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    595 results match your criteria Perioperative Anticoagulation Management

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    Viscoelastic testing inside and beyond the operating room.
    J Thorac Dis 2017 Apr;9(Suppl 4):S299-S308
    Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
    Hemorrhage is a major contributor to morbidity and mortality during the perioperative period. Current methods of diagnosing coagulopathy have various limitations including long laboratory runtimes, lack of information on specific abnormalities of the coagulation cascade, lack of in vivo applicability, and lack of ability to guide the transfusion of blood products. Viscoelastic testing offers a promising solution to many of these problems. Read More

    Novel Anticoagulant Agents in the Perioperative Setting.
    Anesthesiol Clin 2017 Jun 7;35(2):305-313. Epub 2017 Apr 7.
    Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. Electronic address:
    An increasing number of oral anticoagulants have become available over the past decade. Each of these agents has differing implications on both regional and neuraxial anesthetic techniques. This article describes the pharmacology, pharmacokinetics, and pharmacodynamics of the most commonly used novel oral anticoagulants (NOACs). Read More

    Successful Team-Based Management of Renal Cell Carcinoma With Caval Extension of Tumor Thrombus Above the Diaphragm.
    J Cardiothorac Vasc Anesth 2017 Feb 9. Epub 2017 Feb 9.
    Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address:

    [Anesthesiological care of trauma patients in orthogeriatric co-management].
    Anaesthesist 2017 May;66(5):375-392
    Klinik für Anästhesiologie und Allgemeine Intensivmedizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
    Elderly patients increasingly need to undergo surgery under anesthesia, especially following trauma. A timely interdisciplinary approach to the perioperative management of these patients is decisive for the long-term outcome. Orthogeriatric co-management, which includes geriatricians and anesthesiologists from an early stage, is of great benefit for geriatric patients. Read More

    The Perioperative Management of Antithrombotic Therapies Using Enoxaparin.
    J Korean Med Sci 2017 Jun;32(6):942-947
    Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea.
    Oral anticoagulant therapy is frequently and increasingly prescribed for patients at risk of arterial or venous thromboembolism (VTE). Although elective surgical or invasive procedures have necessitated temporary interruption of anticoagulants, managing these patients has been performed empirically and been poorly investigated. This study was designed to evaluate the adequacy of perioperative anticoagulation using enoxaparin. Read More

    Anticoagulation Bridge Therapy in Patients with Atrial Fibrillation: Recent Updates Providing a Rebalance of Risk and Benefit.
    Pharmacotherapy 2017 May 5. Epub 2017 May 5.
    Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University.
    In 2011, we provided a review of clinical updates and controversies surrounding anticoagulation bridge therapy in patients with atrial fibrillation. Since then, options for oral anticoagulation have expanded with the addition of four direct oral anticoagulant (DOAC) agents available in the United States. Nonetheless, vitamin K antagonist (VKA) therapy continues to be the treatment of choice for patients who are poor candidates for a DOAC and for whom bridge therapy remains a therapeutic dilemma. Read More

    Perioperative management of patients with antiphospholipid syndrome: a single-center experience.
    Rheumatol Int 2017 May 4. Epub 2017 May 4.
    Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga 15. Col. Belisario Domínguez, Sección XVI, Tlalpan, 14080, México, D.F., Mexico.
    The objective was to describe the management and risk factors for complications of antiphospholipid syndrome (APS) patients who underwent a surgical procedure in a single center. We reviewed medical records of all patients with primary or secondary APS who underwent an elective surgery during a 6-year period. Demographical data, management of anticoagulation and complications were recorded. Read More

    [Management of hemorrhage in patients treated with direct oral anticoagulants].
    Anaesthesist 2017 Apr 28. Epub 2017 Apr 28.
    Klinik für Anästhesie, Intensiv- und Notfallmedizin, Westpfalz-Klinikum GmbH, Kaiserslautern, Deutschland.
    The introduction of nonvitamin K antagonistic, direct oral anticoagulants (DOAC) made thromboembolic prophylaxis easier for patients. For many physicians, however, there is still uncertainty about monitoring, preoperative discontinuation, and restarting of DOAC therapy. Guidelines for the management of bleeding are provided, but require specific therapeutic skills in the management of diagnostics and therapy of acute hemorrhage. Read More

