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Kukeev I, Quint E, Sebbag G, Dukhno O. Left gastric artery embolization for recurrent massive intraluminal postoperative bleeding after revisional laparoscopic one anastomosis gastric bypass surgery. J Surg Case Rep 2024; 2024:rjae070. [PMID: 38706484 PMCID: PMC11068415 DOI: 10.1093/jscr/rjae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 05/07/2024] Open
Abstract
Laparoscopic one-anastomosis gastric bypass (LOAGB) has gained popularity as safe weight-reduction procedure. Bleeding is the common postoperative complication. We present a successful treatment of recurrent bleeding after LOAGB by embolization of the left gastric artery (LGA) and later development of necrotizing pancreatitis. A 41-year-old patient with previous bariatric surgeries undergone LOAGB surgery with development of massive intraluminal bleeding in the postoperative period. Attempts of unsuccessful endoscopic treatment were done and the bleeding was stopped by LGA embolization. In the post-embolization period, the patients developed necrotizing pancreatitis. Postoperative bleeding is the serious complications of the bariatric LOAGB procedure. Transcatheter Arterial Embolization (TAE) is the possible treatments after unsuccessful endoscopic attempts to stop the bleeding. The technical and clinical success rates of TAE in post-gastrectomy bleeding are 100 and 79%, respectively. TAE can be successfully used to stop obstinate recurrent postoperative bleeding after a LOAGB procedure.
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Affiliation(s)
- Ivan Kukeev
- Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Yitzhack I. Rager Blvd 151, PO Box 151, Beer Sheva 84101, Israel
| | - Elchanan Quint
- Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Yitzhack I. Rager Blvd 151, PO Box 151, Beer Sheva 84101, Israel
| | - Gilbert Sebbag
- Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Yitzhack I. Rager Blvd 151, PO Box 151, Beer Sheva 84101, Israel
| | - Oleg Dukhno
- Bariatric Surgery Unit, Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Yitzhack I. Rager Blvd 151, PO Box 151, Beer Sheva 84101, Israel
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Gu Y, Zhao S. Risk factors for postoperative bleeding following endoscopic submucosal dissection in early gastric cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e37762. [PMID: 38608116 PMCID: PMC11018221 DOI: 10.1097/md.0000000000037762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/08/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Early gastric cancer (EGC) presents a significant challenge in surgical management, particularly concerning postoperative bleeding following endoscopic submucosal dissection. Understanding the risk factors associated with postoperative bleeding is crucial for improving patient outcomes. METHODS Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review and meta-analysis were conducted across PubMed, Embase, Web of Science, and the Cochrane Library without publication date restrictions. The inclusion criteria encompassed observational studies and randomized controlled trials focusing on EGC patients undergoing endoscopic submucosal dissection and their risk factors for postoperative bleeding. The Newcastle-Ottawa Scale was utilized for quality assessment. The effect size was calculated using random or fixed-effects models based on the observed heterogeneity. We assessed the heterogeneity between studies and conducted a sensitivity analysis. RESULTS In our meta-analysis, 6 studies involving 4868 EGC cases were analyzed. The risk of postoperative bleeding was notably increased with intraoperative ulcer detection (odds ratio: 1.97, 95% confidence interval [CI]: 1.03-3.76, I2 = 61.0%, P = .025) and antithrombotic medication use (odds ratio: 2.02, 95% CI: 1.16-3.51, I2 = 57.2%, P = .039). Lesion resection size showed a significant mean difference (5.16, 95% CI: 2.97-7.98, P < .01), and longer intraoperative procedure time was associated with increased bleeding risk (mean difference: 11.69 minutes, 95% CI: 1.82-26.20, P < .05). Sensitivity analysis affirmed the robustness of these findings, and publication bias assessment indicated no significant bias. CONCLUSIONS In EGC treatment, the risk of post-endoscopic submucosal dissection bleeding is intricately linked to factors like intraoperative ulcer detection, antithrombotic medication use, the extent of lesion resection, and the length of the surgical procedure. These interwoven risk factors necessitate careful consideration and integrated management strategies to enhance patient outcomes and safety in EGC surgeries.
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Affiliation(s)
- Yuanbo Gu
- Department of Gastroenterology, Jilin Chemical Hospital, Jilin, China
| | - Shuchang Zhao
- Department of Gastroenterology, Jilin Chemical Hospital, Jilin, China
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Kawai D, Iwamuro M, Takenaka R, Obata T, Yamamoto T, Hirata S, Miura K, Takemoto K, Tsugeno H, Fujiki S. A Prospective Observational Study on Gastric Endoscopic Submucosal Dissection under Continuous Administration of Antithrombotic Agents. J Clin Med 2024; 13:1886. [PMID: 38610651 PMCID: PMC11012390 DOI: 10.3390/jcm13071886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
Background: This study aimed to assess the completion rate and postoperative bleeding incidence of endoscopic submucosal dissection (ESD) for gastric tumors under continuous antithrombotic therapy. Methods: A prospective observational study was conducted including 88 patients with 100 gastric lesions who underwent gastric endoscopic submucosal dissection (ESD) and received continuous antithrombotic therapy. Additionally, retrospective data on gastric ESD in 479 patients with 534 lesions who did not receive antithrombotic therapy were collected for comparison. Results: The en bloc resection rates (100% in the continuous antithrombotic therapy group vs. 100% in the non-antithrombotic therapy group) and complete resection rates (97.0% vs. 96.3%, respectively) were high and comparable between the groups. No significant differences were found in the specimen size or procedure time. Perforation rates were low (0% vs. 2.3%, respectively) and were not significantly different between the groups. However, postoperative bleeding occurred significantly more frequently in the continuous antithrombotic therapy group (10.2% vs. 4.2%, respectively) than in the non-antithrombotic therapy group. The subgroup analysis revealed a higher incidence of postoperative bleeding in patients receiving thienopyridine derivatives. Conclusions: Continuous administration of antithrombotic agents, especially thienopyridines, increased the risk of postprocedural hemorrhage following gastric ESD. These findings support the need for careful consideration of pharamcological management before ESD, aligning with the current guidelines.
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Affiliation(s)
- Daisuke Kawai
- Department of Gastroenterology, Tsuyama Chuo Hospital, Tsuyama 708-0841, Japan; (D.K.); (R.T.)
| | - Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-0082, Japan
| | - Ryuta Takenaka
- Department of Gastroenterology, Tsuyama Chuo Hospital, Tsuyama 708-0841, Japan; (D.K.); (R.T.)
| | - Taisuke Obata
- Department of Gastroenterology, Tsuyama Chuo Hospital, Tsuyama 708-0841, Japan; (D.K.); (R.T.)
| | - Takashi Yamamoto
- Department of Gastroenterology, Tsuyama Chuo Hospital, Tsuyama 708-0841, Japan; (D.K.); (R.T.)
| | - Shoichiro Hirata
- Department of Gastroenterology, Tsuyama Chuo Hospital, Tsuyama 708-0841, Japan; (D.K.); (R.T.)
| | - Ko Miura
- Department of Gastroenterology, Tsuyama Chuo Hospital, Tsuyama 708-0841, Japan; (D.K.); (R.T.)
| | - Koji Takemoto
- Department of Gastroenterology, Tsuyama Chuo Hospital, Tsuyama 708-0841, Japan; (D.K.); (R.T.)
| | - Hirofumi Tsugeno
- Department of Gastroenterology, Tsuyama Chuo Hospital, Tsuyama 708-0841, Japan; (D.K.); (R.T.)
| | - Shigeatsu Fujiki
- Department of Gastroenterology, Tsuyama Chuo Hospital, Tsuyama 708-0841, Japan; (D.K.); (R.T.)
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Higuchi K, Goto O, Matsuda A, Nakagome S, Habu T, Ishikawa Y, Koizumi E, Kirita K, Noda H, Onda T, Akimoto T, Omori J, Akimoto N, Yoshida H, Iwakiri K. Potential of Direct Oral Anticoagulant in Bleeding After Gastric Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis. Dig Dis Sci 2024; 69:940-948. [PMID: 38252209 DOI: 10.1007/s10620-024-08271-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND AIMS An increasing number of patients are undergoing gastric endoscopic submucosal dissection (ESD) with active prescriptions of direct oral anticoagulants (DOACs). Only a few reports have described the effects of DOAC intake on postoperative bleeding. We aimed to investigate the bleeding risk associated with DOACs after gastric ESD. METHODS Clinical studies published up to April 2022 showing bleeding rates after gastric ESD in patients taking DOACs were identified using electronic searches. The primary outcome was the rate of bleeding after gastric ESD in patients receiving DOACs compared to those not receiving antithrombotic therapy. In this meta-analysis, odds ratios (ORs) were calculated and pooled using a random effects model. The secondary outcome was the difference in the bleeding rate between patients treated with DOACs and those treated with warfarin and antiplatelet drugs. RESULTS Seven studies were included in this meta-analysis. The pooled analysis showed that DOACs had a higher bleeding rate than non-thrombotic therapy (17.0% vs. 3.4%; OR 5.72; 95% confidence interval [CI], 4.33-7.54; I2 = 0%). The bleeding risk associated with DOAC administration was similar to that associated with warfarin (17.0% vs. 20.0%; OR 0.83; 95% CI 0.59-1.18; I2 = 0%), whereas it was higher than that associated with antiplatelet administration (16.9% vs. 11.0%; OR 1.63; 95% CI 1.14-2.34; I2 = 8%). CONCLUSIONS This meta-analysis reveals that the bleeding risk of DOACs is higher than that of non-antithrombotics and antiplatelets, whereas it is comparable to that of warfarin. Gastric ESD in patients on anticoagulants requires careful postoperative management.
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Affiliation(s)
- Kazutoshi Higuchi
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Osamu Goto
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
- Endoscopy Center, Nippon Medical School Hospital, Tokyo, Japan
| | - Akihisa Matsuda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Shun Nakagome
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Tsugumi Habu
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yumiko Ishikawa
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Eriko Koizumi
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Kumiko Kirita
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hiroto Noda
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Takeshi Onda
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Teppei Akimoto
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Jun Omori
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Naohiko Akimoto
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Katsuhiko Iwakiri
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Li M, Dai Y, Hu S, Li Y, Lu D, Zheng R, Wang K. The association between preoperative blood calcium and postoperative blood loss in patients undergoing heart valve replacement surgery. Perfusion 2024; 39:310-316. [PMID: 36384323 DOI: 10.1177/02676591221140239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Bleeding after heart valve surgery is a serious clinical challenge. Hypocalcemia has been associated with the extent of bleeding in patients with spontaneous intracerebral hemorrhage. However, the association between blood calcium levels and bleeding extent in heart valve replacement patients has not been clearly established. This study aimed at determining the association between blood calcium levels and perioperative hemorrhage after heart valve replacement therapy. METHODS Based on preoperative blood calcium levels, patients were grouped into the hypocalcemia group and normocalcemia group. Postoperative bleeding, blood product use, and complications were monitored during hospitalization. The association between blood calcium levels and major bleeding was determined by multivariable logistic regression models. RESULTS In the first 12 h after surgery, bleeding in hypocalcemia group was significantly larger than that of the normocalcemia group (338 ± 234 mL vs 232 ± 96 mL; p = .024). The outcome was the same when the overall chest tube output was considered (950 ± 447 mL vs 738 ± 220 mL; p = .038). The incidence of major bleeding was 65.91% in the hypocalcemia group and 18.97% in the normocalcemia group (p = .001). Postoperative complications in the two groups were similar. After adjusting for multiple covariates, the adjusted odds ratios (OR) for participants in hypocalcemia group was 10.01 (95% CI 3.35-34.82), compared with that in normocalcemia group (p < .001). CONCLUSION In patients undergoing heart valve surgery, preoperative blood concentrations of calcium are associated with postoperative blood loss. Hypocalcemia before operation may increase the risk of postoperative bleeding. When patients with valvular heart disease present with hypocalcemia before surgery, prompt intervention may lead to better control of postoperative bleeding.
