717 results match your criteria Perioperative Anticoagulation Management


[Evidence-based perioperative medicine].

Chirurg 2019 Jan 9. Epub 2019 Jan 9.

Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.

Perioperative medical interventions are an integral part of modern surgical management. In addition to the main manual aspects of surgical interventions, surgeons must also be familiar with preoperative and postoperative medical interventions. This ranges from the indications for perioperative anticoagulation, handling of drainage, adjusting the perioperative analgesia, prescribing an antibiotic prophylaxis to deciding whether a preoperative bowel preparation is necessary. Read More

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http://dx.doi.org/10.1007/s00104-018-0776-1DOI Listing
January 2019

Medical therapy for atherosclerotic cardiovascular disease in patients with myocardial injury after non-cardiac surgery.

Int J Cardiol 2018 Dec 12. Epub 2018 Dec 12.

Department of Anesthesiology, Perioperative Care, and Pain Medicine, New York University Langone Medical Center, New York, NY, United States of America.

Background: Myocardial injury after non-cardiac surgery (MINS) is a common post-operative cardiovascular complication and is associated with short and long-term mortality. The objective of this study was to describe the contemporary management of patients with and without MINS after total joint and spine orthopedic surgery at a large urban health system in the United States.

Methods: Adults admitted for total joint and major spine surgery from January 2013 through December 2015 with ≥1 cardiac troponin (cTn) measurement during their hospitalization were identified. Read More

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http://dx.doi.org/10.1016/j.ijcard.2018.12.032DOI Listing
December 2018

Extended thromboprophylaxis with low-molecular weight heparin (LMWH) following abdominopelvic cancer surgery.

Am J Surg 2018 Dec 16. Epub 2018 Dec 16.

Department of Surgery, Centre Hospitalier de l'Université de Montreal (CHUM), Surgical Division, Montreal University, 850 rue Saint-Denis, Montreal, Quebec, H2X 0A9, Canada. Electronic address:

Background: Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Certain abdominopelvic cancer surgeries are associated with a six to 14-fold increased risk of DVT versus surgeries for benign disease, and extended thromboprophylaxis using perioperative LMWHs may further reduce VTE rates over standard duration administration. This review assesses the value of extended low molecular weight heparin (LMWH) thromboprophylaxis as a recommended strategy after abdominopelvic cancer surgery. Read More

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http://dx.doi.org/10.1016/j.amjsurg.2018.11.046DOI Listing
December 2018
1 Read

Stopping or maintaining oral anticoagulation in patients undergoing photoselective vaporization of the prostate (SOAP) surgery for benign prostate obstruction: study protocol for a multicentre randomized controlled trial.

Trials 2018 Dec 27;19(1):705. Epub 2018 Dec 27.

Department of Urology, Clinique Pasteur, 45 avenue de Lombez, BP 27 617, 31076, Toulouse Cedex 3, France.

Background: Lower urinary tract symptoms related to benign prostatic obstruction (BPO) are frequent in men aged > 50 years. Based on the use of innovative medical devices, a number of transurethral ablative techniques have recently been developed for the surgical treatment of BPO. In recent years, GreenLight photoselective vaporization of the prostate (PVP) has been considered as a non-inferior alternative to transurethral resection of the prostate. Read More

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http://dx.doi.org/10.1186/s13063-018-3066-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307178PMC
December 2018
1 Read

Canadian Urological Association guideline on perioperative thromboprophylaxis and management of anticoagulation.

Can Urol Assoc J 2018 Dec 14. Epub 2018 Dec 14.

Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada.

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http://dx.doi.org/10.5489/cuaj.5828DOI Listing
December 2018

Best practice in the management of benign prostatic hyperplasia in the patients requiring anticoagulation.

Ther Adv Urol 2018 Dec 29;10(12):431-436. Epub 2018 Oct 29.

Indiana University School of Medicine, IU Health Physicians Urology, 1801 N. Senate Blvd., Indianapolis, IN 46202-5114, USA.

In today's aging population, urologists are often treating older patients with multiple comorbidities. Lower urinary tract symptoms from benign prostate hyperplasia (LUTS/BPH) is a common condition that affects men, with increasing prevalence as men age. In a subset of patients, the symptoms are too severe or refractory to medical therapy and, therefore, surgical therapy is required to improve their LUTS. Read More

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http://dx.doi.org/10.1177/1756287218807591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6295789PMC
December 2018
1 Read

Peri-Procedural Antithrombotic Management from a Patient Perspective: A Qualitative Analysis.