    Managing the perioperative patient on direct oral anticoagulants.
    Can J Anaesth 2017 Jun 20;64(6):656-672. Epub 2017 Apr 20.
    Department of Anesthesiology and Perioperative Medicine, Queen's University, Victory 2, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
    Purpose: Patients are increasingly treated with direct oral anticoagulants (DOACs) for the prevention of stroke due to non-valvular atrial fibrillation and for the treatment of venous thromboembolism. When these patients present for urgent or emergent surgical procedures, they present a challenge to the anesthesiologist who must manage perioperative risk due to anticoagulation. The purpose of this module is to review the literature surrounding the perioperative management of DOACs. Read More

    Antiplatelets and anticoagulants in vitreoretinal surgery, with a special emphasis on novel anticoagulants: a national survey and review.
    Graefes Arch Clin Exp Ophthalmol 2017 Apr 18. Epub 2017 Apr 18.
    Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre and Institute of Human Development, University of Manchester, Manchester, UK.
    Purpose: To survey current practice and opinion regarding the cessation of antiplatelet and anticoagulant agents prior to vitreoretinal surgery, with special emphasis on novel anticoagulants, and to provide an overview of current literature.

    Methods: An online survey was sent to 167 members of the British and Eire Association of Vitreoretinal Surgeons (BEAVRS). A literature search and analysis was conducted on studies that reviewed the bleeding risk of antiplatelet and anticoagulant agents. Read More

    Perioperative Management of Anticoagulation.
    Neurosurg Clin N Am 2017 Apr 1;28(2):287-295. Epub 2017 Feb 1.
    Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, West Wing, 4th Floor, Toronto, Ontario M5T 2S8, Canada; Division of Neurosurgery, Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada. Electronic address:
    Antiplatelet and anticoagulant drugs (antithrombotics) predispose to acute and chronic subdural hematomas. Patients on these drugs are at higher likelihood of presenting with larger hematomas and more severe neurologic deficits. Standard neurosurgical and neurocritical care of subdural hematomas involves reversal of antithrombosis preoperatively, whereas reversing antiplatelet drugs is less clear. Read More

    Perioperative management of vitamin K antagonists in patients with low thromboembolic risk undergoing elective surgery: A prospective experience.
    Med Clin (Barc) 2017 Mar 7. Epub 2017 Mar 7.
    Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina; Servicio de Medicina Vascular y Trombosis, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
    Background And Objectives: To quantify thromboembolic and bleeding events in patients with low thromboembolic risk, who were chronically receiving vitamin K antagonists and undergoing elective surgery.

    Material And Methods: A descriptive, prospective, single-center study was conducted between December 2010 and July 2014. Patients aged over 18 years old, chronically anticoagulated with vitamin K antagonists and admitted for elective surgery were included in the study. Read More

    [Perioperative anticoagulation with NOAC using the example of rivaroxaban].
    MMW Fortschr Med 2017 Mar 27;159(Suppl 4):18-23. Epub 2017 Feb 27.
    Klinik für Kardiologie, Herzzentrum Klinikum Oldenburg, Oldenburg, Deutschland.
    Background: Recent findings require an update of earlier recommendations on the perioperative management of non Vitamin K antagonist oral anticoagulants (NOAC).

    Method: The present position paper summarises the outcomes of an expert panel discussion.

    Results And Conclusions: Based on the pharmacokinetic profile of rivaroxaban, a preoperative interruption of 24-72 hours is recommended depending on the patient's renal function, as well as individual and surgery-related bleeding risks. Read More

    A simultaneous minimally invasive approach to treat a patient with coronary artery disease and metastatic lung cancer.
    Wideochir Inne Tech Maloinwazyjne 2016 29;11(4):300-303. Epub 2016 Nov 29.
    People's Hospital of Ganzhou, Nanchang University, Ganzhou, China.
    Concurrent lung cancer and coronary artery disease requiring treatment with percutaneous coronary intervention or coronary artery bypass grafting is not rare. An individualized perioperative anticoagulation regimen and minimal surgical trauma will benefit the patient's postoperative recovery. We successfully treated a 68-year-old female patient with a lesion in the left anterior descending artery and metastatic right lung carcinoma by simultaneous minimally invasive direct coronary artery bypass grafting via a small left thoracotomy and thoracoscopic wedge resection of the lung lesion. Read More