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Affiliation(s)
- Mingke Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yawei Dai
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shuai Hu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yansong Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dasheng Lu
- Department of Cardiology, The Second Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Rui Zheng
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Dong Y, Santol J, Gruenberger B, Lenauer A, Laengle F, Thaler J, Piringer G, Eisterer W, Djanani A, Stift J, Gruenberger T. Perioperative Chemotherapy Including Bevacizumab in Potentially Curable Metastatic Colorectal Cancer: Long-Term Follow-Up of the ASSO-LM1 Trial. Cancers (Basel) 2024; 16:857. [PMID: 38473219 DOI: 10.3390/cancers16050857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/06/2024] [Accepted: 02/14/2024] [Indexed: 03/14/2024] Open
Abstract
In 2007, the ASSO-LM1 trial, a multicenter prospective study, was initiated to investigate the resectability (R0) rate following preoperative combination therapy with XELOX and bevacizumab in patients with potentially resectable colorectal liver metastases. Six cycles of systemic therapy were administered preoperatively, although the sixth cycle did not include bevacizumab, resulting in 5 weeks between the last bevacizumab dose and surgery. Treatment with bevacizumab plus XELOX was restarted for another six cycles postoperatively. In total, 43 patients were enrolled in the ASSO-LM1 trial. Eight patients were ineligible for resection due to protocol violation and progression in two patients. The resectability of operated patients was 97% with 34 R0 resections and one R1 resection. Postoperative morbidity occurred in 22% of patients, of which three operative revisions were related to the primary tumor resection. Efficacy results for response in 38 eligible patients confirmed an ORR of 66%, 31% SD and 3% PD according to RECIST. Preoperative grade 3/4 adverse events were 17% diarrhea, 5% HFS and 5% thromboembolic events. Overall survival significantly differed depending upon the fulfillment of adjuvant treatment in curative resected patients (59.1 mo vs. 30.8 mo). In conclusion, the ASSO-LM1 trial is a hypothesis-generating study confirming the prognostic benefits of perioperative therapy with XELOX and bevacizumab in patients with metastatic colorectal cancer confined to the liver.
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Affiliation(s)
- Yawen Dong
- Department of Surgery, Clinic Favoriten, HPB Center, Health Network Vienna, Sigmund Freud Private University Vienna, 1020 Vienna, Austria
| | - Jonas Santol
- Department of Surgery, Clinic Favoriten, HPB Center, Health Network Vienna, Sigmund Freud Private University Vienna, 1020 Vienna, Austria
| | - Birgit Gruenberger
- Department of Internal Medicine, Hematology and Internal Oncology, Landesklinikum Wiener Neustadt, 2700 Wiener Neustadt, Austria
| | - Alfred Lenauer
- Department of Surgery, Landesklinikum Wiener Neustadt, 2700 Wiener Neustadt, Austria
- Department of Surgery, LHK Oberpullendorf, 7350 Oberpullendorf, Austria
| | - Friedrich Laengle
- Department of Surgery, Landesklinikum Wiener Neustadt, 2700 Wiener Neustadt, Austria
| | - Josef Thaler
- Department of Internal Medicine, Klinikum Wels-Grieskirchen, 4600 Wels, Austria
| | - Gudrun Piringer
- Department of Internal Medicine, Klinikum Wels-Grieskirchen, 4600 Wels, Austria
- Medical Faculty, Johannes Kepler University Linz, 4040 Linz, Austria
| | - Wolfgang Eisterer
- Department of Oncology, Klinikum Klagenfurt, 9020 Klagenfurt, Austria
| | - Angela Djanani
- Department of Internal Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Judith Stift
- Department of Pathology, Medical University of Vienna, 2700 Vienna, Austria
| | - Thomas Gruenberger
- Department of Surgery, Clinic Favoriten, HPB Center, Health Network Vienna, Sigmund Freud Private University Vienna, 1020 Vienna, Austria
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Matsui H, Mukaigawa T, Goto S, Okada S, Hiiragi Y, Wada K. Risk factors for late postoperative bleeding after partial glossectomy for tongue cancer. Acta Otolaryngol 2024; 144:76-81. [PMID: 38343347 DOI: 10.1080/00016489.2024.2310695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/18/2024] [Indexed: 03/16/2024]
Abstract
BACKGROUND Partial glossectomy is the most common procedure for early-stage tongue cancer. Although late postoperative bleeding occasionally occurs, the associated risk factors have not been adequately identified. AIMS/OBJECTIVES We aimed to investigate the rate and risk factors for late postoperative bleeding after transoral partial glossectomy with or without neck dissection for tongue cancer at our institution. MATERIAL AND METHODS We analysed 211 patients who had undergone transoral partial glossectomy between January 2016 and January 2023. The potential risk factors associated with late postoperative bleeding were investigated using univariate and multivariate logistic regression analyses. RESULTS Of the 211 patients, 40 (19%) showed late postoperative bleeding, with 19 (9%) classified as grade IIIa (Clavien-Dindo classification). Regarding all grades, late postoperative bleeding was significantly higher in patients aged <70 years and in those with polyglycolic acid (PGA) sheets (p = .046 and .030, respectively). For grade ≥ IIIa, late postoperative bleeding was significantly higher in patients with a history of anticoagulant/platelet administration, a mucosal defect covered with fibrin glue and a PGA sheet (p = .045 and .026, respectively). CONCLUSIONS AND SIGNIFICANCE The findings of this study suggest that primary closure decreases the frequency of late postoperative bleeding.
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Affiliation(s)
- Hidehito Matsui
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan
- Department of Otolaryngology, Toho University Omori Medical Center, Tokyo, Japan
| | - Takashi Mukaigawa
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Seiya Goto
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shinichi Okada
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yohei Hiiragi
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kota Wada
- Department of Otolaryngology, Toho University Omori Medical Center, Tokyo, Japan
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Navarro R, Bojic S, Fatima R, El-Tahan M, El-Diasty M. Recombinant Activated Factor VII (rFVIIa) for Bleeding After Thoracic Aortic Surgery: A Scoping Review of Current Literature. J Cardiothorac Vasc Anesth 2024; 38:275-284. [PMID: 38036397 DOI: 10.1053/j.jvca.2023.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/11/2023] [Accepted: 09/27/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Bleeding after surgery on the thoracic aorta is a frequent complication, and can be associated with a significant increase in morbidity and mortality. Recombinant activated factor VII (rFVIIa) was developed initially for treating patients with hemophilia; however, it has been used increasingly "off-label" to achieve hemostasis after thoracic aortic procedures. OBJECTIVE This scoping review aimed to present the available literature on the role of rFVIIa in the management of refractory postoperative bleeding after thoracic aortic surgery. METHODS/RESULTS An electronic database search was conducted using Medline, Embase, Cochrane Library, and Google Scholar in June 2023. The authors included studies that reported the use of rFVIIa in patients undergoing surgical repair of ascending or descending aortic aneurysm or dissection. Single-case reports were excluded. Ten publications with a pooled number of 649 patients (319 patients received rFVIIa and 330 in the control groups) were identified: 3 case series, 6 retrospective studies, and 1 nonrandomized clinical trial. All studies reported the potential role of rFVIIa in correcting coagulopathy and reducing postoperative blood loss in this group of patients. Overall, there was not enough evidence to suggest that rFVIIa was associated with higher rates of thromboembolic complications or mortality. CONCLUSION Limited evidence suggests that rFVIIa may be useful in managing postoperative refractory bleeding in patients undergoing thoracic aortic surgery. However, the impact of rFVIIa on thromboembolic complications and mortality rates remains unclear.
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Affiliation(s)
- Ryan Navarro
- Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Sandra Bojic
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rubab Fatima
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Mohamed El-Tahan
- Anesthesiology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammad El-Diasty
- Cardiac Surgery Department, Harrington Heart Institute, University Hospitals, Cleveland, Ohio, USA.
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9
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Raab S, Huber L, Fortelny R, Shamiyeh A. Laparoscopic transabdominal preperitoneal (TAPP) groin hernia repair using n-butyl-2-cyanoacrylate (LiquiBandFIX8) for mesh fixation and peritoneal closure: case report about extraperitoneal hematoma. Ann Med Surg (Lond) 2024; 86:481-484. [PMID: 38222725 PMCID: PMC10783228 DOI: 10.1097/ms9.0000000000001439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/17/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction A symptomatic inguinal hernia is a prevalent condition that typically requires surgical intervention. Various surgical approaches have been established for hernia repair, including several techniques for peritoneal closure and mesh fixation in laparoscopic surgery. N-butyl-2-cyanoacrylate, such as LiquiBandFIX8, offers a time-saving alternative to invasive methods for both mesh fixation and peritoneal closure. While n-butyl-2-cyanoacrylate is employed in various closure procedures, LiquiBandFIX8 is specifically designed for mesh fixation in inguinal hernia repair. Case presentation We present a case of a 68-year old man undergoing transabdominal preperitoneal inguinal hernia repair under full heparinization. LiquiBandFIX8 was employed for mesh fixation and peritoneal closure. Upon conducting a revision laparoscopy due to a significant postoperative hematoma, we found that the mesh and peritoneum remained undamaged and fully sealed, indicating an effective fixing technique. Both the initial repair and the subsequent revision surgery were documented and the videos were subsequently analyzed. Conclusion LiquiBandFIX8 provides a reliable adhesive strength and appropriate application for peritoneal closure and mesh fixation. When encountering extraperitoneal fluid collection, there is no anticipation of intraabdominal complications.
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Affiliation(s)
- Sandra Raab
- Department of General and Visceral Surgery, Kepler University Hospital
- Johannes Kepler University, Linz
| | - Livia Huber
- Department for Urology, Hospital Baden-Mödling, Baden, Austria
| | - René Fortelny
- Private Clinic Confraternity, General, and Visceral Surgery, Vienna, Austria
| | - Andreas Shamiyeh
- Department of General and Visceral Surgery, Kepler University Hospital
- Johannes Kepler University, Linz
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Mathieu L, Beurton A, Rougier N, Flambard M, Germain C, Pernot M, Ouattara A. Heparin consumption and inflammatory response according to the coating of cardiopulmonary bypass circuits in cardiac surgery: A retrospective analysis. Perfusion 2023:2676591231215282. [PMID: 37944166 DOI: 10.1177/02676591231215282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
INTRODUCTION There are several types of surface treatments (coatings) aimed at improving the biocompatibility of cardiopulmonary bypass (CPB) circuit. Some coatings appear to require higher doses of heparin to maintain anticoagulation goals, and some of them might induce postoperative coagulopathy. In this study, we compared the amount of heparin required, postoperative bleeding, and inflammatory response according to three types of coatings. METHOD We retrospectively included 300 consecutive adult patients who underwent cardiac surgery with CPB and received one of three coatings (Phisio®, Trillium®, and Xcoating™). Our primary objective was to compare, according to coating, the amount of heparin required to maintain an ACT > 400s during CPB. Our secondary objectives were to compare postoperative bleeding for 48 h and CRP rate. RESULTS Baseline characteristics were comparable between groups except for age and preoperative CRP. We did not find a significant difference between the 3 coatings regarding the amount of heparin reinjected. However, we found less postoperative bleeding with the Xcoating™ circuit compared to the Phisio® circuit (-149 mL [-289; -26.5]; p = 0.02) and a lower elevation of CRP with the Phisio® circuit (2.8 times higher than preoperative CRP) compared to Trillium® (4.9 times higher) and Xcoating™ (6.4 times higher); p < 10-3. CONCLUSION The choice of coating did not influence the amount of heparin required during CPB; however, the post-CPB inflammatory syndrome may be impacted by this choice.
