Search Our Scientific Publications & Authors

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Department of Surgery Kokura Memorial Hospital Kitakyushu Japan.

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

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

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

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

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

Actas Dermosifiliogr 2020 May 14. Epub 2020 May 14.

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

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

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

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

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

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

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

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

Design: Observational cohort study. Read More

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Department of Anesthesiology, Temple University Hospital.

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

Laryngoscope 2020 Feb 28. Epub 2020 Feb 28.

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

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

Study Design: Systematic Review and Metanlysis. Read More

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Study Design: Broad narrative review.

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

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

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

University of Virginia, Charlottesville, VA, USA.

Study Design: Literature review.

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

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

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

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

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

Urol Oncol 2020 Jan 9. Epub 2020 Jan 9.

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

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

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

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

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

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

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

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

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

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

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

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

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

The Royal Wolverhampton NHS Trust, UK.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Surg Endosc 2019 Oct 15. Epub 2019 Oct 15.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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