG improves anticoagulation management during cardiopulmonary bypass complicated by antiphospholipid syndrome.

J Card Surg 2020 Jun 17;35(6):1354-1356. Epub 2020 Apr 17.

Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.

Background And Aim: Cardiopulmonary bypass (CPB) in antiphospholipid syndrome (APS) patients carries a high risk of thrombosis and hemorrhage. However, optimal anticoagulation surveillance methods have not been established and heparin optimization has not yet been totally validated as reflective of anticoagulation status.

Methods And Result: Here, a 45-year-old female with APS underwent mitral valvuloplasty due to infective endocarditis. Read More

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http://dx.doi.org/10.1111/jocs.14557DOI Listing

Management of periprocedural anticoagulant therapy: a novel individualized approach-a transeusophageal echocardiographic study.

J Thromb Thrombolysis 2020 Apr 13. Epub 2020 Apr 13.

Cardiology Department, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafa Street, Kocamustafapasa, Fatih, Istanbul, Turkey.

Patients with non-valvular atrial fibrillation who are under chronic oral anticoagulant therapy (OAC) treatment frequently require interruption of OAC treatment. By examining the presence of left atrial/left atrial appendage (LA/LAA) thrombus or dense spontaneous echo contrast (SEC) with transesophageal echocardiography (TEE) we aimed to develop an individualized strategy. To test the validity of CHADSVASc score based recommendations was our secondary purpose. Read More

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http://dx.doi.org/10.1007/s11239-020-02104-9DOI Listing

Use of Coagulation Point-of-Care Tests in the Management of Anticoagulation and Bleeding in Pediatric Cardiac Surgery: A Systematic Review.

Anesth Analg 2020 06;130(6):1594-1604

Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.

Bleeding and coagulation management are essential aspects in the management of neonates and children undergoing cardiac surgery. The use of point-of-care tests (POCTs) in a pediatric setting is not as widely used as in the adult setting. This systematic review aims to summarize the evidence showed by the literature regarding the use of POCTs in children undergoing cardiac surgery. Read More

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http://dx.doi.org/10.1213/ANE.0000000000004563DOI Listing

[Perioperative management of anticoagulation among patients with atrial fibrillation].

MMW Fortschr Med 2020 Mar;162(5):44-47

Peter Osypka Herzzentrum München, Internistisches Klinikum München Süd, Am Isarkanal 36, D-81379, München, Deutschland.

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http://dx.doi.org/10.1007/s15006-020-0262-9DOI Listing

[Management of a bi-caval dual lumen cannula clot obstruction after TEE guided diagnosis: a case-report].

Rev Bras Anestesiol 2020 Jan - Feb;70(1):55-58. Epub 2020 Feb 19.

University Hospital - London Health Sciences Centre, Western University, Department of Anesthesiology and Perioperative Medicine, London, Ontario, Canada.

Background: Veno-venous extracorporeal membrane oxygenation is an established therapy for patients with refractory acute respiratory distress syndrome (ARDS). One complication related to the use of veno-venous extracorporeal membrane oxygenation is thrombosis despite proper anticoagulation. We report the diagnosis and management of a clot-obstruction in a single site cannula placed through the internal jugular vein, guided by transesophageal echocardiography. Read More

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http://dx.doi.org/10.1016/j.bjan.2019.12.007DOI Listing
February 2020

[A Case of Superior Mesenteric Vein Thrombosis during Administration of Bevacizumab for Rectal Cancer].

Gan To Kagaku Ryoho 2019 Dec;46(13):2491-2493

Dept. of Surgery, Japan Community Healthcare Organization(JCHO)Osaka Hospital.

A colonoscopy to investigate fecal incontinence revealed a type 3 tumor in the rectum of a 67-year-old man. Histological findings demonstrated rectal adenocarcinoma. CT revealed multiple metastases in the liver, and the patient was diagnosed as having rectal cancer(Rb, Ant, type 3, T3, N3, M1a[H2], cStage Ⅳa). Read More

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December 2019

Cangrelor and Heparin for Pulmonary Thromboendarterectomy in Heparin-Induced Thrombocytopenia.

