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JACC Clin Electrophysiol 2022 Jun 27;8(6):735-748. Epub 2022 Apr 27.

Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Background: Catheter ablation for ventricular tachycardia (VT) is associated with perioperative thromboembolic risk. However, the strategy for postprocedural management remains unknown.

Objectives: The aim of this study was to evaluate the prothrombotic response after VT ablation in various coagulation biomarkers in patients with and without the administration of oral anticoagulation (OAC). Read More

Clin Appl Thromb Hemost 2022 Jan-Dec;28:10760296221097969

Hrombosis Center, 432215Service d'Hématologie Biologique Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine Sorbonne Université, Paris, France.

Thrombotic and hemorrhagic complications are related to a significant rate of morbidity and mortality in patients with myeloproliferative neoplasms (MPNs), they are therefore called "thrombohemorrhagic" syndromes. Several clinical factors, such as age and presence of cardiovascular comorbidities are responsible for thrombotic complications. High blood counts, platelet alterations, presence of JAK2 mutation and possibly of other CHIP mutations such as TET2, DNMT3A, and ASXL1, procoagulant microparticles, NETs formation, endothelial activation and neo-angiogenesis are some of the parameters accounting for hypercoagulability in patients with myeloproliferative neoplasms. Read More

JMIR Cardio 2022 Jun 21;6(1):e29481. Epub 2022 Jun 21.

Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany.

Background: Antithrombotic therapy is complex and requires informed decisions and high therapy adherence. Several mobile phone apps exist to either support physicians in the management of antithrombotic therapies or to educate and support patients. For the majority of these apps, both their medical evidence and their development background are unknown. Read More

Surg Endosc 2022 Jun 8. Epub 2022 Jun 8.

Department of Surgery, University of Florida, PO Box 100108, Gainesville, FL, 32610-0108, USA.

Introduction: There are a paucity of data regarding the safety of laparoscopic inguinal hernia repair in patients on antiplatelet and anticoagulant therapy (APT/ACT). We aim to compare the postoperative outcomes of laparoscopic (LIHR) vs. open repair of inguinal hernias (OIHR) in patients on APT/ACT. Read More

Plast Reconstr Surg 2022 Jun 9. Epub 2022 Jun 9.

Division of Plastic and Reconstructive Surgery, Albany Medical Center; Albany, NY, USA.

Background: Microsurgical free tissue transfer has been successfully implemented for various reconstructive applications in children. The goal of this study was to identify the best available evidence on perioperative management of pediatric patients undergoing free tissue transfer, and use it to develop evidence-based care guidelines.

Methods: A systematic review was conducted in Pubmed, Embase, Scopus, and Cochrane Library databases. Read More

Surg Clin North Am 2022 Jun 21;102(3):365-391. Epub 2022 Apr 21.

Orlando Health Heart and Vascular Institute, 1222 South Orange Avenue, Orlando, FL 32806, USA. Electronic address:

This article focuses on the guideline-directed evaluation and management of cardiac dysrhythmias, particularly as they are important to the practice of a noncardiac surgeon. The focus is on atrial fibrillation (AF) as the most common arrhythmia encountered by surgeons. The authors discuss the importance of AF as a risk factor for perioperative morbidity and mortality. Read More

Ann Med Surg (Lond) 2022 May 28;77:103684. Epub 2022 Apr 28.

Department of Anaesthesia, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia.

Background: The diagnosis and treatment of pulmonary embolism have multi-modal approach based on specificity, sensitivity, availability of the machine, and associated risks of imaging modalities.

Aim: This review aimed to provide shreds of evidence that improve perioperative diagnosis and management of suspected pulmonary embolism.

Methods: The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline 2020. Read More

J Clin Anesth 2022 09 13;80:110877. Epub 2022 May 13.

Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany. Electronic address:

Study Objective: We explored the feasibility of a Clinical Decision Support System (CDSS) to guide evidence-based perioperative anticoagulation.