    [A Case of Thyroid Carcinoma in Consideration for Perioperative Management].
    Gan To Kagaku Ryoho 2016 Nov;43(12):2124-2126
    Division of Breast and Endocrine Surgery, Dept. of Surgery, Nihon University School of Medicine.
    When patients are on long-term dialysis, various kinds of medication are given. We report our experience with a 75-yearold woman with thyroid carcinoma incidentally discovered during dialysis. Ultrasonography of the thyroid showed a tumor of about 3 cm in the right lobe center. Read More

    Coagulation Management in Jersey Calves: An ex vivo Study.
    Eur Surg Res 2017 27;58(3-4):128-139. Epub 2017 Jan 27.
    Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany.
    Objective: Jersey calves are frequently used as an experimental animal model for in vivo testing of cardiac assist devices or orthopedic implants. In this ex vivo study, we analyzed the coagulation system of the Jersey calves and the potential of human-based coagulation management to circumvent perioperative bleeding complications during surgery. Experimental Procedure: Blood from 7 Jersey calves was subjected to standard laboratory tests and thromboelastometry analysis. Read More

    Current and emerging treatments for hypercholesterolemia: A focus on statins and proprotein convertase subtilisin/kexin Type 9 inhibitors for perioperative clinicians.
    J Anaesthesiol Clin Pharmacol 2016 Oct-Dec;32(4):440-445
    Department of Anesthesiology, Mayo Clinic, Phoenix, Arizona 85054, USA.
    Statins are a mainstay of hyperlipidemia treatment. These drugs inhibit the enzyme 3-hydroxy-3-methylglutaryl coenzyme A reductase and have beneficial effects on atherosclerosis including plaque stabilization, reduction of platelet activation, and reduction of plaque proliferation and inflammation. Statins also have a benefit beyond atherosclerotic plaque, including anticoagulation, vasodilatation, antioxidant effects, and reduction of mediators of inflammation. Read More

    Evidence for periprocedural antiplatelet therapy, heparinization and bridging of coumarin therapy in carotid revascularization.
    J Cardiovasc Surg (Torino) 2017 Apr 3;58(2):143-151. Epub 2017 Jan 3.
    Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands -
    Thromboembolism prevention is a crucial factor determining both the natural outcome and outcome of intervention of stenotic atherosclerotic carotid artery pathology. Roughly 80% of all natural course cerebral ischemic events are caused by thromboembolism, versus 20% due to hemodynamic insufficiency. The risk of periprocedural cerebral (micro-) thromboembolization during carotid revascularization is considered to be even higher, with a higher rate in carotid artery stenting (CAS) as compared to carotid endarterectomy (CEA). Read More

    Perioperative Management of Direct Oral Anticoagulants (DOACs): A Systemic Review.
    Health Serv Insights 2016 13;9(Suppl 1):25-36. Epub 2016 Dec 13.
    Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA.
    Direct oral anticoagulants (DOACs) are in wide use among patients requiring both short- and long-term anticoagulation, mainly due to their ease of use and the lack of monitoring requirements. With growing use of DOACs, it is imperative that physicians be able to manage patients on these medications, especially in the perioperative period. We aim to provide guidance on the management of DOACs in the perioperative period. Read More

    [Perioperative patient management in orthogeriatrics].
    Orthopade 2017 Jan;46(1):54-62
    Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland.
    The management of major orthopedic surgery in the elderly prototypically reflects the perioperative risks of geriatric, often very frail patients reflecting an aging population. To improve outcome, the risks of anesthesia and surgery as well as of patient comorbidities must be thoroughly assessed and balanced using a multidisciplinary approach. Particular risks include cardiopulmonary morbidity, anemia, risk of hemorrhage and the management by anticoagulation, cerebral impairments as well as frailty and limited physiological reserves in general. Read More

    Healthcare resource utilization in patients receiving idarucizumab for reversal of dabigatran anticoagulation due to major bleeding, urgent surgery, or procedural interventions: interim results from the RE-VERSE AD™ study.
    J Med Econ 2017 May 17;20(5):435-442. Epub 2017 Jan 17.
    l McMaster University and Thrombosis and Atherosclerosis Research Institute , Hamilton , Ontario , Canada.
    Aims: Patients treated with anticoagulants may experience serious bleeding or require urgent surgery or intervention, and may benefit from rapid anticoagulant reversal. This exploratory analysis assessed healthcare resource utilization (HCRU) in patients treated with idarucizumab, a specific reversal agent for dabigatran etexilate.