Ann Thorac Surg 2020 Mar 3. Epub 2020 Mar 3.

Department of Anesthesiology, Temple University Hospital.

Perioperative anticoagulation management for patients with heparin-induced thrombocytopenia requiring cardiopulmonary bypass and deep hypothermic circulatory arrest presents a clinical challenge. Alternative anticoagulants have been used but can cause significant postoperative bleeding. We report the successful use of cangrelor and heparin in a 30-year-old patient with severe heparin-induced thrombocytopenia undergoing urgent pulmonary thromboendarterectomy. Read More

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http://dx.doi.org/10.1016/j.athoracsur.2020.01.051DOI Listing

Bleeding Complications After Transoral Robotic Surgery: A Meta-Analysis and Systematic Review.

Laryngoscope 2020 Feb 28. Epub 2020 Feb 28.

Department of Otolaryngology-Head and Neck Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia.

Objective: Postoperative hemorrhage is the most common complication of transoral robotic surgery (TORS), the severity of which can range from minor bleeding treated with observation to catastrophic hemorrhage leading to death. To date, little is known about the incidence, risk factors, and management of post-TORS hemorrhage.

Study Design: Systematic Review and Metanlysis. Read More

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http://dx.doi.org/10.1002/lary.28580DOI Listing
February 2020

Impact of Patent Foramen Ovale on Total Knee Arthroplasty Cerebrovascular Accident Perioperative Management.

Orthopedics 2020 May 20;43(3):e151-e158. Epub 2020 Feb 20.

Venous thromboembolism and ischemic stroke are major complications following total knee arthroplasty (TKA) and potentially are associated with a patent foramen ovale (PFO). Although this association has been shown in other surgical disciplines, it has not been demonstrated in patients undergoing TKA. This study was undertaken to determine whether patients with a PFO would have a significantly increased risk of cerebrovascular accident (CVA) following TKA. Read More

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http://dx.doi.org/10.3928/01477447-20200213-06DOI Listing

Emergency medicine misconceptions: Utility of routine coagulation panels in the emergency department setting.

Am J Emerg Med 2020 Jun 30;38(6):1226-1232. Epub 2020 Jan 30.

The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States.

Background: Coagulation panels are ordered for a variety of conditions in the emergency department (ED).

Objective: This narrative review evaluates specific conditions for which a coagulation panel is commonly ordered but has limited utility in medical decision-making.

Discussion: Coagulation panels consist of partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT), prothrombin time (PT), and international normalized ratio (INR). Read More

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http://dx.doi.org/10.1016/j.ajem.2020.01.057DOI Listing

Use of argatroban in combination with nafamostat mesilate in open-heart surgery for a pediatric patient with heparin-induced thrombocytopenia type II: a case report.

JA Clin Rep 2020 Jan 13;6(1). Epub 2020 Jan 13.

Department of Anesthesia, Kyoto University Hospital, 54, Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.

Background: Heparin-induced thrombocytopenia type II (HIT II) is a rare, immune-mediated complication of heparin therapy and can cause life-threatening thromboembolism. However, perioperative anticoagulation therapy for patients with a complication of HIT II has not been established.

Case Presentation: A 6-year-old boy with tetralogy of Fallot underwent radical intracardiac repair with administration of argatroban at 1 year old due to positive HIT antibody. Read More

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http://dx.doi.org/10.1186/s40981-020-0310-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6966733PMC
January 2020

Prosthetic Reconstruction of Superior Vena Cava System for Thymic Tumor: A Retrospective Analysis of 22 Cases.

Thorac Cardiovasc Surg 2020 Jan 31. Epub 2020 Jan 31.

Department of Thoracic Surgery, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College of Fujian Medical University, Fuzhou, China.

Objective:  This study aimed to report our experience in superior vena cava (SVC) resection and reconstruction for 22 thymic tumor patients and to make comparisons with previous related reports.