Design: Prospective randomised clinical management simulation multicentre study.

Setting: Five University and 11 general hospitals in Germany. Read More

Geriatr Orthop Surg Rehabil 2022 11;13:21514593221076966. Epub 2022 May 11.

Department of Trauma and Orthopaedics, Kingston Hospital NHS Foundation Trust, Kingston, UK.

Aims: Our aim was to investigate the management of patients who were admitted to hospital with an acute haemarthrosis whilst taking oral anticoagulants, and highlight the outcomes of different management strategies.

Methods: A retrospective review was performed of all orthopaedic admissions over a 42-month period (January 2015-July 2018) to the Orthopaedic Department of a London District General Hospital. All patients admitted with a spontaneous joint haemarthrosis and concomitant use of oral anticoagulants was identified. Read More

Plast Reconstr Surg Glob Open 2022 May 11;10(5):e4318. Epub 2022 May 11.

Rutgers Robert Wood Johnson Medical School, Division of Plastic & Reconstructive Surgery, New Brunswick, N.J.

No consensus exists on ideal perioperative management or anticoagulation regimen for free flap reconstruction of the head and neck. Perceived benefits from antiplatelet therapy need to be balanced against potential complications. Ketorolac, a platelet aggregation inhibitor and a parenteral analgesic, was introduced as part of a standardized perioperative protocol at our institution. Read More

BMC Surg 2022 May 14;22(1):190. Epub 2022 May 14.

Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.

Introduction: Hypercoagulability is associated with an increased risk of microvascular complications and free flap failures. The authors present their experience and approach to diagnosing and treating patients with heterozygotic factor V Leiden (hFVL) thrombophilia undergoing free flap reconstruction.

Methods: Between November 2009 and June 2018, 23 free flap surgeries were performed in 15 hypercoagulable patients with hFVL. Read More

Front Cardiovasc Med 2022 13;9:869243. Epub 2022 Apr 13.

Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China.

Background: Postoperative myocardial injury (PMI) is associated with short- and long-term mortality. The incidence of PMI in very old patients is currently unknown. There is currently neither known effective prophylaxis nor a uniform strategy for the elderly with PMI. Read More

BMC Anesthesiol 2022 04 26;22(1):121. Epub 2022 Apr 26.

Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.

Background: Jcerity Endoscoper Airway is a new back-open endoscopic laryngeal mask airway device with a unique design. Our study sought to compare the implantation, ventilation quality and complications of JEA (Jcerity Endoscoper airway) versus LMA (Laryngeal Mask Airway) Supreme in the procedure of cerebral aneurysm embolization.

Methods: In this prospective, randomised clinical trial, 182 adult patients with American Society of Anesthesiologists class Ι-II scheduled for interventional embolization of cerebral aneurysms were randomly allocated into the Jcerity Endoscoper airway group and the LMA Supreme group. Read More

J Perinatol 2022 Apr 23. Epub 2022 Apr 23.

Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, CO, United States.

Background: Survival for severe (observed to expected lung-head ratio (O:E LHR) < 25%) congenital diaphragmatic hernia (CDH) remains a challenge (15-25%). Management strategies have focused on fetal endoscopic tracheal occlusion (FETO) and/or extracorporeal membrane oxygenation therapy (ECMO) utilization.

Objective(s): Describe single center outcomes for infants with severe CDH. Read More

Front Cardiovasc Med 2022 28;9:846590. Epub 2022 Mar 28.

State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Background: Catheter ablation (CA) effectively restores sinus rhythm in atrial fibrillation (AF) but causes a short-term fluctuation in the coagulation state. Potential risk factors and better management during this perioperative period remain understudied.

Methods: We consecutively included 940 patients with nonvalvular AF who received CA at Fuwai Hospital, Beijing, China. Read More

Ann Card Anaesth 2022 Apr-Jun;25(2):206-209

Baylor College of Medicine, Houston, Texas, USA.