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Affiliation(s)
- Laurent Mathieu
- Department of Cardiovascular Surgery, Haut-Lévêque Hospital, Surgical Centre, Bordeaux University Hospital, Pessac, France
| | - Antoine Beurton
- Department of Cardiovascular Anesthesia and Critical Care, Haut-Lévêque Hospital, Bordeaux University Hospital, Bordeaux, France
- Univ. Bordeaux, INSERM, Biologie des maladies cardiovasculaires, U1034, F-33600 Pessac, France
| | - Nicolas Rougier
- Department of Cardiovascular Surgery, Haut-Lévêque Hospital, Surgical Centre, Bordeaux University Hospital, Pessac, France
| | - Maude Flambard
- Department of Cardiovascular Surgery, Haut-Lévêque Hospital, Surgical Centre, Bordeaux University Hospital, Pessac, France
| | - Christine Germain
- Research and Innovation Unit in Healthcare and Humanities (URISH), Bordeaux-University Hospital, Bordeaux, France
| | - Mathieu Pernot
- Department of Cardiovascular Surgery, Haut-Lévêque Hospital, Surgical Centre, Bordeaux University Hospital, Pessac, France
| | - Alexandre Ouattara
- Department of Cardiovascular Anesthesia and Critical Care, Haut-Lévêque Hospital, Bordeaux University Hospital, Bordeaux, France
- Univ. Bordeaux, INSERM, Biologie des maladies cardiovasculaires, U1034, F-33600 Pessac, France
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11
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Inamasu J, Fujisawa M, Sato M. Spontaneous Intracranial Hypotension Occurring after Craniotomy for Brain Tumor Biopsy Mimicking Postoperative Bleeding. NMC Case Rep J 2023; 10:247-252. [PMID: 37869378 PMCID: PMC10584665 DOI: 10.2176/jns-nmc.2023-0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/21/2023] [Indexed: 10/24/2023] Open
Abstract
In this study, we report on a previously healthy 44-year-old man who underwent an open biopsy under general anesthesia for a tumorous lesion found in his left frontal lobe via a small supratentorial craniotomy. While both postoperative course and brain computed tomography (CT) scans had been considered unremarkable, the patient became stuporous on postoperative day (POD) 4. A brain CT obtained on that day showed a subdural hematoma with marked brain shift which we thought might have been due to postoperative bleeding; he was immediately brought to an operating theater for hematoma removal. However, no bleeding source was found, and the brain remained depressed after hematoma evacuation. Furthermore, the brain shift remained unchanged on postoperative CT. While spontaneous intracranial hypotension (SIH) was considered, imaging studies to search for possible cerebrospinal fluid (CSF) leakage in the spinal column were not performed as the patient's condition has improved. However, he became stuporous again on POD 8, which urged us to perform CT myelogram. The CT myelogram showed a massive CSF leakage at the L1-L2 level. Subsequent autologous blood patch has successfully terminated the CSF leakage, and he became fully oriented shortly after the blood patch therapy. Thus, it should be noted that SIH may occur during postoperative period of intracranial surgery, and it may manifest radiographically as a subdural hematoma indistinguishable from postoperative bleeding. SIH should also be included in a differential diagnosis of postoperative headache, regardless of its characteristics, because headache associated with SIH may not always be orthostatic.
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Affiliation(s)
- Joji Inamasu
- Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Masashi Fujisawa
- Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Mizuto Sato
- Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
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12
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Li Z, Yu F, Wang C, Du Z. Comparing efficacy and factors of postoperative bleeding in endoscopic mucosal resection vs coagulation for intestinal polyps. Medicine (Baltimore) 2023; 102:e34941. [PMID: 37713827 PMCID: PMC10508480 DOI: 10.1097/md.0000000000034941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/04/2023] [Indexed: 09/17/2023] Open
Abstract
This study aimed to assess the effectiveness of Endoscopic Mucosal Resection (EMR) and Argon Plasma Coagulation (APC) as therapeutic approaches for intestinal polyps in patients, and to examine the factors associated with postoperative bleeding. This study included 132 patients diagnosed with colorectal polyps (188 polyps) who underwent endoscopic surgery at our hospital between January 2022 and December 2022. Based on the surgical method employed, the patients were divided into 2 groups: EMR (68 cases, 97 polyps) and APC (64 cases, 91 polyps). Comparative analyses were conducted to assess the clinical efficacy, surgery-related indicators, and quality of life the 2 groups. Furthermore, an investigation was carried out to identify the factors associated with postoperative bleeding. The analysis revealed no statistically significant difference in the cure rate of flat and superficial raised polyps between the EMR group and the APC (P > .05). However, it was found that the EMR group exhibited a significantly higher cure rate for subpedunculated and raised-pedunculated polyps compared to the APC group (P < .05). The results of logistics analysis showed that patients with hypertension (OR = 2.876, 95% CI: 1.119-7.393), patients with diabetes (OR = 5.278, 95% CI: 1.388-20.064), patients with hyperlipidemia (OR = 2.594, 95% CI: 1.054-6.380), the polyps of right hemicolon (OR = 2.743, 95% CI: 1.003-7.504), rectal polyps (OR = 5.143, 95% CI: 1.728-7.504), pedunculated polyps (OR = 4.758, 95% CI: 1.322-17.129), adenomatous polyps (OR = 3.152, 95% CI: 1.018-9.757) were independent risk factors for postoperative bleeding in patients with colorectal polyps (P < .05). The findings suggest that for subpedunculated and pedunculated-raised polyps, EMR can be a suitable treatment approach. On the other hand, flat and superficial-raised polyps can be effectively managed with either EMR or APC. The presence of hypertension, diabetes, hyperlipidemia, polyps of the right hemicolon, rectal polyps, pedunculated polyps, and adenomatous polyps has been established as independent risk factors for postoperative bleeding in patients with colorectal polyps.
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Affiliation(s)
- Zhiang Li
- Department of Anal Surgery, Dongyang People’s Hospital of Wenzhou Medical University, Dongyang, P.R. China
| | - Fei Yu
- Department of Anal Surgery, Dongyang People’s Hospital of Wenzhou Medical University, Dongyang, P.R. China
| | - Chaoqian Wang
- Department of Anal Surgery, Dongyang People’s Hospital of Wenzhou Medical University, Dongyang, P.R. China
| | - Zhang Du
- Department of Anal Surgery, Dongyang People’s Hospital of Wenzhou Medical University, Dongyang, P.R. China
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Khanwalkar A, Chan E, Roozdar P, Kim D, Ma Y, Hwang PH, Nayak JV, Patel ZM. Tranexamic acid does not significantly lower postoperative bleeding after endoscopic sinus and nasal surgery. Int Forum Allergy Rhinol 2023; 13:1584-1591. [PMID: 36608352 DOI: 10.1002/alr.23127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 12/05/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Postoperative epistaxis is a known possibility following endoscopic sinonasal surgery. Tranexamic acid (TXA) has been shown to reduce intraoperative blood loss and improve the visual field. This study evaluated the clinical efficacy of TXA when given at end of surgery to reduce postoperative bleeding. METHODS This randomized, double-blinded placebo-controlled trial was conducted from April to November 2021. Patients scheduled to undergo endoscopic sinus or nasal surgery were randomized to receive an intravenous dose of 1 g TXA or saline intraoperatively prior to extubation. A 10-in. visual analog scale (VAS) was used to query patients regarding postoperative bleeding each day for 1 week. The medical record was examined to determine the need for additional evaluations or interventions for epistaxis. RESULTS Forty patients completed the study. The mean ± SD postoperative bleeding VAS for the TXA group on the day of surgery was not significantly different from the saline group (4.82 ± 2.18 in. vs. 5.03 ± 2.14 in., p = 0.8). There were no significant differences between treatment arms on any postoperative day through day 7 (0.67 ± 1.84 in. vs. 0.87 ± 0.99 in., p = 0.7), nor in the reduction in VAS compared to the respective baseline on the day of surgery. There were no significant differences in terms of additional interventions (e.g., additional evaluation in recovery, ED, or clinic, need for packing, or return to the operating room [OR]). CONCLUSION Although TXA has previously demonstrated efficacy to reduce intraoperative bleeding during sinonasal surgery, when postoperative bleeding is already minimal at baseline, TXA does not appear to reduce it significantly further.
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Affiliation(s)
- Ashoke Khanwalkar
- Department of Otolaryngology, Head and Neck Surgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Erik Chan
- Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Pooya Roozdar
- Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Dayoung Kim
- Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Yifei Ma
- Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Peter H Hwang
- Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jayakar V Nayak
- Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Zara M Patel
- Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
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Docimo G, Filograna Pignatelli M, Ferrandes S, Monaco A, Calisti F, Ruggiero R, Tolone S, Lucido FS, Brusciano L, Parisi S, Conzo G, Docimo L, Gambardella C. Role of Absorbable Polysaccharide Hemostatic Powder in the Prevention of Bleeding and Wound Events after Thyroid Surgery. J Clin Med 2023; 12:5684. [PMID: 37685750 PMCID: PMC10488928 DOI: 10.3390/jcm12175684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/06/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Bleeding is one of the most fearsome and life-threatening complications after thyroid surgery. Several medical devices and haemostatic agents have been proposed to improve haemostasis during total and hemi-thyroidectomy. Resorbable polysaccharide powder (HaemoCer™) is a plant-based polymer that is helpful in terms of the coagulation cascade becoming a gel and forming a barrier to prevent further bleeding, having tested for haemostasis in different districts. The aim of the current study was the evaluation of drain output, the presence of significant postoperative blood loss and complications in patients treated with or without resorbable polysaccharide powder during thyroid surgery. METHODS From January to December 2022, postoperative bleeding, drainage output and the postoperative wound events of patients undergoing thyroid surgery, in a tertiary centre, with haemostasis completion with resorbable polysaccharide powder (Group A) or not (Group B), were retrospectively analysed. RESULTS Eighty-one patients in Group A received a haemostasis improvement with the use of reabsorbable polysaccharide powder, and 96 patients in Group B received thyroid surgery alone. Patients in Group A presented lower drainage output (0.005), lower incidence of neck haematoma (0.005) and seroma (0.021), confirmed also by multivariate analysis. CONCLUSIONS The resorbable polysaccharide powder, in the current series, appeared to be an effective agent in achieving haemostasis in thyroidectomies, reducing the postoperative drainage output, and also neck events such as neck haematoma and seroma, improving the postoperative comfort of the patients. Further larger comparative studies are needed to address this issue.
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Affiliation(s)
- Giovanni Docimo
- Unit of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.D.); (M.F.P.); (S.F.); (A.M.); (F.C.)
| | - Marcello Filograna Pignatelli
- Unit of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.D.); (M.F.P.); (S.F.); (A.M.); (F.C.)
| | - Sonia Ferrandes
- Unit of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.D.); (M.F.P.); (S.F.); (A.M.); (F.C.)
| | - Alessandro Monaco
- Unit of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.D.); (M.F.P.); (S.F.); (A.M.); (F.C.)
| | - Francesco Calisti
- Unit of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.D.); (M.F.P.); (S.F.); (A.M.); (F.C.)
| | - Roberto Ruggiero
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Salvatore Tolone
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Francesco Saverio Lucido
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Luigi Brusciano
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Simona Parisi
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Giovanni Conzo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Ludovico Docimo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Claudio Gambardella
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
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Ranucci M, Di Dedda U, Isgrò G, Giamberti A, Cotza M, Cornara N, Baryshnikova E. Plasma-Free Strategy for Cardiac Surgery with Cardiopulmonary Bypass in Infants < 10 kg: A Retrospective, Propensity-Matched Study. J Clin Med 2023; 12:3907. [PMID: 37373602 DOI: 10.3390/jcm12123907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Infants < 10 kg undergoing cardiac surgery with cardiopulmonary bypass (CPB) may receive either fresh frozen plasma (FFP) or other solutions in the CPB priming volume. The existing comparative studies are controversial. No study addressed the possibility of total avoidance of FFP throughout the whole perioperative course in this patient population. This retrospective, non-inferiority, propensity-matched study investigates an FFP-free strategy compared to an FFP-based strategy. METHODS Among patients <10 kg with available viscoelastic measurements, 18 patients who received a total FFP-free strategy were compared to 27 patients (1:1.5 propensity matching) receiving an FFP-based strategy. The primary endpoint was chest drain blood loss in the first 24 postoperative hours. The level of non-inferiority was settled at a difference of 5 mL/kg. RESULTS The 24-h chest drain blood loss difference between groups was -7.7 mL (95% confidence interval -20.8 to 5.3) in favor of the FFP-based group, and the non-inferiority hypothesis was rejected. The main difference in coagulation profile was a lower level of fibrinogen concentration and FIBTEM maximum clot firmness in the FFP-free group immediately after protamine, at the admission in the ICU and for 48 postoperative hours. No differences in transfusion of red blood cells or platelet concentrate were observed; patients in the FFP-free group did not receive FFP but required a larger dose of fibrinogen concentrate and prothrombin complex concentrate. CONCLUSIONS An FFP-free strategy in infants < 10 kg operated with CPB is technically feasible but results in an early post-CPB coagulopathy that was not completely compensated with our bleeding management protocol.