Methods:  A retrospective study on 22 patients (15 thymomas, 7 thymic cancers) who underwent tumor resection with concomitant SVC reconstruction. All the patients underwent vascular conduit reconstruction by the cross-clamping technique. Read More

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http://dx.doi.org/10.1055/s-0039-3401044DOI Listing
January 2020

Direct oral anticoagulants and cardiac surgery: A descriptive study of preoperative management and postoperative outcomes.

J Thorac Cardiovasc Surg 2019 Dec 17. Epub 2019 Dec 17.

Institut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany. Electronic address:

Objective: Recommendations for perioperative management of direct oral anticoagulant (DOAC) treatment in cardiac surgery are lacking. To establish a standardized approach for these patients, we compared hemorrhagic complications and clinical outcomes in patients on DOAC medication, patients on vitamin K antagonists (VKA), and patients without preoperative anticoagulation.

Methods: All 3 groups underwent major cardiac surgery and were retrospectively analyzed: patients on DOAC were advised to take their last DOAC dose 4 days before hospital admission, and DOAC plasma levels were measured the day before surgery. Read More

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http://dx.doi.org/10.1016/j.jtcvs.2019.11.119DOI Listing
December 2019

Low molecular weight heparin versus unfractioned heparin for anticoagulation during perioperative extracorporeal membrane oxygenation: A single center experience in 102 lung transplant patients.

Artif Organs 2020 Jun 18;44(6):638-646. Epub 2020 Feb 18.

Department of Anesthesiology, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.

Extracorporeal membrane oxygenation (ECMO) is gaining importance in the perioperative management of lung transplant patients. To date, the ideal substance for anticoagulation of ECMO patients is still a matter of debate. In this study, we describe our experience with the use of low molecular weight heparin (LMWH) in comparison with unfractioned heparin (UFH) in lung transplant patients undergoing perioperative ECMO support. Read More

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http://dx.doi.org/10.1111/aor.13642DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317732PMC

Perioperative Management in Patients Using Vitamin K Antagonists: Observational Cohort Study.

Thromb Haemost 2020 Mar 15;120(3):495-504. Epub 2020 Jan 15.

Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.

Background:  The benefit of periprocedural bridging with low-molecular-weight heparin (LMWH) in patients with atrial fibrillation has been contested by the publication of the BRIDGE trial.

Objective:  This article determines whether publication of the BRIDGE trial has led to less bridging procedures and better patient outcomes (i.e. Read More

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http://dx.doi.org/10.1055/s-0039-3402763DOI Listing

Minimizing Blood Loss in Spine Surgery.

Global Spine J 2020 Jan 6;10(1 Suppl):71S-83S. Epub 2020 Jan 6.

Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Study Design: Broad narrative review.

Objective: To review and summarize the current literature on guidelines, outcomes, techniques and indications surrounding multiple modalities of minimizing blood loss in spine surgery.

Methods: A thorough review of peer-reviewed literature was performed on the guidelines, outcomes, techniques, and indications for multiple modalities of minimizing blood loss in spine surgery. Read More

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http://dx.doi.org/10.1177/2192568219868475DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947684PMC
January 2020

Anticoagulation and Spine Surgery.

Global Spine J 2020 Jan 6;10(1 Suppl):53S-64S. Epub 2020 Jan 6.

University of Virginia, Charlottesville, VA, USA.

Study Design: Literature review.

Objective: Preoperative management of therapeutic anticoagulation in spine surgery is critical to minimize risk of thromboembolic events yet prevent postsurgical complications. Limited research is available, and most guidelines are based on drug half-lives. Read More

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http://dx.doi.org/10.1177/2192568219852051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947673PMC
January 2020

Antithrombotic therapy for postinterventional management of peripheral arterial disease.

Am J Health Syst Pharm 2020 02;77(4):269-276

Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX.