    Materials And Methods: RE-VERSE AD™ (NCT02104947), a prospective, multi-center open-label study, is evaluating idarucizumab for dabigatran reversal in patients with serious bleeding (Group A) or undergoing emergency surgery/procedures (Group B). Read More

    Periprocedural Management of Non-Vitamin K Oral Anticoagulants in Chronic Kidney Disease: A Review of Existing Heterogeneity and Contemporary Evidence.
    J Atr Fibrillation 2015 Dec 31;8(4):1230. Epub 2015 Dec 31.
    Chief and Director, Division of Cardiology and Cardiac Catheterization Laboratory, Heartland Veterans Affairs Medical Center, Kansas City, MO, USA.
    Non vitamin-K oral anticoagulants (NOAC) have considerably enhanced anticoagulation practice for non-valvular atrial fibrillation with specific advantages of fixed dosing, non-fluctuant therapeutic levels and obviation of therapeutic level monitoring. NOAC pharmacology is remarkable for considerable renal excretion. Heterogeneity in the precise time cut-offs for discontinuation of NOACs prior to elective surgical or percutaneous procedures arise from the non-linear variations of drug excretion with different levels of creatinine clearances as in chronic kidney disease. Read More

    Perioperative management of adult patients with a history of stroke or transient ischaemic attack undergoing elective non-cardiac surgery.
    Clin Med (Lond) 2016 Dec;16(6):535-540
    Department of Ageing and Health, St Thomas' Hospital, London, UK.
    It is increasingly common for physicians and anaesthetists to be asked for advice in the medical management of surgical patients who have an incidental history of stroke or transient ischaemic attack (TIA). Advising clinicians requires an understanding of the common predictors, outcomes and management of perioperative stroke. The most important predictor of perioperative stroke is a previous history of stroke, and outcomes associated with such an event are extremely poor. Read More

    Current Management in Transurethral Therapy of Benign Prostatic Obstruction in Patients on Oral Anticoagulation: A Worldwide Questionnaire.
    J Endourol 2017 Feb 5;31(2):163-168. Epub 2017 Jan 5.
    Department of Urology, Asklepios Hospital Barmbek , Hamburg, Germany .
    Objective: To assess the current treatment of benign prostatic obstruction (BPO) in patients on ongoing oral anticoagulation (OA).

    Methods: An Internet survey was sent to all active members of the Endourological Society. The survey contained 32 questions regarding transurethral treatment of BPO in patients on ongoing OA, different techniques, and arising complications. Read More

    Perioperative Pharmacological Thromboprophylaxis in Patients With Cancer: A Systematic Review and Meta-analysis.
    Ann Surg 2017 Jun;265(6):1087-1093
    Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu , Sichuan Province, China.
    Objective: To compare the relative effects between pharmacological thromboprophylaxis and no anticoagulation.

    Background: The efficacy and safety of pharmacological thromboprophylaxis in cancer patients undergoing surgery need to be quantified to guide management.

    Methods: We searched multiple electronic databases (up to March 31, 2016) for trials of cancer patients undergoing surgery that assessed the relative benefits and harms of perioperative pharmacological thromboprophylaxis. Read More

    Factors Associated with Patient-Initiated Telephone Calls After Spine Surgery.
    World Neurosurg 2017 Feb 10;98:625-631. Epub 2016 Nov 10.
    Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA. Electronic address:
    Background: Telephone calls play a significant role in the follow-up care of postoperative patients. However, further data are needed to identify the determinants of patient-initiated telephone calls after surgery because these factors may also highlight potential areas of improvement in patient satisfaction and during the hospital discharge process. Therefore, the goal of this study is to determine the number of postoperative patient telephone calls within 14 days after surgery and establish the factors associated with patient-initiated calls and reasons for calling. Read More

    Rivaroxaban for Periprocedural Anticoagulation Therapy in Japanese Patients Undergoing Catheter Ablation of Paroxysmal Non-Valvular Atrial Fibrillation.
    Int Heart J 2016 Dec 4;57(6):712-716. Epub 2016 Nov 4.
    Heart Rhythm Center, Tokyo Medical and Dental University.
    Direct oral anticoagulants (DOACs) have been shown to be safe and effective for the prevention of stroke in nonvalvular atrial fibrillation (NVAF) patients, however, experience with peri-AF ablation management of DOACs is scarce. This study aimed to investigate the safety and feasibility of periprocedural anticoagulation therapy with rivaroxaban in Japanese patients undergoing paroxysmal non-valvular AF (NVAF) ablation using radiofrequency energy.This study was a multicenter, prospective pilot study. Read More