Am J Med 2018 Dec 3. Epub 2018 Dec 3.

Center for Bioethics and Social Science in Medicine, University of Michigan, Ann Arbor, MI; Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI. Electronic address:

Background: Peri-procedural antithrombotic medication management is a complex, often confusing process for patients and their providers. Communication difficulties often lead to suboptimal medication management resulting in delayed or cancelled procedures.

Methods: We conducted telephone surveys with patients taking chronic antithrombotic medications who had recently undergone an endoscopy procedure. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00029343183114
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http://dx.doi.org/10.1016/j.amjmed.2018.11.020DOI Listing
December 2018
16 Reads

Insight into the perioperative management of direct oral anticoagulants: concerns and considerations.

Expert Opin Pharmacother 2018 Dec 6:1-8. Epub 2018 Dec 6.

d Division of Cardiology, Department of Medicine and Therapeutics , The Chinese University of Hong Kong, Prince of Wales Hospital , Hong Kong , China.

Introduction: Direct oral anticoagulants (DOACs) have gained momentum in recent years in patients requiring anticoagulation for the prevention and management of venous thromboembolism and thromboembolic events caused by atrial fibrillation. The use of these agents involves potential bleeding complications, particularly during invasive procedures. With increasing use of DOACs, adequate knowledge regarding the perioperative management of patients on DOACs has become indispensable. Read More

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http://dx.doi.org/10.1080/14656566.2018.1551879DOI Listing
December 2018
2 Reads

A review and analysis of strategies for prediction, prevention and management of post-operative atrial fibrillation after non-cardiac thoracic surgery.

J Thorac Dis 2018 Nov;10(Suppl 32):S3799-S3808

Division of Thoracic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.

Atrial fibrillation (AF) is the most common sustained arrhythmia after non-cardiac thoracic surgery and is associated with a significant increase in perioperative morbidity, intensive care unit (ICU) admission, and mortality. Practical guidance is needed to assist clinicians in managing this critical issue and direct further research. Here we aim to provide a synoptic review and analysis of the literature to distil practical recommendations for prediction, prevention and management of post-operative atrial fibrillation (POAF) suitable for clinical application and further evaluation. Read More

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http://dx.doi.org/10.21037/jtd.2018.09.144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258651PMC
November 2018
1 Read

Prothrombin Complex Concentrates for Warfarin Reversal Prior to Heart Transplantation.

Ann Thorac Surg 2018 Nov 23. Epub 2018 Nov 23.

Department of Cardiothoracic Surgery, New York University Langone Health.

Background: Anticoagulation with warfarin is common prior to heart transplantation and complicates perioperative management.

Methods: This single-center, non-interventional, retrospective cohort study evaluated heart transplants before and after institution of a PCC-based preoperative warfarin reversal protocol for heart transplantation. Patients with international normalized ratio (INR) > 1. Read More

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http://dx.doi.org/10.1016/j.athoracsur.2018.10.032DOI Listing
November 2018
3 Reads

Risk assessment and management of preoperative venous thromboembolism following femoral neck fracture.

J Orthop Surg Res 2018 Nov 20;13(1):291. Epub 2018 Nov 20.

Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China.

Background: Limited studies are available to investigate the prevalence of preoperative venous thromboembolism (VTE) in elderly patients with femoral neck fractures. Our primary aim was to determine the incidences of VTE and its risk or protective factors in such patient population. The secondary objective was to evaluate the need of therapeutic anticoagulation for isolated calf muscular venous thrombosis (ICMVT) prior to femoral neck fracture surgery. Read More

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http://dx.doi.org/10.1186/s13018-018-0998-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245713PMC
November 2018
1 Read

Preoperative Management of Medications.

Anesthesiol Clin 2018 Dec;36(4):663-675

Department of Anesthesiology and Perioperative Medicine, Centro de Desarrollo de Destrezas Medicas, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vaco de Quiroga #15, Col. Belisario Dominguez Sección XVI, Mexico City 14080, Mexico.

Increasingly complex medication regimens for many comorbidities in patients for planned surgical and procedural interventions necessitate detailed preoperative evaluation of the pharmacologic therapy, including the indications, the specific drugs, and dosing amount and interval. The implications of continuing or withholding these agents in the perioperative period need to be elucidated, as well as the risks of interactions and side effects. A comprehensive plan of the management of the therapeutic agents should be devised during the preoperative visit, with input from all relevant specialists, and clearly communicated to the patients in a format that ensures their comprehension and consistent compliance. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S19322275183007
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http://dx.doi.org/10.1016/j.anclin.2018.07.012DOI Listing
December 2018
8 Reads

Laparoscopic procedures in patients with cardiac ventricular assist devices.