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Affiliation(s)
- Marco Ranucci
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Umberto Di Dedda
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Giuseppe Isgrò
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Alessandro Giamberti
- Department of Congenital Heart Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Mauro Cotza
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Noemi Cornara
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Ekaterina Baryshnikova
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
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Han H, Han W, Su T, Shang C, Shi J. Analysis of risk factors for postoperative bleeding and recurrence after laparoscopic myomectomy in patients with uterine fibroids: a retrospective cohort study. Gland Surg 2023; 12:474-486. [PMID: 37200927 PMCID: PMC10186162 DOI: 10.21037/gs-23-92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/14/2023] [Indexed: 05/20/2023]
Abstract
Background In Asia, the incidence of uterine fibroids (UFs) in women is as high as 1.278%. However, there are few analyses of the prevalence and independent risk factors for bleeding and recurrence after laparoscopic myomectomy (LM). This study aimed to analyze the clinical characteristics of patients with UF and identify the independent risk factors for postoperative bleeding and recurrence after LM, so as to provide a reference basis for improving the quality of life of patients. Methods Based on our exclusion and inclusion criteria, we retrospectively analyzed a total of 621 patients who developed UF from April 2018 to June 2021. The t-test, analysis of variance (ANOVA), and chi-square test were used to analyze the relationship between the clinical characteristics of the patients and postoperative bleeding as well as recurrence. Binary logistic regression was used to analyze the independent risk factors for the occurrence of postoperative bleeding and fibroid recurrence in patients. Results The rates of postoperative bleeding and recurrence after LM for uterine fibroids were 4.5% and 7.1%, respectively. Binary logistic regression analysis showed that fibroid size [odds ratio (OR) =5.502, P=0.003], maximum fibroid type (OR =0.293, P=0.048), pathological type (OR =3.673, P=0.013), preoperative prothrombin time level (OR =1.340, P=0.003), preoperative hemoglobin level (OR =0.227, P=0.036), surgery time (OR =1.066, P=0.022), intraoperative bleeding (OR =1.145, P=0.007), and postoperative infection (OR =9.540, P=0.010) were independent risk factors for postoperative bleeding; meanwhile, body mass index (BMI) (OR =1.268, P=0.001), age of menarche (OR =0.780, P=0.013), fibroid size (OR =4.519, P=0.000), fibroid number (OR =2.381, P=0.033), maximum fibroid type (OR =0.229, P=0.001), pathological type (OR =2.963, P=0.008), preoperative delivery (OR =3.822, P=0.003), preoperative C-reactive protein (CRP) level (OR =1.162, P=0.005), intraoperative ultrasonography (OR =0.271, P=0.002), postoperative gonadotropin-releasing hormone agonist treatment (OR =2.407, P=0.029), and postoperative infection (OR =7.402, P=0.005) were independent risk factors for recurrence. Conclusions At present, there is still a high probability of postoperative bleeding and recurrence after LM for UF. Clinical work should pay close attention to clinical features. Adequate preoperative examination to improve surgical precision, and strengthen postoperative care and education, thus reducing the probability of postoperative bleeding and recurrence in patients.
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Affiliation(s)
- Huiqin Han
- Department of Gynaecology, Fenyang Hospital of Shanxi Province, Fenyang, China
| | - Wenping Han
- Nursing Department, Fenyang College of Shanxi Medical University, Fenyang, China
| | - Tianxiong Su
- Department of Gynaecology, Fenyang Hospital of Shanxi Province, Fenyang, China
| | - Chune Shang
- Blood Purification Centre, Fenyang Hospital of Shanxi Province, Fenyang, China
| | - Jing Shi
- Blood Purification Centre, Fenyang Hospital of Shanxi Province, Fenyang, China
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Chen H, Wu Y, Ma Y, Li R. Analysis of risk factors for postoperative bleeding and polyp recurrence in adolescents with gastric polyps treated with endoscopic mucosal resection: a retrospective cohort study. Transl Pediatr 2023; 12:375-386. [PMID: 37035390 PMCID: PMC10080481 DOI: 10.21037/tp-23-43] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/21/2023] [Indexed: 04/11/2023] Open
Abstract
Background The incidence of gastric polyps in adolescents has been increasing every year in recent years. Endoscopic mucosal resection (EMR) is one of the most common treatments for adults, but there are few reports on the association between EMR of gastric polyps and the occurrence of bleeding and recurrence after the procedure in adolescents. This study sought to analyze the independent risk factors for postoperative bleeding and polyp recurrence after EMR to provide a reference for reducing the occurrence of postoperative complications. Methods We retrospectively analyzed the data of 579 adolescent patients who developed gastric polyps from June 2016 to June 2021. Postoperative follow-up was conducted for 1 year by telephone, e-mail, and outpatient review. The general characteristics of the study population were compiled using a general information questionnaire designed by the investigators. The relationship between the patients' clinical characteristics and postoperative bleeding or recurrence was analyzed using the chi-square test. A binary logistic regression analysis was conducted to analyze the independent risk factors for the occurrence of postoperative bleeding and polyp recurrence in patients. Results The results of the binary logistic regression analysis showed that being female [odds ratio (OR) =0.306, P=0.009], polyps >1 cm in diameter (OR =2.557, P=0.029), polyps in gastric sinus (OR =3.889, P=0.032), sessile lesions (OR =0.398, P=0.036), the need for additional intraoperative sedation (OR =3.469, P=0.005), concurrent diverticulum (OR =3.570, P=0.004), and intraoperative bleeding (OR =4.855, P=0.001) were independent risk factors for postoperative bleeding. We also found that polyps >1 cm in diameter (OR =2.134, P=0.003), multiple polyps (OR =2.117, P=0.005), adenomatous polyps (OR =2.684, P=0.041), combined Helicobacter pylori infection (OR =2.036, P=0.009), the occurrence of postoperative gastrointestinal reflux (OR =1.998, P=0.015), and an operative time ≥40 min (OR =2.021, P=0.010) were independent risk factors for the recurrence of polyps. Conclusions There is still a high probability of postoperative bleeding and polyp recurrence after EMR in adolescents with gastric polyps. Clinicians should pay close attention to the clinical features of polyps, such as polyp size, number, morphology, and pathological type, to identify the related risk factors as early as possible and reduce the probability of postoperative bleeding and polyp recurrence in patients.
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Affiliation(s)
- Hong Chen
- Department of Gastroenterology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yanmin Wu
- Department of Gastroenterology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yaping Ma
- Department of Pediatric, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Ruixue Li
- Department of Pediatric, Affiliated Hospital of Jiangnan University, Wuxi, China
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Takahashi A, Kamada K, Fukuda N, Kudoh K, Takamaru N, Kurio N, Sugawara C, Miyamoto Y. Analysis of the sublingual artery using contrast-enhanced computed tomography. Clin Implant Dent Relat Res 2023. [PMID: 36896477 DOI: 10.1111/cid.13197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/09/2023] [Accepted: 02/25/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION This in vivo study aimed to clarify the position of the sublingual artery (SLA) relative to the mandibular bone and to infer the potential risk for injury during dental implant surgery. METHODS Contrast-enhanced computed tomography images of the mouth of 50 edentulous patients (100 sides) treated at Tokushima University Hospital were reviewed. Curved planar reconstructed images perpendicular to the alveolar ridge were processed and classified into molar, premolar, canine, and incisor regions. The SLA and its branches were identified, and the distance from the mandible to the SLA was measured. RESULTS The SLA was located close to the mandible (<2 mm) in the molar, premolar, canine, and incisor segments in 12.0% (95% confidence interval 5.6%-18.4%), 20.6% (12.6%-28.7%), 30.5% (21.3%-39.8%), and 41.8% (28.8%-54.9%) cases, respectively. The SLA was located within ±3 mm craniocaudally to the upper wall of the mandibular canal in the molar and premolar regions in 50% of cases and within ±5 mm craniocaudally to the mylohyoid ridge in the canine and incisor regions in the other cases, with no sex or age-related differences. The vertical distance from the alveolar ridge to the SLA was influenced by sex and age owing to alveolar resorption, indicating that the alveolar ridge is not a reliable reference for predicting SLA position. CONCLUSIONS As the risk of SLA injury always exist during dental implant placement and there is no way to confirm the SLA pathways in a patient, clinicians must avoid injuring the sublingual soft tissue.
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Affiliation(s)
- Akira Takahashi
- Department of Oral Surgery, Tokushima University, Tokushima, Japan
| | - Kumiko Kamada
- Department of Oral Surgery, Tokushima University, Tokushima, Japan
| | - Naoyuki Fukuda
- Department of Oral Surgery, Tokushima University, Tokushima, Japan
| | - Keiko Kudoh
- Department of Oral Surgery, Tokushima University, Tokushima, Japan
| | - Natsumi Takamaru
- Department of Oral Surgery, Tokushima University, Tokushima, Japan
| | - Naito Kurio
- Department of Oral Surgery, Tokushima University, Tokushima, Japan
| | | | - Youji Miyamoto
- Department of Oral Surgery, Tokushima University, Tokushima, Japan
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19
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Messenger H, Kulkarni R, Recht M, He C. A Retrospective Analysis of the American Thrombosis and Hemostasis Network Dataset Describing Outcomes of Dental Extractions in Persons with Hemophilia. J Clin Med 2023; 12:1839. [PMID: 36902626 PMCID: PMC10002874 DOI: 10.3390/jcm12051839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/15/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION dental extractions (DEs) in persons with hemophilia A or B (PWH-A or PWH-B) are often associated with bleeding and needing hemostatic therapies (HTs). AIM to analyze the American Thrombosis and Hemostasis Network (ATHN) dataset (ATHNdataset) to assess trends, uses and impacts of HT on bleeding outcomes following DEs. METHODS PWH seen at ATHN affiliates who underwent DEs and opted to share their data with the ATHNdataset between 2013-2019 were identified. The type of DEs, use of HT and bleeding outcomes were assessed. RESULTS Among 19,048 PWH ≥2 years of age, 1157 underwent 1301 episodes of DE. Those on prophylaxis experienced a nonsignificant reduction in dental bleeding episodes. Standard half-life factor concentrates were used more often than extended half-life products. PWHA were more likely to undergo DE in the first 30 years of life. Those with severe hemophilia were less likely to undergo DE than those with a mild disease (OR: 0.83; 95% CI: 0.72-0.95). PWH with inhibitors had statistically significantly increased odds of dental bleeding (OR: 2.09, 95% CI; 1.21-3.63). CONCLUSION our study showed that persons with mild hemophilia and younger age were more likely to undergo DE; the presence of inhibitors increased the likelihood of bleeding, while those with prophylaxis and receiving HT experienced a non-statistically significant reduction in bleeding.