    Coexisting Cardiac and Hematologic Disorders.
    Anesthesiol Clin 2016 Dec;34(4):659-668
    Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, 111 South 11th Street, Philadelphia, PA 19107, USA.
    Patients with concomitant cardiac and hematologic disorders presenting for noncardiac surgery are challenging. Anemic patients with cardiac disease should be approached in a methodical fashion. Transfusion triggers and target should be based on underlying symptomatology. Read More

    Periprocedural Management of Novel Oral Anticoagulants During Atrial Fibrillation Ablation: Controversies and Review of the Current Evidence.
    Heart Lung Circ 2016 Dec 21;25(12):1164-1176. Epub 2016 Jun 21.
    Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; University of Sydney, NSW, Australia. Electronic address:
    Oral anticoagulation (OAC) has been the cornerstone for the prevention of thromboembolic complications in patients with atrial fibrillation (AF) at significant risk of stroke. Catheter ablation is an established efficacious technique for the treatment of AF. Ameliorating the risk of stroke or transient ischaemic attack (TIA) in patients with AF undergoing ablation requires meticulous planning of pharmacotherapy. Read More

    Administration of Coagulation-Altering Therapy in the Patient Presenting for Oral Health and Maxillofacial Surgery.
    Oral Maxillofac Surg Clin North Am 2016 Nov;28(4):443-460
    Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3 Library, New Haven, CT 203 785-2804, USA. Electronic address:
    Oral health care providers are concerned with how to manage patients prescribed coagulation-altering therapy during the perioperative/periprocedural period for dental and oral surgery interventions. Management and recommendation can be based on medication pharmacology and the clinical relevance of coagulation factor levels/deficiencies. Caution should be used with concurrent use of medications that affect other components of the clotting mechanisms; prompt diagnosis and any necessary intervention to optimize outcome is warranted. Read More

    Best practice for perioperative management of patients with cytoreductive surgery and HIPEC.
    Eur J Surg Oncol 2017 Jun 28;43(6):1013-1027. Epub 2016 Sep 28.
    Department for General- and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg, Germany.
    Due to the significantly improved outcome and quality of life of patients with different tumor entities after cytoreductive surgery (CRS) and HIPEC, there is an increasing number of centers performing CRS and HIPEC procedures. As this procedure is technically challenging with potential high morbidity and mortality, respectively, institutional experience also in the anesthetic and intensive care departments is essential for optimal treatment and prevention of adverse events. Clinical pathways have to be developed to achieve also good results in more comorbid patients with border line indications and extensive surgical procedures. Read More

    Update in perioperative cardiac medicine.
    Cleve Clin J Med 2016 Oct;83(10):723-730
    Professor of Medicine, Harvard Medical School, Boston, MA, USA.
    Recent studies have shed light on preoperative risk assessment, medical therapy to reduce postoperative cardiac complications (beta-blockers, statins, and angiotensin II receptor blockers [ARBs]), perioperative management of patients with coronary stents on antiplatelet therapy, and perioperative bridging anticoagulation. Read More

    Discontinuation and management of direct-acting anticoagulants for emergency procedures.
    Am J Emerg Med 2016 Nov 29;34(11S):14-18. Epub 2016 Sep 29.
    Department of Anesthesiology, Cardiothoracic ICU, Duke University School of Medicine, Durham, NC. Electronic address:
    Patients taking direct oral anticoagulants (DOACs) who then need an emergency invasive procedure require specialized management strategies. Appropriate patient evaluation includes assessment of the current anticoagulation state, including timing of the last dose. DOACs require particular coagulation assays to measure anticoagulation levels accurately, although standard coagulation screening tests may provide qualitative guidance. Read More

