923 results match your criteria Perioperative Anticoagulation Management


Safety and Efficacy of the Woven EndoBridge Device for Treatment of Ruptured Intracranial Aneurysms: A Systematic Review and Meta-analysis.

AJNR Am J Neuroradiol 2021 Jun 11. Epub 2021 Jun 11.

From the Department of Neurosurgery (M.A.E., G.L., W.B.), Mayo Clinic, Rochester, Minnesota.

Background: The Woven EndoBridge device has been increasingly used to treat wide-neck aneurysms, particularly ruptured ones.

Purpose: Our aim was to investigate the safety and efficacy of the Woven EndoBridge device in the treatment of ruptured intracranial aneurysms.

Data Sources: All studies evaluating the outcomes of Woven EndoBridge device use in the treatment of ruptured intracranial aneurysms from inception through 2020 were searched on Ovid Evidence-Based Medicine Reviews, EMBASE, MEDLINE, Scopus, and the Web of Science Core Collection. Read More

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Successful perioperative management of a case of infective endocarditis secondary to a Lemierre's syndrome variant with severe neurological manifestations.

J Card Surg 2021 Jun 10. Epub 2021 Jun 10.

Department of Infectious Disease Medicine, Fukuoka Red Cross Hospital, Fukuoka, Japan.

Lemierre's syndrome (LS) is characterized by septic thrombophlebitis of the internal jugular vein with septicemia and metastatic infection following an oropharyngeal infection. LS is rare but can cause infective endocarditis (IE), complicating IE management. We report a case of IE secondary to thrombophlebitis in the left vertebral vein following pharyngitis (LS variant) with distinctively severe manifestations, including metastatic infection and severe neurological impairment with multiple cerebral infarctions. Read More

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The Use of Extracorporeal Membrane Oxygenation in Severely Burned Patients: A Survey of North American Burn Centers.

J Burn Care Res 2021 Jun 6. Epub 2021 Jun 6.

Department of Surgery, Division of Plastic Surgery, Halifax, NS, Canada.

Respiratory failure and acute respiratory distress syndrome can occur in burn patients with or without inhalational injury, and can significantly increase mortality. For patients with severe respiratory failure who fail conventional therapy with mechanical ventilation, the use of veno-venous extracorporeal membrane oxygen (ECMO) may be a lifesaving salvage therapy. There have been a series of case reports detailing the use of ECMO in burn patients over the last twenty years, but very little is currently known about the status of ECMO use at burn centers in North America. Read More

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Safety and efficacy of holmium laser enucleation of prostate as salvage procedure for persistent or recurrent lower urinary tract symptoms secondary to bladder outlet obstruction after prior prostate artery embolization: a match analysis.

World J Urol 2021 Jun 3. Epub 2021 Jun 3.

Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.

Purpose: To evaluate safety and efficacy of Holmium laser enucleation of Prostate (HoLEP) for management of persistent or recurrent lower urinary tract symptoms after prior prostate artery embolization (PAE). We also evaluated histopathological changes in prostate after PAE.

Methods: Ten patients who underwent HoLEP after prior PAE were matched according to age, weight of resected prostate tissue, and anticoagulation status in 1:2 ratio with patients who underwent HoLEP without prior PAE by a researcher who was blinded to patient's outcome at the time of matching. Read More

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Extracorporeal Membrane Oxygenation Use in Thoracic Surgery.

Membranes (Basel) 2021 May 31;11(6). Epub 2021 May 31.

International Clinical Research Center, St. Anne's University Hospital Brno, 65691 Brno, Czech Republic.

This narrative review is focused on the application of extracorporeal membrane oxygenation (ECMO) in thoracic surgery, exclusive of lung transplantation. Although the use of ECMO in this indication is still rare, it allows surgery to be performed in patients where conventional ventilation is not feasible-especially in single lung patients, sleeve lobectomy or pneumonectomy and tracheal or carinal reconstructions. Comparisons with other techniques, various ECMO configurations, the management of anticoagulation, anesthesia, hypoxemia during surgery and the use of ECMO in case of postoperative respiratory failure are reviewed and supported by two cases of perioperative ECMO use, and an overview of published case series. Read More

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RAND appropriateness panel to determine the applicability of UK guidelines on the management of acute respiratory distress syndrome (ARDS) and other strategies in the context of the COVID-19 pandemic.

Thorax 2021 May 27. Epub 2021 May 27.