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Affiliation(s)
- Heather Messenger
- Department of Pediatrics and Human Development, Michigan State University, East Lansing, MI 48824, USA
| | - Roshni Kulkarni
- Department of Pediatrics and Human Development, Michigan State University, East Lansing, MI 48824, USA
| | - Michael Recht
- American Thrombosis and Hemostasis Network, Rochester, NY 14626, USA
- Department of Pediatrics, Section of Pediatric Hematology-Oncology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Chunla He
- American Thrombosis and Hemostasis Network, Rochester, NY 14626, USA
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20
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Court MH, Kiser JN, Neibergs HL, Zhu Z, Dillberger JE. Identification by whole genome sequencing of genes associated with delayed postoperative hemorrhage in Scottish deerhounds. J Vet Intern Med 2023; 37:510-517. [PMID: 36780177 DOI: 10.1111/jvim.16643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/27/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Delayed postoperative hemorrhage (DEPOH) is an important health concern for Scottish deerhounds. HYPOTHESIS/OBJECTIVES Identify genes associated with DEPOH in Scottish deerhounds. ANIMALS Two hundred sixty-nine privately owned Scottish deerhounds. METHODS Retrospective case-control study. DEPOH cases and controls were identified through an owner health survey. Genome-wide association analysis was performed using whole genome sequences from 8 cases and 17 controls. All cases and controls were genotyped for selected variants. RESULTS Of 269 dogs, 10 met inclusion and exclusion criteria for DEPOH, while 62 controls had undergone similar surgical procedures without DEPOH. Genome-wide association analysis identified a single locus on chromosome 9 spanning 40 genes. One of these genes (SERPINF2 encoding alpha-2 antiplasmin) was directly linked to the pathophysiology of DEPOH. The entire cohort was genotyped for a missense SERPINF2 variant (c.605 C>T; p.A202V). Compared to dogs with the reference C/C genotype, the likelihood of DEPOH was significantly higher for dogs with the T/T genotype (odds ratio [OR] = 1235; 95% confidence interval [CI] = 23-6752; P = 0.0005) and with the C/T genotype (OR = 28; 95% CI = 1.4-542; P = 0.03). CONCLUSIONS AND CLINICAL IMPORTANCE SERPINF2 is associated with DEPOH in Scottish deerhounds. Genetic testing might be able to identify dogs that are susceptible to DEPOH.
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Affiliation(s)
- Michael H Court
- Program in Individualized Medicine (PrIMe), Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Jennifer N Kiser
- Department of Animal Sciences, Washington State University, Pullman, Washington, USA
| | - Holly L Neibergs
- Department of Animal Sciences, Washington State University, Pullman, Washington, USA
| | - Zhaohui Zhu
- Program in Individualized Medicine (PrIMe), Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
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21
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Lee JH. Prevention and management of difficult hemostasis in acute type A aortic dissection repair. Asian Cardiovasc Thorac Ann 2023; 31:15-19. [PMID: 35040355 DOI: 10.1177/02184923221074409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Postoperative bleeding after surgery for acute aortic dissection is one of the most common complications and has an important influence on mortality and morbidity. Therefore, various methods have been introduced to prevent or manage postoperative bleeding. In this article, we investigated the causes of bleeding after surgery for acute aortic dissection, and introduce appropriate transfusion or pharmacologic treatment, topical hemostatic agents, and local compressive maneuver to manage it.
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Affiliation(s)
- Jae Hang Lee
- Department of Thoracic and Cardiovascular Surgery, 65462Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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22
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Yasui Y, Kato H, Oda T, Nakamura M, Morita A. Complications and risk factors of punch biopsy: A retrospective large-scale study. J Dermatol 2023; 50:98-101. [PMID: 36151785 DOI: 10.1111/1346-8138.16585] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 01/04/2023]
Abstract
The authors analyzed the risk factors of punch biopsy by investigating the complications of the technique and their proportions. Patients who underwent punch biopsy in a dermatology clinic between November 2018 and November 2020 (n = 1294; mean age, 62.3 years; 540 men and 754 women) were enrolled in the current study. The most common complication was postoperative bleeding (0.9%). Wound infection (0.2%), surrounding skin damage (0.2%), and vagal reflex (0.1%) were also observed. The main risk factors for bleeding following biopsy were location of biopsy site outside of the trunk (odds ratio [OR], 4.60 [95% CI, 2.65-8.00]; p < 0.001) and platelet count lower than 150 000/μL (OR, 2.82 [95% CI, 1.69-4.73]; p < 0.001). When performing a punch biopsy, an adequate explanation of the risks and complications should be provided before obtaining informed consent. Further, blood sampling tests should be performed in advance and the types of cases that may require wound suture should be appropriately determined.
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Affiliation(s)
- Yukiko Yasui
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takao Oda
- Department of Dermatology, Kainan Hospital, Yatomi, Japan
| | - Motoki Nakamura
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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23
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Dong L, Liu Q, Chen X, Zhang L, Wang J, Peng Q, Li J, He H, Liu P, Lv M. Methylprednisolone is related to lower incidence of postoperative bleeding after flow diverter treatment for unruptured intracranial aneurysm. Front Aging Neurosci 2023; 15:1029515. [PMID: 37143689 PMCID: PMC10151685 DOI: 10.3389/fnagi.2023.1029515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 03/29/2023] [Indexed: 05/06/2023] Open
Abstract
Background and objectives Regarding the anti-inflammatory effect, methylprednisolone is a candidate to prevent patients with unruptured intracranial aneurysms (UIAs) from postoperative bleeding (PB) after flow diverter (FD) treatment. This study aimed to investigate whether methylprednisolone is related to a lower incidence of PB after FD treatment for UIAs. Methods This study retrospectively reviewed UIA patients receiving FD treatment between October 2015 and July 2021. All patients were observed until 72 h after FD treatment. The patients receiving methylprednisolone (80 mg, bid, for at least 24 h) were considered as standard methylprednisolone treatment (SMT) users, otherwise as non-SMT users. The primary endpoint indicated the occurrence of PB, including subarachnoid hemorrhage, intracerebral hemorrhage, and ventricular bleeding, within 72 h after FD treatment. This study compared the incidence of PB between SMT users and non-SMT users and investigated the protective effect of SMT on PB after FD treatment using the Cox regression model. Finally, after controlling the potential factors related to PB, we performed subgroup analysis to further confirm the protective effect of SMT on PB. Results This study finally included 262 UIA patients receiving FD treatment. PB occurred in 11 patients (4.2%), and 116 patients (44.3%) received SMT postoperatively. The median time from the end of surgery to PB was 12.3 h (range: 0.5-48.0 h). SMT users had a lower incidence of PB comparing with non-SMT users (1/116, 0.9% vs. 10/146, 6.8%, respectively; p = 0.017). The multivariate Cox analysis demonstrated that SMT users (HR, 0.12 [95%CI, 0.02-0.94], p = 0.044) had a lower risk of PB postoperatively. After controlling the potential factors related to PB (i.e., gender, irregular shape, surgical methods [FD and FD + coil] and UIA sizes), the patients receiving SMT still had a lower cumulative incidence of PB, comparing with patients receiving non-SMT (all p < 0.05). Conclusion SMT was correlated with the lower incidence of PB for patients receiving FD treatment and may be a potential method to prevent PB after the FD treatment.
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Affiliation(s)
- Linggen Dong
- Department of Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Qingyuan Liu
- Department of Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiheng Chen
- Department of Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Longhui Zhang
- Department of Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jiejun Wang
- Department of Emergency, The Affiliated Wuxi No. 2 People’s Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Qichen Peng
- Department of Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jiangan Li
- Department of Emergency, The Affiliated Wuxi No. 2 People’s Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Hongwei He
- Department of Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Peng Liu
- Department of Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Peng Liu,
| | - Ming Lv
- Department of Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- *Correspondence: Ming Lv,
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24
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Zaib A, Shaheryar M, Shakil M, Sarfraz A, Sarfraz Z, Cherrez-Ojeda I. Local Tranexamic Acid for Preventing Hemorrhage in Anticoagulated Patients Undergoing Dental and Minor Oral Procedures: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10122523. [PMID: 36554047 PMCID: PMC9778130 DOI: 10.3390/healthcare10122523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Dental procedures have posed challenges in managing anticoagulated patients due to early reports of oral hemorrhage. This study aims to evaluate the risks of postoperative bleeding with the local application of tranexamic acid. A systematic search was conducted until 31 March 2022, with keywords including tranexamic acid, oral hemorrhage, dental, and/or coagulation. The following databases were searched: PubMed, Scopus, Web of Science, CINAHL Plus, and Cochrane Library. Statistical analysis was conducted using Review Manager 5.4. In total, 430 patients were pooled in with the local application of tranexamic acid using mouthwash, irrigation, and compression with a gauze/gauze pad. The mean age was 61.8 years in the intervention group and 58.7 in the control group. Only 4 patients in the intervened group out of the 210 discontinued the trial due to non-drug-related adverse events. The risk difference was computed as -0.07 (p = 0.05), meaning that patients administered with local antifibrinolytic therapy for postoperative bleeding reduction for dental procedures were at a 7% less risk of oral bleeding. Current evidence on managing anticoagulated patients undergoing dental or oral procedures remains unclear. The present study presents favorable outcomes of postoperative bleeding with local tranexamic acid used in the postoperative period.
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Affiliation(s)
- Asma Zaib
- Department of Research, University Medical & Dental College Faisalabad, Faisalabad 38800, Pakistan
| | - Muhammad Shaheryar
- Department of Research, Rawal Institute of Health Sciences, Islamabad 45550, Pakistan
| | - Muhammad Shakil
- Department of Research, Frontier Medical & Dental College, Abbottabad 22030, Pakistan
| | - Azza Sarfraz
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi 74800, Pakistan
- Correspondence: (A.S.); (I.C.-O.)
| | - Zouina Sarfraz
- Department of Research and Publications, Fatima Jinnah Medical University, Lahore 54000, Pakistan
| | - Ivan Cherrez-Ojeda
- Department of Allergy and Pulmonology, Universidad Espíritu Santo, Samborondón 092301, Ecuador
- Correspondence: (A.S.); (I.C.-O.)
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25
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Okada T, Mikamo T, Hamamoto W, Iwamoto T, Okamoto T, Maeda K, Yanagitani A, Tanaka K, Isomoto H, Yamaguchi N. Modified BEST-J Score Model Predicts Bleeding after Endoscopic Submucosal Dissection with Fewer Factors. Cancers (Basel) 2022; 14:cancers14225555. [PMID: 36428648 PMCID: PMC9688376 DOI: 10.3390/cancers14225555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/01/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
This study constructed a simplified post-endoscopic submucosal dissection (ESD) prediction model with a prognostic nutritional index (PNI). A total of 449 patients who underwent gastric ESD was included, divided with a ratio of 2:1, and assigned to the model or validation cohort. A prediction model of post-ESD (modified BEST-J score) was constructed using the model cohort. The modified BEST-J score was evaluated by comparing its accuracy to the BEST-J score in the validation cohort. Within 4 weeks of ESD, melena, hematemesis, or a 2 g/dL or greater decrease in hemoglobin level that required esophagogastroduodenoscopy was defined as post-ESD bleeding. In the model cohort, 299 patients were enrolled and 25 (8.4%) had post-ESD bleeding. Independent risk factors for post-ESD bleeding were use of P2Y12RA, tumor size > 30 mm, location of lesion at lower one-third of the stomach, and PNI ≤ 47.9. Constructing the modified BEST-J score based on these variables, the sensitivity, specificity, and positive likelihood ratio were 73.9%, 78.1%, and 3.37. When comparing the modified BEST-J score to the BEST-J score in the validation cohort, no significant difference was observed by ROC-AUC (0.77 vs. 0.75, p = 0.81). Modified BEST-J score can predict post-ESD bleeding more simply, with the same accuracy as the BEST-J score.