Patients with Antiphospholipid syndrome (APLS) are at high risk for both bleeding and thrombotic complications during cardiac surgery involving cardiopulmonary bypass (CPB). In this case we present a patient with APLS and Immune Thrombocytopenic Purpura who successfully underwent aortic valve replacement (AVR) with CPB despite recent craniotomy for subdural hematoma evacuation. Anticoagulation for CPB was monitored by targeting an Activated Clotting Time (ACT) that was 2× the upper limit of normal. Read More

J Vasc Surg 2022 Apr 1. Epub 2022 Apr 1.

Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.

Objective: Arterial thoracic outlet syndrome (ATOS) is rare. We present our 30-year experience with the management of ATOS at a high-volume referral center.

Methods: A retrospective review of all patients who had undergone primary operative treatment for ATOS from 1988 to 2018 was performed. Read More

Medicina (Kaunas) 2022 Mar 4;58(3). Epub 2022 Mar 4.

Working Committee on Geriatric Trauma Registry of the German Trauma Society, 80538 München, Germany.

The increased use of direct oral anticoagulants (DOACs) results in an increased prevalence of DOAC treatment in hip fractures patients. However, the impact of DOAC treatment on perioperative management of hip fracture patients is limited. In this study, we describe the prevalence of DOAC treatment in a population of hip fracture patients and compare these patients with patients taking vitamin K antagonists (VKA) and patients not taking anticoagulants. Read More

J Crit Care Med (Targu Mures) 2022 Jan 13;8(1):55-60. Epub 2021 Nov 13.

Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.

Perioperative management of pheochromocytoma in the setting of catecholamine-induced heart failure requires careful consideration of hemodynamic optimization and possible mechanical circulatory support. A Jehovah's Witness patient with catecholamine-induced acutely decompensated heart failure required dependable afterload reduction for a cardio-protective strategy. This was emphasized due to the relative contraindication to perioperative anticoagulation required for mechanical circulatory support. Read More

Kyobu Geka 2022 Mar;75(3):208-211

Cardiovascular & Thoracic Surgery, Toyama Red Cross Hospital, Toyama, Japan.

Antiphospholipid antibody syndrome (APS) is associated with high morbidity and mortality resulting from hemorrhagic or thromboembolic events and compromised host immunity due to steroid use. We reported a successful surgery for aortic valve regurgitation (AR) and dissecting aortic aneurysm (DAA) in the ascending aorta in a patient with APS. A 75-year-old woman with AR and primary APS was transferred to our institute because of fever and dyspnea. Read More

Crit Care Nurs Q 2022 Apr-Jun 01;45(2):119-131

Department of Pharmacy, Mississippi Baptist Medical Center, Jackson (Dr Briete); Department of Pharmacy, MD Anderson Cancer Center, Houston, Texas (Dr Towers); Department of Pharmacy, Methodist University Hospital, Memphis, Tennessee (Drs Bone and Cutshall); Department of Cardiothoracic Surgery, Stanford Healthcare, Stanford, California (Mr Nair); Department of Pharmacy, Indiana University Health Arnett Hospital, Lafayette (Dr Steck); and Department of Pharmacy, Mercy Health, Janesville, Wisconsin (Dr Shah).

Management of anticoagulation in individuals undergoing operative procedures is a complex situation. Each case should be assessed individually with proper risk assessment, monitoring, and plan for perioperative and postoperative anticoagulation. Clinical evidence for the management of these patients is relatively scarce, and clinicians are often assessing each individual case with minimal guidance. Read More

J Clin Med 2022 Feb 3;11(3). Epub 2022 Feb 3.

Department of Plastic Surgery, University Hospital of St. Poelten, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria.

Background: Surgical breast reconstruction is an integral part of cancer treatment but must not compromise oncological safety. Patient-dependent risk factors (smoking, BMI, etc.) are said to influence perioperative outcomes and have often been investigated. Read More

J Spine Surg 2021 Dec;7(4):458-466

Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.