Surg Endosc 2018 Oct 26. Epub 2018 Oct 26.

Department of Surgery, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA.

Background: Cardiac left ventricular assist device (LVAD) placement is a common therapy for heart failure. Non-cardiac surgical care of these patients can be complex given the need for anticoagulation, perioperative monitoring, comorbidities, and anatomical considerations due to the device itself. There are no guidelines or significant patient series reported to date for laparoscopic procedures in this population. Read More

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http://link.springer.com/10.1007/s00464-018-6497-1
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http://dx.doi.org/10.1007/s00464-018-6497-1DOI Listing
October 2018
10 Reads

[A case of systemic lupus erythematosus in pregnancy complicated by pulmonary hypertension].

Beijing Da Xue Xue Bao Yi Xue Ban 2018 Oct;50(5):928-931

Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.

To investigate the pathophysiology, screening, diagnosis and treatment of the systemic lupus erythematosus (SLE) in pregnancy complicated with pulmonary hypertension. Retrospective analysis was made of one case of SLE in pregnancy complicated with pulmonary hypertension in Peking University Third Hospital. Literature was reviewed to investigate the pathophysiology, screening, diagnosis and treatment of the SLE in pregnancy complicated with pulmonary hypertension. Read More

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October 2018
7 Reads

Survey of the management of perioperative bridging of anticoagulation and antiplatelet therapy in neurosurgery.

Acta Neurochir (Wien) 2018 Nov 20;160(11):2077-2085. Epub 2018 Sep 20.

Department of Neurosurgery, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany.

Background: A growing number of patients on anticoagulation or antiplatelet therapy (APT) are planned for elective surgery. The management of perioperative anticoagulation and APT is challenging because it must balance the risk of thromboembolism and bleeding, and specific recommendations for the management of bridging in neurosurgical patients are lacking. We surveyed German neurosurgical centers about their management of perioperative bridging of anticoagulation and APT to provide an overview of the current bridging policy. Read More

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http://dx.doi.org/10.1007/s00701-018-3679-5DOI Listing
November 2018
3 Reads

Current practices in microvascular reconstruction in otolaryngology-head and neck surgery.

Laryngoscope 2019 Jan 8;129(1):138-145. Epub 2018 Sep 8.

Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, U.S.A.

Objectives/hypothesis: Despite major advances in the field of head and neck microvascular free tissue transfer (MFTT) over the past several decades, there are no standardized perioperative regimens for the care of patients undergoing free flap reconstructive surgery, and continued variation in practice exists. This study aimed to report current trends in the field of MFTT performed by otolaryngologists, including surgeon training, institutional operative practices, and perioperative management.

Study Design: Cross-sectional survey. Read More

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http://dx.doi.org/10.1002/lary.27257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6320283PMC
January 2019
5 Reads

Nutrition and Perioperative Care for the Patient with Head and Neck Cancer.

Oral Maxillofac Surg Clin North Am 2018 Nov 31;30(4):411-420. Epub 2018 Aug 31.

Department of Otolaryngology-Head and Neck Surgery, UC Davis School of Medicine, Sacramento, CA, USA. Electronic address:

Recovery after major head and neck cancer surgery is a complex process. In addition to perioperative sequelae such as pain, wound infections, venous thromboembolism (VTE), and pneumonia, these patients frequently suffer from malnutrition. We provide a contemporary evidence-based approach to common aspects of perioperative care to guide the clinician in the optimal management of patients. Read More

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http://dx.doi.org/10.1016/j.coms.2018.06.003DOI Listing
November 2018
3 Reads

Antithrombotic therapy management of adult and pediatric cardiac surgery patients.

J Thromb Haemost 2018 Nov 30;16(11):2133-2146. Epub 2018 Sep 30.

University of Alberta, Department of Pediatrics, Edmonton, Alberta, Canada.

Despite the development of catheter-based interventions for ischemic and valvular heart disease, hundreds of thousands of people undergo open heart surgery annually for coronary artery bypass graft (CABG), valve replacement or cardiac assist device implantation. Cardiac surgery patients are unique because therapeutic anticoagulation is required during cardiopulmonary bypass. Developmental hemostasis and altered drug metabolism affect management in children. Read More

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http://doi.wiley.com/10.1111/jth.14276
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http://dx.doi.org/10.1111/jth.14276DOI Listing
November 2018
6 Reads

A Narrative Review for Perioperative Physicians of the 2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants.