Guy's and St Thomas' NHS Foundation Trust, London, UK.

Background: COVID-19 has become the most common cause of acute respiratory distress syndrome (ARDS) worldwide. Features of the pathophysiology and clinical presentation partially distinguish it from 'classical' ARDS. A Research and Development (RAND) analysis gauged the opinion of an expert panel about the management of ARDS with and without COVID-19 as the precipitating cause, using recent UK guidelines as a template. Read More

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Current Practices in Microvascular Reconstruction by Oral & Maxillofacial Surgeons.

J Oral Maxillofac Surg 2021 Apr 17. Epub 2021 Apr 17.

Chalmers J. Lyons Professor and Chair, School of Dentistry, Section Head, Department of Surgery, Michigan Medicine, Ann Arbor, MI. Electronic address:

Purpose: Microvascular free tissue transfer (MFTT) is a reliable reconstructive option with variation in perioperative care and a general lack of clinical practice guidelines. Oral and maxillofacial surgeons' (OMSs) current MFTT perioperative practices in the United States have not been described. This study describes these practices including surgeon practice environment, operative practices, perioperative management, and success. Read More

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Carotid approach to anterior circulation thromboembolectomy in an adult with failing fontan physiology: a case report.

BMC Anesthesiol 2021 May 18;21(1):151. Epub 2021 May 18.

Department of Anesthesiology, Columbia University College of Physicians and Surgeons, NY, New York, USA.

Background: Anesthetic management of an adult with failing Fontan physiology is complicated given inherent anatomical and physiological alterations. Neurosurgical interventions including thromboembolectomy may be particularly challenging given importance of blood pressure control and cerebral perfusion.

Case Presentation: We describe a 29 year old patient born with double outlet right ventricle (DORV) with mitral valve atresia who after multi-staged surgeries earlier in life, presented with failing Fontan physiology. Read More

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Year in Review 2020: Noteworthy Literature in Cardiothoracic Anesthesiology.

Semin Cardiothorac Vasc Anesth 2021 Jun 3;25(2):94-106. Epub 2021 May 3.

University of Colorado Anschutz Medical Campus, Aurora, CO, USA.

The year 2020 was marred by the emergence of a deadly pandemic that disrupted every aspect of life. Despite the disruption, notable research accomplishments in the practice of cardiothoracic anesthesiology occurred in 2020 with an emphasis on optimizing care, improving outcomes, and expanding what is possible for patients undergoing cardiac surgery. This year's edition of Noteworthy Literature Review will focus on specific themes in cardiac anesthesiology that include preoperative anemia, predictors of acute kidney injury following cardiac surgery, pain management modalities, anticoagulation strategies after transcatheter aortic valve replacement, mechanical circulatory support, and future directions in research. Read More

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The Triple HIT: Perioperative Management of Heparin-Induced Thrombocytopenia Using Plasma Exchange, Intravenous Immunoglobulin, and Protamine Infusion for Left Ventricular Assist Device Implantation.

J Cardiothorac Vasc Anesth 2021 Mar 30. Epub 2021 Mar 30.

Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.

Heparin-induced thrombocytopenia (HIT) is a serious complication in patients exposed to heparin, leading to thrombocytopenia and, potentially, thrombosis. This disorder is challenging in cardiac surgery when anticoagulation for cardiopulmonary bypass is required. Herein a patient with HIT who had active thrombosis and successfully underwent urgent left ventricular assist device implantation managed with plasma exchange, intravenous immunoglobulin, and protamine infusion is described. Read More

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Management of patients receiving novel antithrombotic treatment in endodontic practice: Review and clinical recommendations.

Int Endod J 2021 Apr 24. Epub 2021 Apr 24.

School of Dentistry, College of Biomedical Sciences, Cardiff University, Cardiff, UK.

Cardiovascular diseases are a major component of non-communicable diseases and death, with thrombosis constituting the most common underlying pathosis of the three major cardiovascular disorders: ischaemic heart disease (acute coronary syndrome), stroke, and venous thromboembolism (VTE). The introduction of direct oral anticoagulants (DOACs) in recent years has necessitated a more complex approach to periprocedural and perioperative anticoagulation management and the need for revised management strategies and protocols. Currently, patients taking classic oral anticoagulants are advised to stop taking the drugs and have their INR values checked 72 hours prior to dental surgery (e. Read More

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Middle meningeal artery embolization with subdural evacuating port system for primary management of chronic subdural hematomas.