Purpose: Evidence on the use of antithrombotic pharmacotherapy in patients undergoing revascularization of lower extremities for symptomatic peripheral arterial disease (PAD) is reviewed.

Summary: Individuals with PAD can experience leg pain, intermittent claudication, critical limb ischemia, and acute limb ischemia. In such patients, revascularization may be indicated to improve the quality of life and to prevent amputations. Read More

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http://dx.doi.org/10.1093/ajhp/zxz315DOI Listing
February 2020
2.205 Impact Factor

Management of anticoagulation and antiplatelet agents in the radical cystectomy patient.

Urol Oncol 2020 Jan 9. Epub 2020 Jan 9.

Department of Urology, The University of Kansas Health System, Kansas City, KS.

Background: Bladder cancer is a disease of the older adult, and management of comorbid conditions requiring anticoagulation (AC) or antiplatelet agents (APA) around the time of radical cystectomy (RC) is a frequent clinical challenge. It is estimated that 10% of adult surgical patients are on chronic anticoagulation medications, and considerations surrounding the perioperative disruption, resumption, and modification or substitution of AC and APA in patients undergoing radical cystectomy are critical for the practicing urologist.

Methods: In our report, we performed a comprehensive literature review using PubMed to evaluate all available studies from 1950 to present. Read More

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http://dx.doi.org/10.1016/j.urolonc.2019.12.011DOI Listing
January 2020

Novel Antiplatelet Perioperative Bridging Protocol for Lung Lobectomy: A Case Report.

Perm J 2019 25;23. Epub 2019 Oct 25.

Department of Surgery, Kaiser Permanente Oakland Medical Center, CA.

Introduction: Some patients with cardiac stents will need thoracic surgery during the dual antiplatelet therapy (DAPT) period. When surgery cannot be safely delayed to allow 1 year of uninterrupted DAPT, appropriate perioperative management of anticoagulation is critical.

Case Presentation: A patient treated with new drug-eluting stents and DAPT was concomitantly diagnosed with lung cancer and required a lobectomy. Read More

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http://dx.doi.org/10.7812/TPP/18.119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836554PMC
October 2019

Acute Limb Ischemia Secondary to Patent Foramen Ovale-Mediated Paradoxical Embolism: A Case Report and Systematic Review of the Literature.

Ann Vasc Surg 2020 Jul 2;66:668.e5-668.e10. Epub 2020 Jan 2.

Division of Vascular and Endovascular Surgery, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, MO. Electronic address:

Background: Paradoxical embolism is the translocation of a thrombus originating in the systemic venous circulation into the arterial circulation through a cardiac defect, most commonly a patent foramen ovale (PFO). PFO exists in 15-35% of the adult population. The most common manifestation is cerebrovascular accident; acute limb ischemia is much rarer. Read More

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http://dx.doi.org/10.1016/j.avsg.2019.12.022DOI Listing

Acute Perioperative Pulmonary Embolism-Management Strategies and Outcomes.

J Cardiothorac Vasc Anesth 2020 Jul 16;34(7):1972-1984. Epub 2019 Nov 16.

Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN. Electronic address:

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http://dx.doi.org/10.1053/j.jvca.2019.11.018DOI Listing

Interruption of long-term warfarin is not necessary in patients undergoing total hip arthroplasty.

J Orthop 2020 Jan-Feb;17:139-143. Epub 2019 Jul 1.

The Royal Wolverhampton NHS Trust, UK.

Introduction: The management of anticoagulation in patients undergoing arthroplasty remains a challenge. Guidelines for perioperative management of long-term warfarin recommend discontinuation of warfarin preoperatively in low risk patients. We hypothesised that patients who had their warfarin continued during the perioperative period would have shorter hospital stay and no significant increase risk of surgical complications compared to patients who had their warfarin interrupted. Read More

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http://dx.doi.org/10.1016/j.jor.2019.06.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6919369PMC

Perioperative bridging of anticoagulation: towards a more reserved approach.

Neth J Med 2019 10;77(8):280-286

Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, the Netherlands.