J Cardiothorac Vasc Anesth 2019 02 20;33(2):290-301. Epub 2018 Jul 20.

Miller School of Medicine, University of Miami, Miami, FL.

In 2017 the American College of Cardiology issued an Expert Consensus Decision Pathway dedicated specifically to the management of bleeding in patients on anticoagulants. The consensus document is both timely and important as indications for more novel anticoagulants expand rapidly. The document reviews in detail recommendations for interruption, management and re-initiation of anticoagulation in bleeding scenarios. Read More

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http://dx.doi.org/10.1053/j.jvca.2018.07.023DOI Listing
February 2019
3 Reads

Antithrombotic Therapy after Bioprosthetic Aortic Valve Replacement: A Therapeutic Morass.

Cardiology 2018 23;140(4):213-221. Epub 2018 Aug 23.

Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA.

Valvular heart disease is a common pathologic condition that affects 6 million people in the United States and more than 100 million worldwide. The most common valvular disorder is aortic stenosis. Current American and European guidelines recommend surgical management for symptomatic aortic stenosis with low risk of perioperative complications and endovascular intervention for high-risk patients with multiple comorbidities. Read More

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http://dx.doi.org/10.1159/000490924DOI Listing
August 2018
5 Reads

Perioperative considerations in free flap surgery: A review of pressors and anticoagulation.

Oral Oncol 2018 Aug 28;83:154-157. Epub 2018 Jun 28.

Oregon Health and Sciences University, Department of Otolaryngology-HNS, United States.

Given the high stakes for microvascular reconstruction, the majority of reconstructive surgeons have developed paradigms for pre, intra, and postoperative management that have proven to result in individual high success rates. Much has been done to identify and avoid perioperative factors that could potentially increase flap failure rates. Two example of this practice has been the generalized use of anticoagulation in free tissue transfer and the prohibition against vasopressor use in patients that are undergoing free tissue transfer. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S13688375183024
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http://dx.doi.org/10.1016/j.oraloncology.2018.06.025DOI Listing
August 2018
31 Reads

Perioperative coagulation management: Evolving strategies.

Authors:
Jerrold H Levy

Anaesth Crit Care Pain Med 2018 08;37(4):317-318

Department of Anesthesiology, Critical Care Medicine, and Surgery (Cardiothoracic), Duke University School of Medicine, Duke University Medical Center, 2301 Erwin Rd, Box 3094, 27710 Durham, NC, USA. Electronic address:

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http://dx.doi.org/10.1016/j.accpm.2018.07.002DOI Listing
August 2018
2 Reads

Perioperative interruption of direct oral anticoagulants in patients with atrial fibrillation: A systematic review and meta-analysis.

Res Pract Thromb Haemost 2018 Apr 16;2(2):282-290. Epub 2018 Feb 16.

Department of Medicine Ottawa Hospital Research Institute at the University of Ottawa Ottawa ON Canada.

Background: Patients with atrial fibrillation (AF) frequently undergo invasive procedures that require temporary interruption of anticoagulation. There is little evidence to guide the perioperative interruption of direct oral anticoagulants (DOACs).

Methods: A systematic literature search including studies that evaluated the perioperative interruption of DOACs for non-emergent invasive procedures in patients with AF was performed. Read More

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http://doi.wiley.com/10.1002/rth2.12076
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http://dx.doi.org/10.1002/rth2.12076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055497PMC
April 2018
6 Reads

[Oral Anticoagulants: Management of Elective and Emergency Surgery].

Anasthesiol Intensivmed Notfallmed Schmerzther 2018 Jul 23;53(7-08):543-550. Epub 2018 Jul 23.

In most patients, oral anticoagulation is performed with vitamin K antagonists (VKA) or non-vitamin K antagonist oral anticoagulants (NOAC). Because of a long half-life, VKA are dosed by measuring INR. In standard cases coagulation tests for NOAC are not necessary; application is performed in a fixed dose. Read More

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http://dx.doi.org/10.1055/s-0043-111006DOI Listing
July 2018
8 Reads

Perioperative Management of New Oral Anticoagulants in Urological Surgery.

Curr Urol 2018 Jun 30;11(4):169-174. Epub 2018 Mar 30.

Department of Urology and Transplantation, Beaumont Hosiptal, Dublin, Ireland.