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Affiliation(s)
- Tomoyuki Okada
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
- Correspondence: ; Tel.: +0857-26-2271
| | - Tsuyoshi Mikamo
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Wataru Hamamoto
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Taku Iwamoto
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | | | - Kazunori Maeda
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | | | - Kiwamu Tanaka
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Hajime Isomoto
- Division of Medicine and Clinical Science, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Naoyuki Yamaguchi
- Department of Endoscopy, Nagasaki University Hospital, Nagasaki 852-8501, Japan
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26
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Klen J, Horvat G, Blinc A. Perioperative Prevention of Venous Thromboembolism in Abdominal Surgery Patients Based on the Caprini or the Padua Risk Score-A Single Centre Prospective Observational Study. Life (Basel) 2022; 12. [PMID: 36430978 DOI: 10.3390/life12111843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/27/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022] Open
Abstract
Surgical patients should receive perioperative thromboprophylaxis based on risk assessment, and the Caprini score is validated for this purpose. Whether the Padua score, originally devised for medical patients, can be useful in surgical patients remains to be fully clarified. This study aimed to evaluate perioperative thromboprophylaxis based on the Caprini or the Padua score in elective abdominal surgery. A total of 223 patients undergoing elective abdominal surgery for malignant or benign disease were prospectively evaluated. The patients were divided into two groups in which thromboprophylaxis was prescribed according to either the Caprini score (n = 122) or the Padua score (n = 101). Patients with high-risk scores in both groups received nadroparin. The alternate risk score in each group was calculated for evaluation purposes only. During a 3-month follow-up, we assessed patients for symptomatic venous thromboembolism (VTE), bleeding, or mortality. In the Caprini score group, 87 patients (71%) had a high risk for VTE (≥5 points), while 38 patients (38%) had a high risk for VTE (≥4 points) in the Padua score group; p < 0.00001. The overall correlation between the Caprini and Padua scores was moderate (r= 0.619), with 85 patients having high Caprini and discordant Padua scores. Ten patients died during follow-up (4.5%), and five developed non-fatal symptomatic VTE (2.2%). Among the five major bleeding incidents recorded (1.8%), two cases were possibly associated with pharmacological thromboprophylaxis. The incidence of adverse outcomes did not differ between the two groups. The odds ratio for adverse outcomes was significantly higher with a high Caprini or Padua risk score, malignant disease, age ≥65 years, and active smoking. We found no significant differences in adverse outcomes between abdominal surgical patients who received perioperative thromboprophylaxis based on either the Caprini or the Padua risk score. However, a discordant Padua score was noted in almost 40% of patients who had a high Caprini score, suggesting that the latter may be more sensitive than the Padua score in surgical patients.
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Zhang S, Chen Z, Huang M, Zhan R, Wu L, Zhang Q, Lin Y, Jiang W, Chi P, Yang F. Monoclonal gammopathy of undetermined significance (MGUS) characterized by refractory lower gastrointestinal postoperative bleeding with coagulopathy. Intractable Rare Dis Res 2022; 11:206-210. [PMID: 36457584 PMCID: PMC9709621 DOI: 10.5582/irdr.2022.01120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022] Open
Abstract
Bleeding is a common complication after lower gastrointestinal surgery, and cases due to coagulation dysfunction are rare. The current authors encountered a 54-year-old Chinese man with refractory bleeding after endoscopic rectal polypectomy, and multiple endoscopic and surgical interventions failed to control that bleeding. An APTT mixing test could not be corrected and there was no evidence of autoimmune-related disease, so the presence of nonspecific antibodies was considered. After empiric therapy with a cyclophosphamide and glucocorticoid, APTT was corrected and gastrointestinal bleeding stopped. Based on laboratory results and therapeutic results, the patient was ultimately diagnosed with prolonged APTT induced by monoclonal gammopathy of undetermined significance (MGUS). MGUS and coagulopathy characterized by a prolonged APTT has rarely been reported. Here, studies noting elevated monoclonal immunoglobulins and coagulopathy have been reviewed. If a prolonged APTT of undetermined significance cannot be corrected with an APTT mixing test and if autoimmune-related factors are excluded, then plasma cell-related diseases such as MGUS need to be considered.
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Affiliation(s)
- Shuxia Zhang
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhifen Chen
- Colorectal Surgery Department, Fujian Medical University Union Hospital, Fuzhou, China
| | - Meijuan Huang
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Rong Zhan
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Long Wu
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qian Zhang
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yu Lin
- Colorectal Surgery Department, Fujian Medical University Union Hospital, Fuzhou, China
| | - Weizhong Jiang
- Colorectal Surgery Department, Fujian Medical University Union Hospital, Fuzhou, China
| | - Pan Chi
- Colorectal Surgery Department, Fujian Medical University Union Hospital, Fuzhou, China
- Address correspondence to:Feng'e Yang, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou 350001, China. E-mail:
| | - Feng'e Yang
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
- Address correspondence to:Feng'e Yang, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou 350001, China. E-mail:
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Kohyama K, Kato H, Kuroki M, Okuda H, Shibata H, Ohashi T, Ogawa T. Posterior ischemic optic neuropathy following postoperative bleeding and internal jugular vein compression. Nagoya J Med Sci 2022; 84:877-883. [PMID: 36544603 PMCID: PMC9748323 DOI: 10.18999/nagjms.84.4.877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/28/2021] [Indexed: 12/24/2022]
Abstract
Perioperative blindness, especially posterior ischemic optic neuropathy (PION), is an uncommon but potentially devastating complication. We report a case of a 65-year-old male patient who underwent laryngopharyngectomy, bilateral neck dissection, and free jejunum flap reconstruction, but then experienced PION in his right eye following postoperative bleeding and bilateral internal jugular veins (IJVs) compression. Despite systemic corticosteroid therapy, his visual recovery prognosis was poor. The specific mechanism responsible for PION remains unclear, and no therapy has been shown to improve this condition. As such, prevention of perioperative PION remains the only available strategy. Surgeons should be aware of this rare potential complication and its risk factors and strive to avoid it. As postoperative bleeding and IJV compression are one of important risk factors for PION, avoiding these are critical.
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Affiliation(s)
- Keishi Kohyama
- Department of Plastic and Reconstructive Surgery, Gifu University Hospital, Gifu, Japan
| | - Hisakazu Kato
- Department of Plastic and Reconstructive Surgery, Gifu University Hospital, Gifu, Japan
| | - Masashi Kuroki
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroshi Okuda
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hirofumi Shibata
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Toshimitsu Ohashi
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takenori Ogawa
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu, Japan
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Velho TR, Ferreira R, Willmann K, Pedroso D, Paixão T, Pereira RM, Junqueira N, Guerra NC, Brito D, Almeida AG, Nobre Â, Köcher T, Pinto F, Moita LF. Role of Omega-6 Fatty Acid Metabolism in Cardiac Surgery Postoperative Bleeding Risk. Crit Care Explor 2022; 4:e0763. [PMID: 36248314 DOI: 10.1097/CCE.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cardiac surgery is frequently associated with significant postoperative bleeding. Platelet-dysfunction is the main cardiopulmonary bypass (CPB)-induced hemostatic defect. Not only the number of platelets decreases, but also the remaining are functionally impaired. Although lipid metabolism is crucial for platelet function, little is known regarding platelet metabolic changes associated with CPB-dysfunction. Our aim is to explore possible contribution of metabolic perturbations for platelet dysfunction after cardiac surgery. DESIGN Prospective cohort study. SETTING Tertiary academic cardiothoracic-surgery ICU. PATIENTS Thirty-three patients submitted to elective surgical aortic valve replacement. INTERVENTIONS Samples from patients were collected at three time points (preoperative, 6- and 24-hr postoperative). Untargeted metabolic analysis using high-performance liquid chromatography-tandem mass spectrometry was performed to compare patients with significant postoperative bleeding with patients without hemorrhage. Principal component analyses, Wilcoxon matched-pairs signed-rank tests, adjusted to FDR, and pairwise comparison were used to identify pathways of interest. Enrichment and pathway metabolomic complemented the analyses. MEASUREMENTS AND MAIN RESULTS We identified a platelet-related signature based on an overrepresentation of changes in known fatty acid metabolism pathways involved in platelet function. We observed that arachidonic acid (AA) levels and other metabolites from the pathway were reduced at 6 and 24 hours, independently from antiagreggation therapy and platelet count. Concentrations of preoperative AA were inversely correlated with postoperative chest tube blood loss but were not correlated with platelet count in the preoperative, at 6 or at 24 hours. Patients with significant postoperative blood-loss had considerably lower values of AA and higher transfusion rates. Values of postoperative interleukin-6 were strongly correlated with AA variability. CONCLUSIONS AND RELEVANCE Our observations suggest that an inflammatory-related perturbation of AA metabolism is a signature of cardiac surgery with CPB and that preoperative levels of AA may be more relevant than platelet count to anticipate and prevent postoperative blood loss in patients submitted to cardiac surgery with CPB.
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Inokoshi M, Soeda Y, Akiyama Y, Ueda K, Kubota K, Minakuchi S. Fully Digital Workflow for the Fabrication of Three-Dimensionally Printed Surgical Splints for Preventing Postoperative Bleeding: A Case Report. Int J Environ Res Public Health 2022; 19:12773. [PMID: 36232073 PMCID: PMC9566380 DOI: 10.3390/ijerph191912773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/25/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
The management of postoperative bleeding is mandatory in patients receiving anticoagulants. In this case report, we introduce a fully digital workflow for surgical splint fabrication to prevent postoperative bleeding in patients receiving anticoagulants and/or at risk of inadvertent extraction of a mobile tooth during impression making. An 87-year-old woman using apixaban had a left mandibular canine that required extraction due to chronic apical periodontitis. A digital impression was obtained using an intraoral scanner. First, the tooth to be extracted was deleted using three-dimensional (3D) computer-aided design (CAD) software (Geomagic Freeform, 3D Systems) and a stereolithography (STL) file was exported. This modified STL file was imported into another CAD software (3Shape Dental System, 3Shape) and a surgical splint was designed. The splint was fabricated using a 3D printer (Form 3; Formlabs) and light-curable resin (Dental LT Clear, Formlabs) and was delivered after the tooth extraction. The patient was followed-up 2 days after the extraction; no postoperative bleeding was detected and the surgical splint was removed. The additively manufactured surgical splint fabricated using a fully digital workflow was efficacious for managing postoperative bleeding after a dental extraction.
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Ling X, Lin R, Chen Y, Nie C, Sheng L, Liu J, Han C, Ding Z. The risk of aspirin induced postoperative hemorrhage: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2022; 16:981-992. [PMID: 36245097 DOI: 10.1080/17474124.2022.2137489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVE Current guidelines recommend aspirin maintenance for high-risk endoscopic procedures. Some Asian physicians noticed increasing postoperative bleeding in patients taking aspirin. We aimed to explore whether risk of postoperative hemorrhage due to aspirin differs in the East and the West. METHODS PubMed, EMBASE and Cochrane library database were systematically reviewed. We only included trials that met our criteria. RESULTS There is significant association between aspirin and postoperative bleeding (P < 0.001), especially in Eastern population (data from Japan, Korea, Turkey and China, P < 0.001). Result from the West (data from America, Canada and Australia) had no statistical significance (P = 0.07). For Easterners, aspirin increased bleeding risk after endoscopic submucosal dissection (ESD) and endoscopic sphincterotomy (EST). For Westerners, aspirin increased bleeding risk post endoscopic mucosal resection (EMR). For patients undergoing ESD, those who continued to receive aspirin had higher bleeding risk than patients who interrupted it for more than 7 days (P = 0.005). CONCLUSION Aspirin increases risk of postoperative hemorrhage. Easterners are more likely to suffer from bleeding after aspirin administration than Westerners. Stopping aspirin for more than 7 days may be advisable to control bleeding post ESD for patients with low risk of thrombosis.
