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Yang XC, Qin YL, Xiang H, Mo W, Huang AZ, Xiang B, Xu Y, Zhu ZL. Risk Factors for Postoperative Puncture Site Bleeding after Interventional Treatment of Cerebrovascular Disease via Common Femoral Artery Puncture: A Retrospective Analysis of 710 Cases. TOHOKU J EXP MED 2023; 261:109-116. [PMID: 37407440 DOI: 10.1620/tjem.2023.j054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
This study aimed to identify the risk factors associated with puncture site bleeding following percutaneous puncture of the common femoral artery during interventional treatment of cerebrovascular disease (CVD). A retrospective analysis was conducted on 710 patients who underwent interventional treatment for CVD via femoral artery puncture. Among them, 26 individuals (3.66%) experienced bleeding at the femoral artery puncture site. Binary logistic regression analysis was performed to identify risk factors for puncture site bleeding. The impact of salt bag compression on postoperative bleeding was evaluated in patients with intermediate to high bleeding risk scores. The bleeding group showed higher blood pressure, lower platelet counts, longer prothrombin time and activated partial thromboplastin time, as well as a higher prevalence of larger vascular sheath sizes and variations in the timing of anti-coagulant and anti-platelet therapy administration. The bleeding risk score was higher in the bleeding group, indicating its predictive value for bleeding risk. Higher bleeding risk score, unstable blood pressure, repeated puncture, and serious vascular conditions were significant risk factors for puncture site bleeding. Application of salt bag compression for a duration of 2 hours reduced postoperative puncture site bleeding in patients with intermediate to high bleeding risk scores. Our study identified several significant risk factors for puncture site bleeding after cerebral vascular intervention via femoral artery puncture, including the bleeding risk score, blood pressure, repeated puncture, and vascular conditions. Implementing salt bag compression as a preventive measure can help mitigate bleeding complications in these high-risk patients.
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Affiliation(s)
- Xiu-Chun Yang
- Department of Interventional Vascular Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Yue-Lan Qin
- Nursing Management Department, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Hua Xiang
- Department of Interventional Vascular Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Wei Mo
- Department of Interventional Vascular Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Ai-Zhen Huang
- Department of Interventional Vascular Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Bin Xiang
- Department of Interventional Vascular Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Yuan Xu
- Department of Interventional Vascular Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Zhi-Lan Zhu
- Department of Interventional Vascular Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
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Almas T, Musheer A, Ejaz A, Niaz Shaikh F, Awais Paracha A, Raza F, Sarwar Khan M, Masood F, Siddiqui F, Raza S, Fahad Wasim M, Hasnain Mankani M, Fatima K, Mannan Khan Minhas A. Efficacy and safety of direct oral anticoagulants with and without Aspirin: A systematic review and Meta-analysis. IJC HEART & VASCULATURE 2022; 40:101016. [PMID: 35355928 PMCID: PMC8958538 DOI: 10.1016/j.ijcha.2022.101016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/01/2022] [Accepted: 03/22/2022] [Indexed: 01/10/2023]
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Talal Almas
- Department of Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Corresponding author at: RCSI University of Medicine and Health Sciences, 123 St. Stephen’s Green, Dublin 2, Ireland..
| | - Adeena Musheer
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Arooba Ejaz
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Fahd Niaz Shaikh
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Fizza Raza
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Maryam Sarwar Khan
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Fahad Masood
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Faiza Siddiqui
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Saamia Raza
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | - Kaneez Fatima
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
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Oji K, Otowa Y, Yamazaki Y, Arai K, Mii Y, Kakinoki K, Nakamura T, Kuroda D. Taking antithrombic therapy during emergency laparoscopic cholecystectomy for acute cholecystitis does not affect the postoperative outcomes: a propensity score matched study. BMC Surg 2022; 22:42. [PMID: 35120469 PMCID: PMC8817483 DOI: 10.1186/s12893-022-01501-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/27/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Continuing antithrombic therapy (ATT) during surgery increases the risk of bleeding. However, it is difficult to discontinue the ATT in emergency surgery. Therefore, safety of emergency laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) is still unclear. We aimed to clarify the affect of ATT during emergency LC for AC. METHODS Patients with AC were classified into ATT group (n = 30) and non-ATT group (n = 120). Postoperative outcomes were compared after propensity score matching (n = 22). RESULTS Higher level of c-reactive protein level and shorter activated partial thromboplastin time (APTT) was observed in ATT group than in non-ATT group after matching. No significant difference was found between other patient characteristics and perioperative results. Blood loss over 100 mL was observed in 8 patients. Multivariate analyze showed that APTT was an independent risk factor for bleeding over 100 mL (P = 0.039), while ACT and APT was not. CONCLUSIONS Taking ATT does not affect the blood loss or complications during emergency LC for AC. Controlling intraoperative bleeding is essential for a safe postoperative outcome.