New oral anticoagulants (NOACs) are increasingly replacing the use of warfarin in clinical practice. Their use has now also been extended to thromboprophylaxis in many orthopedic surgeries. This, in addition to an increasingly aging population with many complex comorbidities means that these medications will be ever more frequently encountered by urologists. Read More

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http://dx.doi.org/10.1159/000447214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6036579PMC
June 2018
2 Reads

Management of cardiac tamponade during catheter-directed thrombolysis of saddle pulmonary embolism: A clinical dilemma.

Lung India 2018 Jul-Aug;35(4):336-338

Department of Radiology, Medical College of Georgia, Augusta University, Augusta, GA, USA.

Catheter-directed thrombolysis (CDT) for the treatment of acute pulmonary embolism (PE) has gained popularity in recent years, but potential complications during the procedure and their management are not frequently discussed in the literature. In this case report, we describe the clinical dilemma regarding the postoperative anticoagulation management of a 60-year-old male who developed cardiac perforation during a CDT of an acute saddle PE. Early resumption of systemic heparin in such cases may help in clot resolution; however, it can worsen the hemopericardium. Read More

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http://dx.doi.org/10.4103/lungindia.lungindia_383_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034378PMC
July 2018
8 Reads

[Bridging anticoagulation in patients receiving vitamin K antagonists : Current status].

Internist (Berl) 2018 07;59(7):744-752

Klinik für Gefäßmedizin - Angiologie, Klinikum Darmstadt GmbH, Darmstadt, Deutschland.

Approximately 30% of patients receiving oral anticoagulation using vitamin K antagonists (VKA) require surgery within 2 years. In this context, a clinical decision on the need and the mode of a peri-interventional bridging with heparin is needed. While a few years ago, bridging was almost considered a standard of care, recent study results triggered a discussion on which patients will need bridging at all. Read More

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http://dx.doi.org/10.1007/s00108-018-0447-9DOI Listing
July 2018
1 Read

Validation of a New Small-Volume Sodium Citrate Collection Tube for Coagulation Testing in Critically Ill Patients with Coagulopathy.

Clin Lab 2018 06;64(6):1083-1089

Background: Blood loss due to phlebotomy leads to hospital-acquired anemia and more frequent blood transfusions that may be associated with increased risk of morbidity and mortality in critically ill patients. Multiple blood conservation strategies have been proposed in the context of patient blood management to minimize blood loss. Here, we evaluated a new small-volume sodium citrate collection tube for coagulation testing in critically ill patients. Read More

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http://dx.doi.org/10.7754/Clin.Lab.2018.171008DOI Listing
June 2018
8 Reads

Perioperative Safety and Efficacy of Different Anticoagulation Strategies With Direct Oral Anticoagulants in Pulmonary Vein Isolation: A Meta-Analysis.

JACC Clin Electrophysiol 2018 Jun;4(6):794-806

Department of Medicine and Surgery, University of Insubria, Varese, Italy. Electronic address:

Objectives: The purpose of this study was to evaluate the safety and efficacy of uninterrupted and interrupted direct oral anticoagulant (DOAC) administration in patients undergoing pulmonary vein isolation (PVI).

Background: The optimal periprocedural management of DOACs in patients undergoing PVI is not well defined, and different strategies are used.

Methods: A systematic search of PubMed/MEDLINE, Ovid/MEDLINE, and EMBASE was performed. Read More

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http://dx.doi.org/10.1016/j.jacep.2018.04.006DOI Listing
June 2018
2 Reads

[Bridging anticoagulation in patients receiving vitamin K antagonists : Current status].

Anaesthesist 2018 Aug;67(8):599-606

Klinik für Gefäßmedizin - Angiologie, Klinikum Darmstadt GmbH, Darmstadt, Deutschland.

Approximately 30% of patients receiving oral anticoagulation using vitamin K antagonists (VKA) require surgery within 2 years. In this context, a clinical decision on the need and the mode of a peri-interventional bridging with heparin is needed. While a few years ago, bridging was almost considered a standard of care, recent study results triggered a discussion on which patients will need bridging at all. Read More

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http://dx.doi.org/10.1007/s00101-018-0463-0DOI Listing
August 2018
2 Reads

Perioperative and Periprocedural Management of Antithrombotic Therapy: Consensus Document of SEC, SEDAR, SEACV, SECTCV, AEC, SECPRE, SEPD, SEGO, SEHH, SETH, SEMERGEN, SEMFYC, SEMG, SEMICYUC, SEMI, SEMES, SEPAR, SENEC, SEO, SEPA, SERVEI, SECOT and AEU.