Neurosurg Rev 2021 Apr 24. Epub 2021 Apr 24.

Department of Neurosurgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, PHC7, Washington, DC, USA.

Optimal treatment for chronic subdural hematomas remains controversial and perioperative risks and comorbidities may affect management strategies. Minimally invasive procedures are emerging as alternatives to the standard operative treatments. We evaluate our experience with middle meningeal artery (MMA) embolization combined with Subdural Evacuating Port System (SEPS) placement as a first-line treatment for patients with cSDH. Read More

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Aortic valve surgery for aortic regurgitation caused by Libman-Sacks endocarditis in a patient with primary antiphospholipid syndrome: a case report.

J Cardiothorac Surg 2021 Apr 17;16(1):92. Epub 2021 Apr 17.

Department of Cardiothoracic Surgery, Penang General Hospital, Jalan Residensi, 10990, George Town, Pulau Pinang, Malaysia.

Background: Antiphospholipid syndrome is an antibody mediated pro-thrombotic state leading to various arterial and venous thromboses. The syndrome can be either primary or secondary to other autoimmune diseases, commonly systemic lupus erythematosus. Cardiac involvement, in particular valvular disease is common in patients with antiphospholipid syndrome, occurring in about a third of these patients. Read More

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Managing anticoagulation in pregnancy for the anaesthetist on the labour ward.

Br J Hosp Med (Lond) 2021 Mar 31;82(3):1-7. Epub 2021 Mar 31.

Department of Anaesthesia and Perioperative Medicine, University College Hospital NHS Foundation Trust, London, UK.

Pregnancy is a hypercoaguable state. As part of the multidisciplinary team on labour ward, the anaesthetist plays a role particularly in advising the women and the obstetric team regarding the timing and even choice of regional analgesia given the potential risk of complications, as this may be affected by the anticoagulation treatment pregnant women may be on. It is important to understand the type of anticoagulation regimens parturients might be on and what sort of risk assessment they must undergo, as this has obstetric and anaesthetic implications. Read More

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Current practice patterns of society of urologic oncology members in performing inguinal lymph node staging/therapy for penile cancer: A survey study.

Urol Oncol 2021 Mar 25. Epub 2021 Mar 25.

Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.

Objectives: Inguinal lymph node (ILN) staging and therapeutic procedures are important for the diagnosis and management of suspected Inguinal lymph node metastasis in the setting of penile cancer. Morbidity associated with inguinal lymph node dissection (ILND) and the lack of standardization in its perioperative management are both significant. In this study, we aimed to define current management approaches and potential opportunities for improving outcomes. Read More

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Society of Family Planning clinical recommendations: Management of individuals with bleeding or thrombotic disorders undergoing abortion.

Contraception 2021 Mar 22. Epub 2021 Mar 22.

Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, United States.

Individuals who have bleeding disorders, thrombophilias, a history of venous thromboembolism (VTE), or who are taking anticoagulation medication for other reasons may present for abortion. Clinicians should be aware of risk factors and histories concerning for excessive bleeding and thrombotic disorders around the time of abortion. This document will focus on how to approach abortion planning in these individuals. Read More

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Office hysteroscopy safety and feasibility in women receiving anticoagulation and anti-platelet treatment.

Eur J Obstet Gynecol Reprod Biol 2021 May 17;260:110-113. Epub 2021 Mar 17.

Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.

Objectives: More than 60,000 hysteroscopies are performed every year in the UK for common reasons such as heavy menstrual bleeding (HMB) or postmenopausal bleeding. A significant number of women requiring hysteroscopy receive oral anticoagulants and there is often a reluctance to perform these procedures due to bleeding concerns.

Study Design: We are presenting the first proof of concept cohort of patients undergoing minor hysteroscopic procedures while on anticoagulant or antiplatelet medication. Read More

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Pre-operative assessment of patients undergoing spinal cord stimulation for refractory angina pectoris.

Pain Med 2021 Mar 18. Epub 2021 Mar 18.

Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN.

Spinal cord stimulation (SCS) is used to treat a variety of chronic pain conditions refractory to more conservative management including refractory angina pectoris. We identified thirty-one patients who underwent SCS implantation for the indication of refractory angina at a single institution from 2003 through 2018. Sixteen patients were male and fifteen were female. Read More

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Expert Consensus Decision Pathway of the American College of Cardiology on Management of Bleeding in Patients With Oral Anticoagulants: A Review of the 2020 Update for Perioperative Physicians.