Background: Most invasive procedures require the interruption of oral anticoagulation. In 2015, an international randomised trial demonstrated that perioperative bridging caused more harm than benefit in most anticoagulated patients with atrial fibrillation, leading to a more restrictive Dutch national guideline in April 2016. The objective of the present study was to analyse the integration of the 2016 Dutch guideline for perioperative antithrombotic management from after publication until update of hospital protocols. Read More

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October 2019

From Budd-Chiari syndrome to acquired von Willebrand syndrome: thrombosis and bleeding complications in the myeloproliferative neoplasms.

Hematology Am Soc Hematol Educ Program 2019 12;2019(1):397-406

Division of Hematology/Oncology and Robert H. Lurie Comprehensive Cancer Center, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.

Thrombotic and hemorrhagic complications are prevalent in patients with essential thrombocythemia, polycythemia vera, and myelofibrosis. Given the impact on morbidity and mortality, reducing the risk of thrombosis and/or hemorrhage is a major therapeutic goal. Historically, patients have been risk stratified on the basis of traditional factors, such as advanced age and thrombosis history. Read More

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http://dx.doi.org/10.1182/hematology.2019001318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913438PMC
December 2019

Randomised controlled trial on vitreoretinal surgery with and without oral anticoagulants: surgical complications, visual results and perioperative thromboembolic events.

Trials 2019 Dec 4;20(1):677. Epub 2019 Dec 4.

Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.

Background: Vitreoretinal surgery in anticoagulated patients is a challenging situation for vitreoretinal surgeons, who have to choose between being faced with the systemic thromboembolic risks that the interruption of anticoagulation involves, or the intra- and postoperative haemorrhagic risks associated with maintenance of this therapy. So far, no trial has compared, in a prospective and randomized manner, perioperative complications and the visual results associated with continuation or interruption of oral anticoagulant therapy before pars plana vitrectomy (PPV) under retrobulbar anaesthesia. The main objective of this trial is to compare haemostasis-related perioperative complications of PPV in patients maintaining anticoagulant therapy before surgery compared to patients with an interruption in this therapy before surgery. Read More

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http://dx.doi.org/10.1186/s13063-019-3805-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894279PMC
December 2019

Periprocedural Bivalirudin Versus Unfractionated Heparin During Percutaneous Coronary Intervention Following Fibrinolysis for ST-Segment Elevation Myocardial Infarction.

J Invasive Cardiol 2019 Dec;31(12):E387-E391

University of Ottawa Heart Institute, 40 Ruskin street, Ottawa, Ontario K1Y 4W7, Canada.

Background: A pharmacoinvasive strategy for ST-segment elevation myocardial infarction (STEMI) management combines the use of fibrinolysis with the routine transfer to coronary angiography, with percutaneous coronary intervention (PCI) if needed. This method reduces the risk of major adverse cardiovascular event (MACE) compared with fibrinolysis alone; however, it is associated with higher bleeding risk. We sought to assess the bivalirudin compared with unfractionated heparin (UFH) used during PCI as part of a pharmacoinvasive strategy. Read More

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December 2019

Atrial Flutter and Fibrillation Following Lung Transplantation: Incidence, Associations and a Suggested Therapeutic Algorithm.

Heart Lung Circ 2019 Nov 22. Epub 2019 Nov 22.

Department of Respiratory Medicine, Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia.

Background: Atrial arrhythmias are relatively common following lung transplantation and confer considerable perioperative risk, specifically haemodynamic instability, pulmonary congestion, dyspnoea, and can mask other post-transplant complications such as infection or acute rejection. However, for most patients, arrhythmias are limited to the short-term perioperative period.

Methods: We present a retrospective case-control analysis of 200 lung transplant recipients and using multivariate regression analysis, document the present incidence, risk factors, and outcomes between the two groups. Read More

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http://dx.doi.org/10.1016/j.hlc.2019.10.011DOI Listing
November 2019

Severe Enoral Bleeding with a Direct Oral Anticoagulant after Tooth Extraction and Heparin Bridging Treatment.