Rev Esp Cardiol (Engl Ed) 2018 Jul 8;71(7):553-564. Epub 2018 Jun 8.

Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.

During the last few years, the number of patients receiving anticoagulant and antiplatelet therapy has increased worldwide. Since this is a chronic treatment, patients receiving it can be expected to need some kind of surgery or intervention during their lifetime that may require treatment discontinuation. The decision to withdraw antithrombotic therapy depends on the patient's thrombotic risk versus hemorrhagic risk. Read More

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http://dx.doi.org/10.1016/j.rec.2018.01.029DOI Listing
July 2018
21 Reads

The Use of Cangrelor and Heparin for Anticoagulation in a Patient Requiring Pulmonary Thromboendarterectomy Surgery with Suspected Heparin-Induced Thrombocytopenia.

J Cardiothorac Vasc Anesth 2018 Apr 30. Epub 2018 Apr 30.

Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, CA.

The management of heparin-induced thrombocytopenia (HIT) in the perioperative period for patients undergoing cardiac surgery requiring cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) can be a challenging clinical scenario. Once a diagnosis of HIT has been established, heparin products typically are avoided and alternative therapies for anticoagulation are started. Alternative anticoagulation strategies for CPB are limited and often have various pharmacokinetic profiles that may lead to increased perioperative bleeding. Read More

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http://dx.doi.org/10.1053/j.jvca.2018.04.051DOI Listing
April 2018
5 Reads

Guideline Implementation: Prevention of Venous Thromboembolism: 1.6 www.aornjournal.org/content/cme.

Authors:
Terri Link

AORN J 2018 Jun;107(6):737-748

Venous thromboembolism (VTE) is a serious and costly complication of surgery. Many cases of health care-associated VTE could be prevented with the use of evidenced-based interventions. Perioperative nurses are in a position to advocate for patients by assessing each patient's risk for VTE and implementing preventive measures, such as administering anticoagulants as ordered and correctly applying graduated compression stockings and intermittent pneumatic compression devices. Read More

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http://dx.doi.org/10.1002/aorn.12146DOI Listing
June 2018
20 Reads

Early surgical treatment in patients with pulmonary embolism and thrombus-in-transit.

J Thorac Dis 2018 Apr;10(4):2338-2345

Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Background: Floating right heart thrombi (RHT) are in transit from the legs to the pulmonary arteries and thus are a severe form of venous thromboembolism (VTE), with a high early mortality rate without treatment. There is a lack of evidence-based recommendations for its management. The objective of this study is to describe our experience in the surgical management of thrombus-in-transit and pulmonary embolism (PE) in a tertiary hospital. Read More

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http://dx.doi.org/10.21037/jtd.2018.04.41DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5949483PMC
April 2018
4 Reads

Plasmapheresis for Management of Antiphospholipid Syndrome in the Neurosurgical Patient.

Oper Neurosurg (Hagerstown) 2018 May 24. Epub 2018 May 24.

Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri.

Background And Importance: Antiphospholipid syndrome (APS) is an autoimmune disorder associated with a hypercoagulable state and increased risk of intraoperative and postoperative thrombosis. Few neurosurgical studies have examined the management of these patients, though the standard of care in most other disciplines involves the use of anticoagulation therapy. However, this is associated with risks such as hemorrhage, thrombosis due to warfarin withdrawal, and is not compatible with operative intervention. Read More

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http://dx.doi.org/10.1093/ons/opy135DOI Listing
May 2018
3 Reads

ECMO for Acute Respiratory Distress Syndrome After Thoracoabdominal Aortic Aneurysm Repair.

Ann Thorac Surg 2018 Oct;106(4):e171-e172

Department of Surgery, Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas.

Acute respiratory distress syndrome (ARDS) after thoracoabdominal aortic aneurysm (TAAA) repair poses a formidable challenge. Despite conventional maneuvers in the operating room, perioperative ARDS may require extracorporeal membrane oxygenation (ECMO). We present three cases of successful ECMO for ARDS after TAAA repair and discuss management of anticoagulation and cerebrospinal fluid drains. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00034975183067
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http://dx.doi.org/10.1016/j.athoracsur.2018.04.045DOI Listing
October 2018
5 Reads
3.850 Impact Factor

[Management of anticoagulants in ophthalmic surgery-a survey among ophthalmic surgeons in Germany].

Ophthalmologe 2018 May 16. Epub 2018 May 16.

Gerinnungsambulanz und Hämophiliezentrum an der Charité, Berlin, Deutschland.