J Cardiothorac Vasc Anesth 2021 Feb 12. Epub 2021 Feb 12.

Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL. Electronic address:

The use and evolution of oral anticoagulation therapies continue to advance for multiple reasons, including a growing segment of older patients with associated chronic prothrombotic illnesses including cardiovascular, pulmonary, hematologic and oncologic conditions. Correlated to this increased use of oral anticoagulants is bleeding complications associated with their use. Based on these trends, it is expected that perioperative physicians will be facing more and more of these patients requiring scheduled, urgent or emergent surgical procedures During May 2020, the American College of Cardiology updated its Expert Consensus Decision Pathway devoted to the approach of bleeding in patients on oral anticoagulants. Read More

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February 2021

[Effectiveness and safety of idarucizumab in the management of perioperative complications of atrial fibrillation catheter ablation in atrial fibrillation patients under dabigatran therapy].

Zhonghua Xin Xue Guan Bing Za Zhi 2021 Mar 24;49(3):217-223. Epub 2021 Mar 24.

Cardiology Center of Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing 100029, China.

To investigate the efficacy and safety of idarucizumab in the treatment of perioperative cardiac tamponade and thromboembolic events during catheter ablation in atrial fibrillation (AF) patients under dabigatran therapy. This study was a retrospective analysis enrolling patients under dabigatran therapy, who underwent catheter ablation for AF at Beijing Anzhen Hospital from January 2019 to December 2020 and developed perioperative cardiac tamponade or acute ischemic stroke (AIS) and received idarucizumab to reverse the anticoagulant effect of dabigatran. Patients' age, sex, renal function, coagulation test and safety events at 30 d after idarucizumab administration were collected and analyzed. Read More

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Perioperative Management of Chronic Antithrombotic Agents in Elective Hip and Knee Arthroplasty.

Medicina (Kaunas) 2021 Feb 23;57(2). Epub 2021 Feb 23.

Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA.

Total hip and knee arthroplasty are common major orthopedic operations being performed on an increasing number of patients. Many patients undergoing total joint arthroplasty (TJA) are on chronic antithrombotic agents due to other medical conditions, such as atrial fibrillation or acute coronary syndrome. Given the risk of bleeding associated with TJAs, as well as the risk of thromboembolic events in the post-operative period, the management of chronic antithrombotic agents perioperatively is critical to achieving successful outcomes in arthroplasty. Read More

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February 2021

Management of anticoagulated patients in dentoalveolar surgery: a retrospective study comparing bridging with heparin versus unpaused vitamin K antagonist medication.

BMC Oral Health 2021 03 5;21(1):96. Epub 2021 Mar 5.

Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Glückstrasse 11, 91054, Erlangen, Germany.

Background: The aim of this study was to investigate the occurrence of postoperative bleeding following dentoalveolar surgery in patients with either continued vitamin K antagonist medication or perioperative bridging using heparin.

Methods: A retrospective study was performed analyzing patients who underwent tooth extraction between 2012 and 2017. Patients were retrospectively allocated into two comparative groups: un-paused vitamin K antagonist medication versus bridging using heparin. Read More

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Management of warfarin-associated intracerebral hemorrhage before and after implementation of an order set and prospective pharmacist order verification.

J Thromb Thrombolysis 2021 Mar 4. Epub 2021 Mar 4.

Department of Pharmacy, The Ohio State University Wexner Medical Center, Doan Hall Room 368 410 W, 10th Ave, Columbus, OH, 43210, USA.

Management of warfarin-associated intracerebral hemorrhage (ICH) necessitates rapid reversal of anticoagulation. Guideline-based management of warfarin-associated ICH includes timely administration of prothrombin complex concentrate (PCC) and intravenous (IV) vitamin K. In 2017, our hospital implemented an order set for warfarin reversal to facilitate computerized provider order entry (CPOE), and the pharmacy department began prospective verification and dispensing of all PCC orders for anticoagulant reversal. Read More

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Venous Reconstruction During Pancreatectomy Using Polytetrafluoroethylene Grafts: A Single-Center Experience with Standardized Perioperative Management.

Ann Surg Oncol 2021 Mar 2. Epub 2021 Mar 2.

Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, Marseille, France.