    Re-initiation of dabigatran and direct factor Xa antagonists after a major bleed.
    Am J Emerg Med 2016 Nov 28;34(11S):19-25. Epub 2016 Sep 28.
    Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Hofstra North Shore-LIJ School of Medicine, North Shore-LIJ Health System, Manhasset, NY.
    Direct oral anticoagulants (DOACs) are a relatively recent addition to the oral anticoagulant armamentarium, and provide an alternative to the use of vitamin K antagonists such as warfarin. Regardless of the type of agent used, bleeding is the major complication of anticoagulant therapy. The decision to restart oral anticoagulation following a major hemorrhage in a previously anticoagulated patient is supported largely by retrospective studies rather than randomized clinical trials (mostly with vitamin K antagonists), and remains an issue of individualized clinical assessment: the patient's risk of thromboembolism must be balanced with the risk of recurrent major bleeding. Read More

    Risk stratification, perioperative and periprocedural management of the patient receiving anticoagulant therapy.
    J Clin Anesth 2016 Nov 18;34:586-99. Epub 2016 Jul 18.
    Yale University School of Medicine, New Haven, CT.
    As a result of the aging US population and the subsequent increase in the prevalence of coronary disease and atrial fibrillation, therapeutic use of anticoagulants has increased. Perioperative and periprocedural management of anticoagulated patients has become routine for anesthesiologists, who frequently mediate communication between the prescribing physician and the surgeon and assess the risks of both thromboembolic complications and hemorrhage. Data from randomized clinical trials on perioperative management of antithrombotic therapy are lacking. Read More

    Management of direct oral anticoagulants in patients undergoing elective surgeries and invasive procedures: Updated guidelines from the French Working Group on Perioperative Hemostasis (GIHP) - September 2015.
    Anaesth Crit Care Pain Med 2017 Feb 20;36(1):73-76. Epub 2016 Sep 20.
    Department of Hematology and Transfusion, Lille University Hospital, Institut Pasteur de Lille, EGID, INSERM UMR 1011, University of Lille 2, Lille, France.
    Since 2011, data on patients exposed to direct oral anticoagulants (DOAs) while undergoing invasive procedures have accumulated. At the same time, an increased hemorrhagic risk during perioperative bridging anticoagulation without thrombotic risk reduction has been demonstrated. This has led the GIHP to update their guidelines published in 2011. Read More

    Anticoagulation management during cross-clamping and bypass.
    Best Pract Res Clin Anaesthesiol 2016 Sep 27;30(3):359-70. Epub 2016 Jul 27.
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA. Electronic address:
    Anticoagulation is required for successful implementation of cardiopulmonary bypass (CPB), as well as for surgeries requiring temporary aortic occlusion. It is well established that both coagulation and fibrinolysis are activated during CPB (Teufelsbauer et al., 1992) [1]. Read More

    Perioperative Management of the Direct Oral Anticoagulants: A Case-Based Review.
    Hematol Oncol Clin North Am 2016 Oct;30(5):1073-84
    Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, St. Joseph's Hospital, 50 Charlton Avenue East, Room F-544, Hamilton, ON L8N 4A6, Canada.
    The periprocedural management of patients on direct oral anticoagulants (DOACs) is a common but potentially challenging clinical problem because there are few prospective studies to guide clinical decisions. Retrospective analyses from randomized trials and observational data suggest that DOACs can be managed in a standardized manner, based on surgical and patient characteristics, that does not result in excess major bleeding or thrombosis. In a case-based manner, this article presents a perioperative DOAC management algorithm and reviews the available and emerging evidence supporting the safety and efficacy of this approach. Read More

    [2016 review on catastrophic antiphospholipid syndrome].
    Presse Med 2016 Dec 9;45(12 Pt 1):1084-1092. Epub 2016 Sep 9.
    Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie, hôpital Pitié-Salpêtrière, centre de référence national pour le lupus systémique et le syndrome des antiphospholipides, département de médecine interne et d'immunologie clinique, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
    The catastrophic antiphospholipid syndrome (CAPS) develops in at least 1% of patients with antiphospholipid syndrome, either primary or associated with systemic lupus erythematosus. CAPS reveals the antiphospholipid syndrome in about 50% of cases. The CAPS is characterized by rapidly-progressive widespread thromboses mainly affecting the microvasculature in the presence of antiphospholipid antibodies. Read More

    2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.
    Can J Cardiol 2016 Oct 6;32(10):1170-1185. Epub 2016 Sep 6.
    Southlake Regional Health Centre, Newmarket, Ontario, Canada.
    The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Read More