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Affiliation(s)
- Xin Ling
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Rong Lin
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanhong Chen
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chi Nie
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Liping Sheng
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jun Liu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chaoqun Han
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhen Ding
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Ullah K, Mukhtar H, Khalid U, Sarfraz Z, Sarfraz A. Is Antifibrinolytic Therapy Effective for Preventing Hemorrhage in Patients with Hemophilia Undergoing Dental Extractions? A Systematic Review and Meta-Analysis. Clin Appl Thromb Hemost 2022; 28:10760296221114862. [PMID: 35850548 PMCID: PMC9309773 DOI: 10.1177/10760296221114862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives This systematic review aims to analyze the systemic administration of
antifibrinolytics (tranexamic acid and aminocaproic acid) to prevent
postoperative bleeding in patients with hemophilia. Methods This systematic review was conducted adhering to PRISMA guidelines. Only
randomized controlled trials that assessed human subjects of any age or
gender with any severity of hemophilia undergoing dental extractions, and
systemically administered antifibrinolytic therapy compared to placebo were
included. Post-operative bleeding episodes and adverse events were
presented. PubMed, Cochrane, Embase, CINAHL, Web of Science, and Scopus were
searched through April 15, 2022. The risk ratio (RR) and odds ratio (OR)
applying 95% confidence intervals (CI) were computed using RevMan 5.4.1
(Cochrane). Results Two randomized, placebo-controlled trials pooling in a total of 59 patients
were pooled in this analysis. Among patients administered antifibrinolytic
therapy, 84% reduced risk of post-operative bleeding was reported
(RR = 0.16, 95% CI = 0.05–0.47, P = 0.0009). The chances of post-operative
bleeding were reduced by 95% among the antifibrotics group (OR = 0.05, 95%
CI = 0.01–0.22, P < 0.0001). Conclusion This review finds favorable outcomes for the routine use of antifibrinolytic
therapy for dental extractions in hemophiliacs. Further trials are required
to rationalize existing evidence.
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Affiliation(s)
- Kaleem Ullah
- 194774Independent Medical College, Faisalabad, Pakistan
| | - Humza Mukhtar
- 194774Independent Medical College, Faisalabad, Pakistan
| | - Ushna Khalid
- 172462Sheikh Zayed Medical College, Rahim Yar Khan, Pakistan
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Kim SH, Han K, Kang G, Lee SW, Park CM, Cho J, Choi JW, Park SJ, Kang M, Kim TJ, Hong SH, Kwon YC, Park J, Shin D. Risk of Postoperative Gastrointestinal Bleeding and Its Associated Factors: A Nationwide Population-Based Study in Korea. J Pers Med 2021; 11:jpm11111222. [PMID: 34834574 PMCID: PMC8621831 DOI: 10.3390/jpm11111222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/05/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022] Open
Abstract
Postoperative gastrointestinal bleeding (PGIB) is a serious complication with expensive medical costs and a high mortality rate. This study aims to analyze the incidence of PGIB and its associated factors, including its relationship with postoperative analgesic use. Patients aged ≥20 years who received various kinds of surgery from 2013 to 2017 were included (n = 1,319,807). PGIB was defined by admission with ICD-10 codes of gastrointestinal bleeding plus transfusion within 2 months after surgery. A total of 3505 (0.27%) subjects had PGIB, and the incidence was much higher for those who underwent major gastrointestinal and major cardiovascular surgery (1.9% for both), followed by major head and neck (0.7%), major genitourinary (0.5%), and orthopedic surgery (0.45%). On multivariate analysis, older age, male sex, lower income, comorbidities, peptic ulcer disease, and congestive heart failure were associated with a higher risk of gastrointestinal bleeding. Among analgesics, steroid use was associated with increased postoperative bleeding risk (adjusted OR: 1.36, 95% CI: 1.25–1.48). Acetaminophen/nonsteroidal anti-inflammatory drugs, cyclooxygenase 2 inhibitors, anticonvulsants, antidepressants, and opioids were not associated with increased risk. PGIB is considerable for major surgeries, and its risk should be considered, especially for patients with older age and comorbidities and use of steroids.
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Affiliation(s)
- Sang Hyuck Kim
- Department of Family Medicine, Bumin Hospital, Seoul 07590, Korea;
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Korea; (K.H.); (G.K.)
| | - Gunseog Kang
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Korea; (K.H.); (G.K.)
| | - Seung Woo Lee
- Department of Biostatistics, College of Medicine, Catholic University, Seoul 06591, Korea;
| | - Chi-Min Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Jongho Cho
- Department of Cardiovascular and Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Jung Won Choi
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Se Jun Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Minyong Kang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Tae Jun Kim
- Department of Gastroenterology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Seo-Hee Hong
- Medical Affairs, Pfizer Essential Health Business Unit, Pfizer Pharmaceuticals Korea Limited, Seoul 04631, Korea; (S.-H.H.); (Y.-C.K.)
| | - Yong-Chol Kwon
- Medical Affairs, Pfizer Essential Health Business Unit, Pfizer Pharmaceuticals Korea Limited, Seoul 04631, Korea; (S.-H.H.); (Y.-C.K.)
| | - Junhee Park
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Seoul 06351, Korea;
| | - Dongwook Shin
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Seoul 06351, Korea;
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Korea
- Correspondence: ; Tel.: +82-2-3410-5252; Fax: +82-2-3410-0388
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Ishtiaque Al-Manzo M, DasGupta S, Biswas S, Basak B, Rahman MZ, Kumar Biswas S, Islam Talukder Q, K Chanda P, Ahmed F. Effect of Preoperative Continuation of Aspirin on Postoperative Bleeding After Off-Pump Coronary Artery Bypass Graft: A Prospective Cohort Study. Cureus 2021; 13:e18697. [PMID: 34786268 PMCID: PMC8581953 DOI: 10.7759/cureus.18697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/06/2022] Open
Abstract
Background Despite ample evidence of continuing preoperative aspirin to improve coronary artery bypass surgery outcomes, practice for the routine continuation of preoperative aspirin is inconsistent due to concern for increased postoperative bleeding. The purpose of this study was to investigate preoperative aspirin use and its effect on postoperative bleeding after off-pump coronary artery bypass grafting (OPCABG). Methodology This cohort study involved patients (n = 74) who underwent OPCABG at a single center between August 2017 and January 2018. After considering the inclusion and exclusion criteria, the patients were divided into two groups: one (n = 37) received tablet aspirin 75 mg till the day of the surgery, and for the other group (n = 37) aspirin was stopped five days before the surgery. Postoperative bleeding was recorded in both groups. After considering preoperative, intraoperative, and postoperative variables, statistical analysis was performed. Results There was no significant difference between the two groups concerning peroperative and postoperative variables. In addition, no significant difference was observed between the two groups in chest tube drainage at one, two, three, twenty-four, forty-eight, and seventy-two hours (p = 0.845, 0.126, 0.568, 0.478, 0.342, and 0.717, respectively). No significant difference was seen in the transfusion requirement of blood and fresh frozen plasma (FFP). Conclusions Continuation of preoperative aspirin till the day of the surgery is neither associated with an increase in chest tube drainage, reoperation for bleeding complications nor transfusion of blood and FFP.
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Affiliation(s)
| | - Saikat DasGupta
- Department of Cardiothoracic Surgery, Square Hospitals Limited, Dhaka, BGD
| | - Sonjoy Biswas
- Department of Cardiac Surgery, United Hospital Limited, Dhaka, BGD
| | - Bappy Basak
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, GBR
| | - Md Ziaur Rahman
- Department of Cardiac Surgery, National Heart Foundation Hospital & Research Institute, Dhaka, BGD
| | - Samir Kumar Biswas
- Department of Cardiac Surgery, National Heart Foundation Hospital & Research Institute, Dhaka, BGD
| | - Quamrul Islam Talukder
- Department of Cardiac Surgery, National Heart Foundation Hospital & Research Institute, Dhaka, BGD
| | - Prasanta K Chanda
- Department of Cardiothoracic Surgery, Square Hospitals Limited, Dhaka, BGD
| | - Farooque Ahmed
- Department of Cardiac Surgery, National Heart Foundation Hospital & Research Institute, Dhaka, BGD
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Lee MJ, Kim JK, Tang J, Ming JM, Chua ME. The Efficacy and Safety of Tranexamic Acid in the Management of Perioperative Bleeding After Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis of Comparative Studies. J Endourol 2021; 36:303-312. [PMID: 34569280 DOI: 10.1089/end.2021.0498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: We performed a systematic review and meta-analysis of the current literature to assess the efficacy and safety of tranexamic acid (TXA) in the management of postoperative bleeding after percutaneous nephrolithotomy (PCNL). Methods: A systematic literature review was performed in March 2021. Two reviewers independently screened, identified, and evaluated comparative studies assessing the effectiveness of TXA in preventing bleeding after PCNL when compared with placebo or no intervention. The incidence of transfusion, complete stone clearance, and complications were extracted among TXA and control groups to generate the risk ratio (RR) and corresponding 95% confidence interval (CI). Blood loss, hemoglobin (Hb) drop, length of hospital stays, and operative (OR) time were analyzed using standard mean difference (SMD) with corresponding 95% CI. Effect estimates were pooled using the inverse-variance approach with a random-effect model. Results: A total of 11 studies (8 randomized controlled trial, 1 prospective cohort, and 2 retrospective cohort studies; total 1842 patients) of low-to-moderate-quality were included in the meta-analysis. Overall pooled effect estimates demonstrated a decreased transfusion rate (RR 0.36; 95% CI 0.25 to 0.51), blood loss (SMD -0.74; 95% CI -1.14 to -0.34), and Hb drop (SMD -0.95; 95% CI -1.51 to -0.39) among patients in the TXA group when compared with those in the control. The number needed to treat was 11 to prevent one transfusion. Patients who received TXA also had improved stone clearance (RR 1.08; 95% CI 1.02 to 1.14), lower minor (RR 0.72; 95% CI 0.58 to 0.89) and major (RR 0.38; 95% CI 0.21 to 0.69) complications, shorter hospital stays (SMD -0.52; 95% CI -1.01 to -0.04) and decreased OR time (SMD -0.89; 95% CI -1.46 to -0.31). Conclusions: TXA can effectively reduce postoperative bleeding after PCNL. Future studies should identify a subset of patients who may benefit from preoperative TXA administration for PCNL.
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Affiliation(s)
- Min Joon Lee
- Division of Urology, Department of Surgery, University of Toronto, Ontario, Canada.,Division of Urology, Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jin K Kim
- Division of Urology, Department of Surgery, University of Toronto, Ontario, Canada.,Division of Urology, Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Tang
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jessica M Ming
- Section of Urology, Department of Surgery, University of New Mexico, Albuquerque, New Mexico, USA
| | - Michael E Chua
- Division of Urology, Department of Surgery, University of Toronto, Ontario, Canada.,Division of Urology, Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines
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Park SY, Plambeck C, Joyce LD, Joyce DL. Bleeding After LVAD Implant: If Things Do Not Add Up, Take a Look! Innovations (Phila) 2021; 16:488-490. [PMID: 34605310 DOI: 10.1177/15569845211042369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 63-year-old male underwent re-exploration after HVAD implantation due to persistent postoperative bleeding. We present an unusual cause of postoperative bleeding after LVAD implantation for which early re-exploration and consideration of unusual etiologies is appropriate.