Background: Factor Xa inhibitors (Xai) are an increasingly common consideration in perioperative anticoagulation management. However, there no existing guidelines established for use in Spine Surgery. This survey study aims to capture current practice trends regarding the perioperative management of Xai among spine surgeons. Read More

Eur J Surg Oncol 2022 Jun 31;48(6):1384-1389. Epub 2022 Jan 31.

Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address:

Introduction: The incidence of postoperative symptomatic venous thromboembolism (VTE) in western colorectal cancer is 1.1-2.5%. Read More

Indian J Surg Oncol 2021 Dec 8;12(4):816-821. Epub 2021 Sep 8.

Department of Otolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, India.

Oral cancers are amongst the most common cancers in the Indian subcontinent; in India alone, an estimated 1.2 lakh new patients were diagnosed with it. Reconstruction with free flaps slowly gained popularity over time to become the standard for care for treating large head and neck defects. Read More

Perioper Med (Lond) 2022 Feb 1;11(1). Epub 2022 Feb 1.

Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Background: Preoperative medical consultations add expense and burden for patients and the impact of these consults on patient outcomes is conflicting. Previous work suggests that 10-40% of preoperative medical consult recommendations are not followed. This limits measurement of the effect of perioperative medical consultation on patient outcomes and represents a quality gap, given the patient time and healthcare cost associated with consultation. Read More

Rev Cardiovasc Med 2022 Jan;23(1):34

Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, CA 92354, USA.

Background: Perioperative anticoagulation management with uninterrupted or minimally interrupted anticoagulation during atrial fibrillation (AF) ablation is thought to be critical to minimize thromboembolic complications. Protamine is often administered to neutralize the effects of heparin and expedite vascular hemostasis post-procedure.

Objective: We performed a systematic review and meta-analysis to determine the effectiveness of protamine to expedite vascular hemostasis and ambulation in patients undergoing AF ablation. Read More

HPB (Oxford) 2022 05 20;24(5):575-585. Epub 2021 Dec 20.

Indiana University, Indianapolis, IN, USA.

Background: Major abdominal surgery and malignancy lead to a hypercoagulable state, with a risk of venous thromboembolism (VTE) of approximately 3% after pancreatic surgery. No guidelines exist to assist surgeons in managing VTE prophylaxis or anticoagulation in patients undergoing elective pancreatic surgery for malignancy or premalignant lesions. A systematic review specific to VTE prophylaxis and anticoagulation after resectional pancreatic surgery is herein provided. Read More

Lupus 2022 Feb 18;31(2):261-267. Epub 2022 Jan 18.

12297Department of Rheumatology at NYU Langone Health, New York, NY, USA.

Background: The American College of Chest Physicians (ACCP) and National Institutes for health and care Excellence in the United Kingdom (NICE) recommend that patients who are high risk for thrombotic events but require cessation of oral anticoagulation with warfarin, due to bleeding risk of a planned procedure, undergo bridging therapy with heparin. However, those conditions which are considered high risk are not universal, nor do guidelines differentiate between low molecular weight heparin (LMWH) and unfractionated heparin. Triple positive antiphospholipid syndrome (APS) is a thrombophilic state with a very high risk for thrombotic events during periods of anticoagulation cessation. Read More

Pediatr Neurol 2022 03 28;128:20-24. Epub 2021 Dec 28.

Bayer AG, Wuppertal, Germany.

Background: We aimed to describe the clinical presentation, risk of bleeding and recurrent thrombosis, and perioperative anticoagulant management of children with cerebral venous thrombosis (CVT) and an associated head or neck infection.

Methods: In this subgroup analysis of the EINSTEIN-Jr study, we included children with CVT and an associated head or neck infection who received therapeutic anticoagulants with either low-molecular-weight heparin (with or without subsequent vitamin K antagonists) or rivaroxaban for a period of 3 months. Analyses are descriptive. Read More