    Venous Thromboembolism in Patients with High-Grade Glioma.
    Semin Thromb Hemost 2016 Nov 30;42(8):877-883. Epub 2016 Aug 30.
    Department of Neurosurgery, Cushing Neurosurgical Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
    Venous thromboembolism (VTE), incorporating both deep vein thrombosis and pulmonary embolism, is a common, morbid, and potentially fatal condition. Patients undergoing surgery are at increased risk of VTE due to many perioperative factors, and patients undergoing surgery for high-grade glioma (HGG) have been found to be at an even higher risk than general surgical patients. Chemical prophylaxis of VTE during the postneurosurgical period remains one of the major dilemmas in modern neurosurgical practice due to a potential increased risk of devastating intracranial hemorrhage in the setting of anticoagulation. Read More

    Re-Initiation of Dabigatran and Direct Factor Xa Antagonists After a Major Bleed.
    Am J Med 2016 Nov 26;129(11S):S54-S63. Epub 2016 Aug 26.
    Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Hofstra North Shore-LIJ School of Medicine, North Shore-LIJ Health System, Manhasset, NY.
    Direct oral anticoagulants (DOACs) are a relatively recent addition to the oral anticoagulant armamentarium, and provide an alternative to the use of vitamin K antagonists such as warfarin. Regardless of the type of agent used, bleeding is the major complication of anticoagulant therapy. The decision to restart oral anticoagulation following a major hemorrhage in a previously anticoagulated patient is supported largely by retrospective studies rather than randomized clinical trials (mostly with vitamin K antagonists), and remains an issue of individualized clinical assessment: the patient's risk of thromboembolism must be balanced with the risk of recurrent major bleeding. Read More

    Bivalirudin anticoagulation for minimal invasive transapical transcatheter aortic valve replacement in a patient with antiphospholipid antibodies.
    J Clin Anesth 2016 Sep 2;33:373-5. Epub 2016 Jun 2.
    Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Center NRW, Bad Oeynhausen, Ruhr-University Bochum, Germany.
    The occurrence of lupus anticoagulant is associated with the hazard of developing an antiphospholipid syndrome, a severe prothrombotic condition which may particularly occur after major surgical trauma. This disease requires certain considerations regarding surgical strategy and anticoagulation management. We describe the perioperative management of a patient scheduled for elective aortic valve replacement and diagnosed for having antiphospholipid antibodies. Read More

    Silent pulmonary thromboembolism in neurosurgery patients: Report of 2 cases and literature review.
    Medicine (Baltimore) 2016 Aug;95(33):e4589
    Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
    Background: The requirement of postoperative bedridden and immobilization renders neurosurgical patients with higher risk of deep vein thrombosis (DVT), then more vulnerable for pulmonary thromboembolism (PTE). But silent pulmonary thromboembolism (SPTE) can be the very early stage of any typical form of PTE, its diagnosis and management is therefore critical in neurosurgical departments. However, to date, perioperative SPTE has not been attached with enough attention. Read More

    Ventricular Assist Devices in Pediatric Cardiac Intensive Care.
    Pediatr Crit Care Med 2016 Aug;17(8 Suppl 1):S160-70
    All authors: Department of Pediatrics, Section of Cardiology, Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
    Objectives: The objectives of this review are to discuss the process of patient and mechanical device selection, operative management, and postoperative care with a focus on the management of right ventricular failure, anticoagulation strategies, device-related infections and neurologic sequelae.

    Data Sources: MEDLINE, PubMed.

    Conclusion: The number of patients with advanced heart failure due to either acquired or congenital heart disease continues to increase, necessitating in some mechanical circulatory support and in others cardiac transplantation. Read More

    Ablation protocols and ancillary procedures in tumor ablation therapy: consensus from Japanese experts.
    Jpn J Radiol 2016 Sep 23;34(9):647-56. Epub 2016 Jul 23.
    Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
    Purpose: A panel of Japanese experts on tumor ablation therapy gathered to reach a general consensus on topics surrounding ablation therapy.

    Materials And Methods: Questionnaires relating to ablation protocols for radiofrequency ablation (RFA) and cryoablation, as well as ancillary procedures required for safe and secure ablation therapy, were sent to seven institutions. Experts from these institutions discussed each topic based on the evidence and the questionnaire data, and a consensus was reached at an annual meeting of the Japan Image-guided Ablation Group in Maebashi, Japan, in October 2015. Read More

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