Case Rep Emerg Med 2019 29;2019:6208604. Epub 2019 Oct 29.

Department of Emergency Medicine, Inselspital University Hospital, Bern, Switzerland.

Background: The number of patients receiving direct oral anticoagulants (DOACs) is increasing, however, this treatment is associated with the risk of bleeding. More than 10 percent of patients on DOACs have to interrupt their anticoagulation for an invasive procedure every year. For this reason, the correct management of DOACs in the perioperative setting is mandatory. Read More

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http://dx.doi.org/10.1155/2019/6208604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875271PMC
October 2019

From Budd-Chiari syndrome to acquired von Willebrand syndrome: thrombosis and bleeding complications in the myeloproliferative neoplasms.

Blood 2019 11;134(22):1902-1911

Thrombotic and hemorrhagic complications are prevalent in patients with essential thrombocythemia, polycythemia vera, and myelofibrosis. Given the impact on morbidity and mortality, reducing the risk of thrombosis and/or hemorrhage is a major therapeutic goal. Historically, patients have been risk stratified on the basis of traditional factors, such as advanced age and thrombosis history. Read More

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http://dx.doi.org/10.1182/blood.2019001318DOI Listing
November 2019

Natural history and management outcomes of segmental arterial mediolysis.

J Vasc Surg 2019 12;70(6):1877-1886

Division of Vascular Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, Ariz.

Background: Segmental arterial mediolysis (SAM) is a poorly understood, nonatherosclerotic, noninflammatory disease resulting from arterial medial degeneration. Patients may present with aneurysm, dissection, stenosis, or bleeding from visceral or renal arteries. Treatment algorithms are poorly characterized. Read More

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http://dx.doi.org/10.1016/j.jvs.2019.02.068DOI Listing
December 2019

Intraoperative Practice Variability in Total Knee Arthroplasty.

J Arthroplasty 2020 Mar 15;35(3):725-731. Epub 2019 Oct 15.

Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Redwood City, CA.

Background: Considerable practice variability exists among orthopedic surgeons performing total knee arthroplasty (TKA). The purpose of this study is to understand what TKA surgical and perioperative techniques are standard among high-volume academic knee arthroplasty surgeons.

Methods: A written survey with 59 questions regarding management preferences in TKA was distributed by the 2018 John N. Read More

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http://dx.doi.org/10.1016/j.arth.2019.10.014DOI Listing
March 2020
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Optimizing Perioperative Blood and Coagulation Management During Cardiac Surgery.

Anesthesiol Clin 2019 Dec 27;37(4):713-728. Epub 2019 Sep 27.

Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, Berlin 10249, Germany.

Bleeding and transfusion are common in cardiac surgery and associated with poorer outcome. Bleeding is frequently due to coagulopathy caused by the complex interaction between cardiopulmonary bypass, major surgical trauma, anticoagulation management, and perioperative factors. Patient blood management has emerged to improve outcome by the prediction, prevention, monitoring, and treatment of bleeding and transfusion. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.08.006DOI Listing
December 2019
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Through Thick or Thin: Disparities in Perioperative Anticoagulant Use in Trauma Patients.

Am Surg 2019 Sep;85(9):1040-1043

Although vascular surgery guidelines recommend immediate anticoagulation for acute occlusion of a peripheral artery, it is unclear whether trauma surgeons follow this practice. A survey regarding the use of perioperative anticoagulation was sent to surgeons who perform their own peripheral arterial repairs after traumatic injury to define contemporary practice patterns. This survey demonstrated minimal consensus opinion regarding the management of extremity vascular injuries, strongly suggesting the need for a consensus conference, meta-analysis, and prospective studies to guide further care. Read More

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September 2019
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Anesthetic management of geriatric patients.

Korean J Anesthesiol 2020 Feb 22;73(1):8-29. Epub 2019 Oct 22.

Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.