Introduction: As our population ages and comorbidities rise, ophthalmic surgeons are increasingly faced with patients on anticoagulant therapy or with clotting disorders. The ophthalmic surgeon has to weigh the perioperative risk of haemorrhage when anticoagulation continues against the risk of thromboembolism caused by discontinuation or changing the patient's medication (bridging, switching, cessation). There are currently no guidelines or recommendations. Read More

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http://dx.doi.org/10.1007/s00347-018-0732-yDOI Listing
May 2018
6 Reads

[Oral anticoagulation : Current overview and perioperative management in ophthalmic surgery].

Ophthalmologe 2018 May 15. Epub 2018 May 15.

Augenklinik, Universitätsmedizin Göttingen, Göttingen, Deutschland.

Antithrombotic treatment with oral anticoagulants and antiplatelet agents can increase the risk for perioperative bleeding. In contrast to other surgical fields, the optimal perioperative management in ophthalmic surgery has not yet been exactly defined and, thus, is not standardized. In this contribution, we provide an overview of currently available oral anticoagulants and discuss potential strategies for the management of these agents in different ophthalmic surgical procedures. Read More

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http://dx.doi.org/10.1007/s00347-018-0724-yDOI Listing
May 2018
2 Reads

Perioperative Management of the Gynecologic Patient on Long-term Anticoagulation.

Clin Obstet Gynecol 2018 06;61(2):278-293

Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina.

The perioperative management of patients taking antithrombotic or antiplatelet medications is based on an assessment of the individual patient's risk for thrombosis or bleeding, the specific medication involved, and the nature of the planned procedure. This article describes specific strategies for whether and how these medications should be interrupted before gynecologic procedures, when they can be restarted following the procedure, and whether bridging therapy should be considered. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000371DOI Listing
June 2018
5 Reads

Comparison of two pediatric cases requiring the use of bivalirudin during cardiopulmonary bypass.

Perfusion 2018 10 11;33(7):525-532. Epub 2018 Apr 11.

1 Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.

Introduction: Comparison of two pediatric cases at our institution that utilized bivalirudin for anticoagulation on cardiopulmonary bypass (CPB); a bilateral lung transplant (BLT) and a ventricular assist device (VAD) implantation.

Methods: The same bivalirudin protocol was utilized in both cases with an initial bolus of 1 mg/kg administered by the anesthesia team, a 50 mg bolus in the pump prime at the time of the initial patient bolus and an initial infusion rate of 2.5 mg/kg/h, with titration as needed during CPB to maintain kaolin-activated clotting time (K-ACT) values >400 s. Read More

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http://dx.doi.org/10.1177/0267659118767374DOI Listing
October 2018
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Use of Anticoagulants Remains a Significant Threat to Timely Hip Fracture Surgery.

Geriatr Orthop Surg Rehabil 2018 22;9:2151459318764150. Epub 2018 Mar 22.

James Cook University Hospital, Middlesbrough, United Kingdom.

Introduction: Hip fracture remains the biggest single source of morbidity and mortality in the elderly trauma population, and any intervention focused on quality improvement and system efficiency is beneficial for both patients and clinicians. Two of the variables contributory to improving care and efficiency are time to theater and length of stay, with the overall goal being to improve care as reflected within the achievement of best practice tariff. One of the biggest barriers to optimizing these variables is preinjury anticoagulation. Read More

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http://dx.doi.org/10.1177/2151459318764150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871052PMC
March 2018
3 Reads

Perioperative Anticoagulation Management.

AORN J 2018 Apr;107(4):503-508

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http://dx.doi.org/10.1002/aorn.12115DOI Listing
April 2018
7 Reads

Enoxaparin-induced skin necrosis at injection site after total knee arthroplasty.

Arthroplast Today 2018 Mar 21;4(1):10-14. Epub 2017 Oct 21.

Department of Orthopaedics, University of California, Sacramento, CA, USA.

Enoxaparin is a widely used low-molecular-weight heparin for perioperative thromboembolic prophylaxis. Enoxaparin-induced skin necrosis in the setting of arthroplasty has been rarely reported in the literature with varying outcomes and management decisions. Our patient developed skin necrosis at his injection site and thrombocytopenia 10 days following left total knee arthroplasty surgery and after receiving subcutaneous Lovenox injections postoperatively. Read More

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http://dx.doi.org/10.1016/j.artd.2017.09.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859518PMC
March 2018
7 Reads

New atrial fibrillation diagnosed perioperatively-anticoagulation practices in a secondary hospital.