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Affiliation(s)
- Kentaro Oji
- Department of Surgery, Kita-Harima Medical Center, 926-250 Ichiba-cho, Ono, Hyogo, 675-1392, Japan
| | - Yasunori Otowa
- Department of Surgery, Kita-Harima Medical Center, 926-250 Ichiba-cho, Ono, Hyogo, 675-1392, Japan. .,Radiation Biology Branch, National Cancer Institute, 9000 Rockville Pike, Bethesda, Maryland, 20892, USA.
| | - Yuta Yamazaki
- Department of Surgery, Kita-Harima Medical Center, 926-250 Ichiba-cho, Ono, Hyogo, 675-1392, Japan
| | - Keisuke Arai
- Department of Surgery, Kita-Harima Medical Center, 926-250 Ichiba-cho, Ono, Hyogo, 675-1392, Japan
| | - Yasuhiko Mii
- Department of Surgery, Kita-Harima Medical Center, 926-250 Ichiba-cho, Ono, Hyogo, 675-1392, Japan
| | - Keitaro Kakinoki
- Department of Surgery, Kita-Harima Medical Center, 926-250 Ichiba-cho, Ono, Hyogo, 675-1392, Japan
| | - Tetsu Nakamura
- Department of Surgery, Kita-Harima Medical Center, 926-250 Ichiba-cho, Ono, Hyogo, 675-1392, Japan
| | - Daisuke Kuroda
- Department of Surgery, Kita-Harima Medical Center, 926-250 Ichiba-cho, Ono, Hyogo, 675-1392, Japan
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Ugajin M, Kani H, Hattori H. Anticoagulant Use as an Independent Risk Factor and Higher In-Hospital Mortality in Patients Showing Alveolar Hemorrhage in Diffuse Lung Disease. ACTA ACUST UNITED AC 2021; 57:medicina57101094. [PMID: 34684131 PMCID: PMC8538906 DOI: 10.3390/medicina57101094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 01/15/2023]
Abstract
Background and objectives: Bronchoalveolar lavage (BAL) is commonly performed to evaluate diffuse lung disease and occasionally to identify alveolar hemorrhage. However, the clinical impact of alveolar hemorrhage and its risk factors in patients with diffuse lung disease have not been clarified. Materials and Methods: We retrospectively analyzed the medical records of all patients who underwent BAL to evaluate diffuse lung disease from January 2017 to December 2020. Alveolar hemorrhage was defined as progressive hemorrhagic BAL fluid or the presence of ≥20% hemosiderin-laden macrophages in the BAL fluid. Logistic regression analysis was performed to assess the association between alveolar hemorrhage and other factors. Results: Sixty subjects were enrolled in this study. Alveolar hemorrhage was observed in 19 subjects (31.7%) with idiopathic interstitial pneumonia, acute respiratory distress syndrome, interstitial pneumonia with autoimmune features, drug-induced lung injury, eosinophilic pneumonia, adenocarcinoma, and systemic lupus erythematosus. The use of anticoagulants was a significant risk factor for alveolar hemorrhage (odds ratio 7.57, p = 0.049). Patients with alveolar hemorrhage required intubated mechanical ventilation more frequently (63.2% vs. 24.4%, p = 0.005) and had higher in-hospital mortality rates (26.3% vs. 4.9%, p = 0.028) than those without alveolar hemorrhage. Conclusions: Alveolar hemorrhage was observed in various etiologies. The use of anticoagulants was a significant risk factor for alveolar hemorrhage. Patients with alveolar hemorrhage showed more severe respiratory failure and had higher in-hospital mortality than those without alveolar hemorrhage.
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Affiliation(s)
- Motoi Ugajin
- Department of Respiratory Medicine, Nagoya Tokushukai General Hospital, 2-52 Kouzouji-cho Kita, Kasugai City 487-0016, Japan
- Department of Respiratory Medicine and Allergology, Aichi Medical University Hospital, Nagakute City 480-1195, Japan
- Correspondence: ; Tel.: +81-568-51-8711; Fax: +81-568-51-7115
| | - Hisanori Kani
- Department of Thoracic Surgery, Nagoya Tokushukai General Hospital, Kasugai City 487-0016, Japan;
| | - Hideo Hattori
- Department of Pathology, Nagoya Tokushukai General Hospital, Kasugai City 487-0016, Japan;
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Emergent cholecystectomy in patients on antithrombotic therapy. Sci Rep 2020; 10:10122. [PMID: 32572122 PMCID: PMC7308317 DOI: 10.1038/s41598-020-67272-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/05/2020] [Indexed: 12/20/2022] Open
Abstract
The Tokyo Guidelines 2018 (TG18) recommend emergent cholecystectomy (EC) for acute cholecystitis. However, the number of patients on antithrombotic therapy (AT) has increased significantly, and no evidence has yet suggested that EC should be performed for acute cholecystitis in such patients. The aim of this study was to evaluate whether EC is as safe for patients on AT as for patients not on AT. We retrospectively analyzed patients who underwent EC from 2007 to 2018 at a single center. First, patients were divided into two groups according to the use of antithrombotic agents: AT; and no-AT. Second, the AT group was divided into three sub-groups according to the use of single antiplatelet therapy (SAPT), double antiplatelet therapy (DAPT), or anticoagulant with or without antiplatelet therapy (AC ± APT). We then evaluated outcomes of EC among all four groups. The primary outcome was 30- and 90- day mortality rate, and secondary outcomes were morbidity rate and surgical outcomes. A total of 478 patients were enrolled (AT, n = 123, no-AT, n = 355) patients. No differences in morbidity rate (6.5% vs. 3.7%, respectively; P = 0.203), 30-day mortality rate (1.6% vs. 1.4%, respectively; P = 1.0) or 90-day mortality rate (1.6% vs. 1.4%, respectively; P = 1.0) were evident between AT and no-AT groups. Between the no-AT and AC ± APT groups, a significant difference was seen in blood loss (10 mL vs. 114 mL, respectively; P = 0.017). Among the three AT sub-groups and the no-AT group, no differences were evident in morbidity rate (3.7% vs. 8.9% vs. 0% vs. 6.5%, respectively; P = 0.201) or 30-day mortality (1.4% vs. 0% vs. 0% vs. 4.3%, respectively; P = 0.351). No hemorrhagic or thrombotic morbidities were identified after EC in any group. In conclusion, EC for acute cholecystitis is as safe for patients on AT as for patients not on AT.
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