The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Read More

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http://dx.doi.org/10.4097/kja.19391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000283PMC
February 2020

Preoperative anticoagulation in patients undergoing bariatric surgery is associated with worse outcomes.

Surg Endosc 2019 Oct 15. Epub 2019 Oct 15.

Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, USA.

Introduction: Management of patients on chronic anticoagulation (AC) in bariatric surgery may present a challenge, as there is a delicate balance between risks of bleeding and thrombotic events, such as deep vein thrombosis (DVT) and pulmonary embolism (PE). The purpose of this study was to evaluate and compare rates of bleeding, thrombotic events, and outcomes of patients on preoperative AC during bariatric surgery.

Methods: The MBSAQIP data sets for 2015 and 2016 was used to identify all patients undergoing adjustable gastric banding (AGB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB). Read More

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http://dx.doi.org/10.1007/s00464-019-07191-1DOI Listing
October 2019
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Defining Global Benchmarks in Bariatric Surgery: A Retrospective Multicenter Analysis of Minimally Invasive Roux-en-Y Gastric Bypass and Sleeve Gastrectomy.

Ann Surg 2019 11;270(5):859-867

Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.

Objective: To define "best possible" outcomes for bariatric surgery (BS)(Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy [SG]).

Background: Reference values for optimal surgical outcomes in well-defined low-risk bariatric patients have not been established so far. Consequently, outcome comparison across centers and over time is impeded by heterogeneity in case-mix. Read More

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http://dx.doi.org/10.1097/SLA.0000000000003512DOI Listing
November 2019
7 Reads

Noncardiac determinants of death and intensive care morbidity in adult congenital heart disease surgery.

J Thorac Cardiovasc Surg 2020 06 29;159(6):2407-2415.e2. Epub 2019 Aug 29.

Department of Anesthesia, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address:

Objectives: Predicting perioperative morbidity and mortality in cardiac surgery for adult congenital heart disease is challenging because it encompasses a wide spectrum of disease. There is a paucity of published outcome data, and there are no perioperative risk score calculators for this population group. We set out to identify robust determinants of morbidity and mortality in this patient population under going cardiac surgery. Read More

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http://dx.doi.org/10.1016/j.jtcvs.2019.07.106DOI Listing
June 2020
3 Reads

Predictors of Groin Access Pseudoaneurysm Complication: A 10-Year Institutional Experience.

Vasc Endovascular Surg 2020 Jan 2;54(1):42-46. Epub 2019 Oct 2.

Division of Vascular Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.

Objective: In clinical practice, the incidence of femoral pseudoaneurysms requiring repair is small, but at a tertiary care center, the repair rate is higher due to referrals. We sought to specifically study patients who suffered postcatheterization pseudoaneurysms requiring thrombin injection or operative repair and compare them to our routine transfemoral endovascular patients to identify predictors of clinically significant pseudoaneurysms. The underlying goal would be to identify what makes these patients that develop pseudoaneurysms different. Read More

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http://dx.doi.org/10.1177/1538574419879568DOI Listing
January 2020

Anesthesiologists Guide to the 2019 AHA/ACC/HRS Focused Update for the Management of Patients With Atrial Fibrillation.

J Cardiothorac Vasc Anesth 2020 Jul 3;34(7):1925-1932. Epub 2019 Sep 3.

Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, The Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Perioperative physicians should be well versed in atrial fibrillation (AF) management because it is the most common sustained arrythmia in the United States. In this narrative review of the 2019 American Heart Association/American College of Cardiologists/Heart Rhythm Society Focused Update on Atrial Fibrillation, the authors detail the emergence of new evidence from completed studies that may affect the management of patients with AF presenting for surgery. Updates regarding non-vitamin K oral anticoagulants (NOACs) comprise the bulk of the update with newer evidence emerging regarding their equivalence and/or superiority compared to Coumadin. Read More

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http://dx.doi.org/10.1053/j.jvca.2019.08.046DOI Listing
July 2020
4 Reads