Background: Although primary end-to-end anastomosis is preferred for portal vein-superior mesenteric vein (PV-SMV) reconstruction, interposition graft use may be required in some situations. We investigated the efficacy of polytetrafluoroethylene (PTFE) grafts when used during pancreatectomy in this context.

Methods: From 2014 to 2019, 19 patients who underwent pancreatectomy requiring PV-SMV reconstruction using ringed PTFE grafts were entered prospectively into a clinical database (NCT02871336, CNIL No. Read More

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2020 Clinical Update in Liver Transplantation.

J Cardiothorac Vasc Anesth 2021 Feb 6. Epub 2021 Feb 6.

Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE. Electronic address:

The gold standard treatment of end-stage liver disease continues to be liver transplantation (LT). The challenges of LT require skilled anesthesiologists to anticipate physiologic changes associated with end-stage liver disease and surgical considerations that affect multiple organ systems. While on the waiting list, patients may be placed on new anticoagulation medications that can confound already complex coagulopathy in LT patients. Read More

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February 2021

Neurologic complications of infective endocarditis.

Handb Clin Neurol 2021 ;177:125-134

Department of Neurology, Mayo Clinic, Rochester, MN, United States.

Infective endocarditis (IE) is an infection primarily affecting the endocardium of heart valves that can embolize systemically and to the brain. Neurologic manifestations include strokes, intracerebral hemorrhages, mycotic aneurysms, meningitis, cerebral abscesses, and infections of the spine. Neurologic involvement is associated with worse mortality, though it does not always portend a poor functional prognosis. Read More

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January 2021

GTH 2021 State of the Art-Cardiac Surgery: The Perioperative Management of Heparin-Induced Thrombocytopenia in Cardiac Surgery.

Hamostaseologie 2021 Feb 15;41(1):59-62. Epub 2021 Feb 15.

Department of Anesthesiology, Cardiothoracic and Vascular Anesthesia, Lausanne University Hospital (CHUV), Lausanne, Switzerland.

Heparin-induced thrombocytopenia (HIT) is a severe, immune-mediated, adverse drug reaction that paradoxically induces a prothrombotic state. Particularly in the setting of cardiac surgery, where full anticoagulation is required during cardiopulmonary bypass, the management of HIT can be highly challenging, and requires a multidisciplinary approach. In this short review, the different perioperative strategies to run cardiopulmonary bypass will be summarized. Read More

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February 2021

A Learning Health System for Pediatric Liver Transplant: The Starzl Network for Excellence in Pediatric Transplantation.

J Pediatr Gastroenterol Nutr 2021 03;72(3):417-424

Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.

Objective: Learning health systems (LHS) integrate research, improvement, management, and patient care, such that every child receives "the right care at the right time... Read More

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Surviving Sepsis Campaign Guidelines on the Management of Adults With Coronavirus Disease 2019 (COVID-19) in the ICU: First Update.

Crit Care Med 2021 03;49(3):e219-e234

Warren Alpert School of Medicine at Brown University, Providence, RI.

Background: The coronavirus disease 2019 pandemic continues to affect millions worldwide. Given the rapidly growing evidence base, we implemented a living guideline model to provide guidance on the management of patients with severe or critical coronavirus disease 2019 in the ICU.

Methods: The Surviving Sepsis Campaign Coronavirus Disease 2019 panel has expanded to include 43 experts from 14 countries; all panel members completed an electronic conflict-of-interest disclosure form. Read More

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Heparin-Free Lung Transplantation on Venovenous Extracorporeal Membrane Oxygenation Bridge.

ASAIO J 2021 Jan 28. Epub 2021 Jan 28.

From the Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy Department of Thoracic Surgery and Lung Transplant, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.

Extracorporeal membrane oxygenation (ECMO) bridge to lung transplantation (LuTX) exposes the patients to a high risk of perioperative bleeding secondary to systemic anticoagulation and coagulation factors deficiency. With this case series, we propose innovative "no-heparin" management of ECMO-bridge support during LuTX, based upon 1) control heparin resistance with antithrombin III in the preoperative period; 2) relying upon a fully functional, brand new heparinized ECMO circuit; 3) completely avoiding perioperative heparin; 4) hampering fibrinolysis with tranexamic acid; and 5) limiting venoarterial (VA) ECMO escalation, and the following need for full anticoagulation. Following the application of this new approach, we carried out three challenging clinical cases of bilateral ECMO-bridged LuTX effectively, with limited intraoperative blood requirement and no major postoperative bleeding or thromboembolic events. Read More

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January 2021