N Z Med J 2018 03 9;131(1471):72-78. Epub 2018 Mar 9.

Consultant Physician, Department of General Medicine, Hutt Hospital, Lower Hutt.

Background: Atrial fibrillation (AF) is a common arrhythmia encountered perioperatively in patients undergoing non-cardiac surgery. There is emerging evidence suggesting high risk of ischaemic stroke. There are no clear guidelines surrounding initiation of anticoagulation in this setting. Read More

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March 2018
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New Trends in Anticoagulation Therapy.

Surg Clin North Am 2018 Apr 3;98(2):219-238. Epub 2018 Feb 3.

Section of Vascular Surgery, Department of Surgery, University of Michigan, 5372 Cardiovascular Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5867, USA. Electronic address:

Anticoagulation pharmacy has been dramatically altered with US Food and Drug Administration (FDA) approval of 5 direct oral anticoagulants, 1 novel reversal agent and, a second designated for fast-track approval. Trial data surrounding current trends in anticoagulant choice for VTE, reversal, and bridging are constantly redefining practice. Extended therapy for unprovoked VTE has expanded to include low-dose direct oral anticoagulants, aspirin, and the use of the HERDOO2 system to identify women who can stop anticoagulant therapy without increased risk of recurrent VTE. Read More

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http://dx.doi.org/10.1016/j.suc.2017.11.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5973805PMC
April 2018
6 Reads

The role of preoperative deep vein thrombosis screening in neurooncology.

J Neurosurg 2018 Feb 1:1-6. Epub 2018 Feb 1.

Departments of1Neurosurgery and.

OBJECTIVEVenous thromboembolism (VTE) is a major cause of morbidity in patients undergoing neurosurgical intervention. The authors postulate that the introduction of a routine preoperative deep vein thrombosis (DVT) screening protocol for patients undergoing neurosurgical intervention for brain tumors would result in a more effective diagnosis of DVT in this high-risk subgroup, and subsequent appropriate management of the condition would reduce pulmonary embolism (PE) rates and improve patient outcomes.METHODSThe authors conducted a prospective study of 115 adult patients who were undergoing surgical intervention for a brain tumor. Read More

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http://dx.doi.org/10.3171/2017.9.JNS17176DOI Listing
February 2018
8 Reads

Perioperative Outcomes are Adversely Affected by Poor Pretransfer Adherence to Acute Limb Ischemia Practice Guidelines.

Ann Vasc Surg 2018 Jul 23;50:46-51. Epub 2018 Feb 23.

Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.

Background: The accepted treatment for acute limb ischemia (ALI) is immediate systemic anticoagulation and timely reperfusion to restore blood flow. In this study, we describe the retrospective assessment of pretransfer management decisions by referring hospitals to an academic tertiary care facility and its impact on perioperative adverse events.

Methods: A retrospective analysis of ALI patients transferred to us via our Level I Vascular Emergency Program from 2010 to 2013 was performed. Read More

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http://dx.doi.org/10.1016/j.avsg.2017.11.050DOI Listing
July 2018
5 Reads

Perioperative management of a patient with Glanzmann thrombasthenia undergoing a coronary artery bypass graft surgery: a case report.

Blood Coagul Fibrinolysis 2018 Apr;29(3):327-329

Department of Biological Hematology.

: We report herein the successful perioperative management of a 57-year-old man with a type I Glanzmann thrombasthenia undergoing coronary artery bypass graft surgery and right carotid endarterectomy. The patient suffered from several lesions in the three major coronary arteries and in the right carotid necessitating surgery. Prophylactic human leukocyte antigen (HLA)-matched platelets transfusions were continuous administrated before, and through the immediate perioperative period. Read More

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http://dx.doi.org/10.1097/MBC.0000000000000719DOI Listing
April 2018
13 Reads

Bariatric Surgery in Patients on Chronic Anticoagulation Therapy.

Obes Surg 2018 Aug;28(8):2225-2232

Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Desk M61, 9500 Euclid Ave, Cleveland, OH, 44195, USA.

Background: Perioperative management of chronically anti-coagulated patients undergoing bariatric surgery requires a balance of managing hemorrhagic and thromboembolic risks. The aim of this study is to evaluate the incidence of hemorrhagic complications and their management in chronically anticoagulated (CAT) patients undergoing bariatric surgery.

Methods: A retrospective review of CAT patients undergoing bariatric surgery at an academic center from 2008 to 2015 was studied. Read More

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http://dx.doi.org/10.1007/s11695-018-3120-4DOI Listing
August 2018
5 Reads