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Affiliation(s)
- Sarah Y Park
- 5506 Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christopher Plambeck
- 5506 Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lyle D Joyce
- 5506 Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David L Joyce
- 5506 Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Murakami K, Kitade M, Kumakiri J, Ozaki R, Ikuma S, Jinushi M, Itakura A. Monitoring drainage flow rate facilitates prompt intervention with re-laparoscopy for postoperative bleeding after laparoscopic gynecologic surgery: A case-control study. Asian J Endosc Surg 2021; 14:748-755. [PMID: 33779066 DOI: 10.1111/ases.12936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/28/2021] [Accepted: 03/14/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We aimed to identify the characteristics of cases involving postoperative bleeding after laparoscopic gynecologic surgery, and to clarify the optimal cutoff value of postoperative drainage and vital sign trends for predicting the need for re-laparoscopy. METHODS Of 6366 patients with gynecologic benign pathologies who underwent laparoscopic surgery at our institution between 2009 and 2018, 13 (0.2%) required re-laparoscopy for postoperative bleeding. After reviewing the perioperative course in the re-laparoscopy group, we examined the postoperative total drainage volume (mL), drainage flow rate (mL/h), and vital sign trends in the re-laparoscopy group (n = 13) and among patients with substantial drainage volume ≥300 mL at 12 hours postoperatively but who did not need re-laparoscopy (observation group, n = 107). RESULTS In the re-laparoscopy group, initial laparoscopic surgery included uterine surgery (myomectomy, n = 7; hysterectomy, n = 1), adnexal surgery (n = 3), and uterine plus adnexal surgery (n = 2). Postoperative bleeding sites included the uterine wound (n = 6), adnexal wound (n = 5), umbilical trocar site (n = 1), and mesentery (n = 1). The re-laparoscopy and observation groups did not differ regarding initial surgical characteristics or postoperative vital sign trends. For distinguishing between the re-laparoscopy and observation groups, the drainage flow rate was superior to total drainage volume. Continuous excessive drainage (flow rate >50 mL/h) at 3 hours postoperatively was associated with a remarkably increased risk for re-laparoscopy (odds ratio, 40.07; 95% confidence interval, 5.44 to 1776.41, P < 0.001). CONCLUSION In cases with continuous excessive drainage later than 3 hours postoperatively (flow rate >50 mL/h) should be considered for exploratory re-laparoscopy to enable prompt diagnosis and intervention.
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Affiliation(s)
- Keisuke Murakami
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Mari Kitade
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Jun Kumakiri
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan
| | - Rie Ozaki
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shinichiro Ikuma
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Makoto Jinushi
- Department of Obstetrics and Gynecology, International Goodwill Hospital, Kanagawa, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
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Ullmann M, Guzman R, Mariani L, Soleman J. The effect of anti-thrombotics on the postoperative bleeding rate in patients undergoing craniotomy for brain tumor. Br J Neurosurg 2021:1-7. [PMID: 34423703 DOI: 10.1080/02688697.2021.1968340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/15/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The peak prevalence of many brain tumors is in elderly patients. These patients are often treated with platelet inhibitors (PIs) or anticoagulants (ACs), creating a challenge for neurosurgeons concerning the perioperative management. The aim of this study is to analyze the effect of PI/AC treatment on the postoperative bleeding rates in patients undergoing craniotomy due to a brain tumor. METHODS Retrospective analysis of 415 consecutive patients undergoing craniotomy/craniectomy due to a brain tumor. Ninety-nine patients with PI/AC treatment (PI/AC group consisting of 64 PI, 29 AC, and six multiple) and 316 patients without PI/AC (control group) were primarily compared for hemorrhage rate. Secondary outcome measures were clinical outcome and mortality. The association between short preoperative discontinuation (≤5 days), early postoperative resumption time (≤5 days), as well as short total discontinuation time (≤5 days) of PI/AC and postoperative bleeding rates was analyzed. RESULTS Postoperative bleeding rates were comparable between the groups (12.2% and 13.5% in the PI/AC and control group, respectively; p=.74). The majority of bleeds were asymptomatic (85.2%). No significant difference in the postoperative mortality rate was observed (1.0% and 1.6% in the PI/AC and the control group, respectively; p=.67). Shorter discontinuation time of PI/AC was not significantly associated with higher postoperative bleeding rates (preoperative: 12.1% vs. 12.3%; p=.94, postoperative: 11.1% vs. 12.5%, respectively; p=.87, total: 16.7% vs. 12%, respectively; p=.73). CONCLUSIONS Patients treated with PI/AC undergoing craniotomy for the resection of brain tumor do not seem to have increased rates of postoperative bleeding or mortality. We did not find a significant correlation between short discontinuation time of PI/AC in the perioperative period and postoperative bleeding.
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Affiliation(s)
- Muriel Ullmann
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Raphael Guzman
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Luigi Mariani
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Jehuda Soleman
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
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Sabapathy SR, Mohan M, Venkateswaran G, Ranjani S. Bleeding Post Constriction Ring Release Surgery Causing Lower Limb Ischemia in an Infant with Undetected Hemophilia B. Indian J Plast Surg 2021; 54:218-220. [PMID: 34239249 PMCID: PMC8257317 DOI: 10.1055/s-0041-1729509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bleeding in the immediate postoperative period causing compromised limb circulation is an alarming complication. It is known to occur in coagulation disorders like hemophilia. When such complications happen in a child with no previous history of bleeding problems, one has to have a low threshold for suspecting a coagulation disorder. Repeated diffuse bleeding in the whole of the surgical wound with no specific bleeders must raise the suspicion and appropriate laboratory tests must immediately be ordered. Bleeding in coagulation disorders can stop only with supplementation of the appropriate missing clotting factor. Early diagnosis is important to avoid excess morbidity. We are reporting a 6-month-old child who underwent surgery for constriction ring syndrome in the limbs with Z-plasty and developed impending limb ischemia due to bleeding in the immediate postoperative period. The article emphasizes the need to think of the possibility while encountering recurrent bleeding in the postoperative period.
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Affiliation(s)
- S Raja Sabapathy
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Monusha Mohan
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - G Venkateswaran
- Department of Anaesthesiology, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Shashi Ranjani
- Visiting Pediatric hematologist, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Saikawa Y, Tsunoda A, Sata N, Anzai T. An incidental latent adult hemophilia case found after a tonsillectomy. SAGE Open Med Case Rep 2021; 9:2050313X20988410. [PMID: 33717485 PMCID: PMC7924005 DOI: 10.1177/2050313x20988410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/28/2020] [Indexed: 11/16/2022] Open
Abstract
Severe bleeding after a tonsillectomy may cause airway obstruction and be life-threatening. We report post-tonsillectomy bleeding in a 32-year-old patient with hemophilia A, who had not been aware of his disease for more than 30 years. He underwent tonsillectomy for recurrent tonsillitis. He denied episodes of bleeding tendency. The preoperative workup was normal, including platelet count, prothrombin time, and activated partial thromboplastin time. The surgery itself was uneventful, but severe bleeding from the inferior pole of the tonsillar bed developed 7 days after surgery. Emergency hemostasis was performed under general anesthesia in the operating room. The patient then remembered several episodes of bleeding tendency. Coagulation tests revealed a mild lack of coagulation factor VIII to 35%, and a diagnosis of hemophilia A was made. Hemophilia might only be found after surgery and can cause life-threatening complications. However, latent hemophilia detected after a tonsillectomy in a 32-year-old adult is very rare. A careful history of bleeding tendency is important to achieve a diagnosis of coagulopathy, perform a safer surgery, and prevent postoperative complications.
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Affiliation(s)
- Yuichiro Saikawa
- Department of Otolaryngology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Atsunobu Tsunoda
- Department of Otolaryngology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Naoko Sata
- Department of Otolaryngology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Takashi Anzai
- Department of Otolaryngology, Juntendo University Nerima Hospital, Tokyo, Japan
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Murugesh WR, Prasad SS, Ramachandrappa Sujay K, Dinesh Kumar US. Is a fixed low-dose protamine better at reducing postoperative bleeding in off pump coronary artery bypass grafting? Asian Cardiovasc Thorac Ann 2021; 29:922-927. [PMID: 33626877 DOI: 10.1177/0218492321997393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CONTEXT Protamine is used ubiquitously in all cardiac surgeries for reversal of heparin. Risk of postoperative bleeding is increased with inadequate heparin reversal or due to anticoagulant side effects of protamine; hence, it is important to dose protamine properly. This study compares 80% protamine dose with full dose on postoperative bleeding and transfusion needs in OPCAB. AIMS The aim of our study was to find whether lower dose of protamine could reduce postoperative bleeding and need for blood product transfusions in off pump coronary artery bypass grafting as compared to the regular dose of protamine. SETTINGS AND DESIGN This was a double-blinded randomised controlled trial where patients posted for off pump CABG meeting the inclusion criteria were included in the study. METHODS AND MATERIAL Ninety patients were randomised to two groups, group F receiving full dose of protamine of 1 mg per mg heparin used, and group L received 0.8 mg per mg. Postoperative activated clotting time, bleeding at 1 h, 4 h, 24 h and total drainage till drains removal and blood product transfusion requirements were noted.Statistical analysis used: SPSS software. RESULTS Both groups were matched in demographics, preoperative cessation of heparin and aspirin and platelet counts. Both groups received equal heparin dose, activated clotting time before protamine, activated clotting time post protamine in OT and ICU were equal as were the conduits used. There was no significant difference between the groups in post-operative drainage over time or in the need for blood product transfusions. CONCLUSIONS Eighty per cent of the dose of protamine can adequately reverse the heparin used during off pump cardiac surgery without any increase in incidence of postoperative bleeding or need for blood product transfusions.
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Affiliation(s)
- Wali R Murugesh
- Department of Cardiac Anaesthesia, JSS Medical College and Hospital, Mysuru, India
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Slouka D, Čejková Š, Hanáková J, Hrabačka P, Kormunda S, Kalfeřt D, Skálová A, Šimánek V, Kucera R. Risk of Postoperative Bleeding in Tonsillectomy for Peritonsillar Abscess, as Opposed to in Recurrent and Chronic Tonsillitis-A Retrospective Study. Int J Environ Res Public Health 2021; 18:1946. [PMID: 33671349 DOI: 10.3390/ijerph18041946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 11/24/2022]
Abstract
Tonsillectomy is a routine surgery in otorhinolaryngology and the occurrence of postoperative bleeding is not a rare complication. The aim of this retrospective, observational, analytic, cohort study is to compare the incidence of this complication for the most common indications. A group of patients indicated for tonsillectomies for peritonsillar abscess (group I) was compared to a group of patients indicated for chronic and recurrent tonsillitis (group II). There are a lot of pathophysiological differences in patients indicated for acute tonsillectomy for peritonsillar abscess and in patients indicated for elective tonsillectomy for chronic or recurrent tonsillitis. No technique to minimize the risk of bleeding after tonsillectomy has been found and a large part of postoperative bleeding occurs in postoperative home-care, which makes this issue topical. In total, 2842 unilateral tonsillectomies from the years 2014–2019 were included in the study. Bleeding occurred in 10.03% and, surprisingly, despite completely different conditions in the field of surgery (oedema, acute inflammation in peritonsillar abscess), there was no statistically significant difference between incidence of postoperative bleeding in the studied groups (p = 0.9920). The highest incidence of bleeding was found in the patients of group I on the eighth postoperative day, with those aged 20–24 years (p = 0.0235) being the most at risk, and in group II, on the sixth postoperative day, with those aged 25–29 years (p = 0.0128) and 45–49 years (p = 0.0249) being the most at risk.
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Bastopcu M, Özhan A, Erdoğan SB, Kehlibar T. Factors associated with excessive bleeding following elective on-pump coronary artery bypass grafting. J Card Surg 2021; 36:1277-1281. [PMID: 33484200 DOI: 10.1111/jocs.15364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Excessive bleeding following cardiac surgery is associated with worse outcomes. We aimed to analyze preoperative and operative factors associated with excessive bleeding in coronary artery bypass patients to better understand which patients are under increased risk. METHODS The study was conducted as an observational study in a tertiary center for cardiac surgery by retrospective analysis of the hospital database. Patients were grouped according to chest tube output within the postoperative 24 h. Patients in the 4th percentile of chest tube output per kilogram were categorized as having excessive bleeding. Patients with excessive bleeding were compared with the other patients for preoperative and operative factors. Factors significant in univariate analysis were carried onto the multivariate analysis. RESULTS Patients with excessive bleeding were more likely to be males (91.4% vs. 78.7%, p = .002), have lower body mass index (BMI) (27.4 vs. 29.2, p < .001), and low platelets (6.9% vs. 1.5%, p = .006). Cardiopulmonary bypass (101.8 vs. 110.9 min, p = .022) time was longer in the excessive bleeding group. Patients with excessive bleeding were more likely to have more than three vessels revascularized. Male sex, lower BMI, low platelets, and longer cardiopulmonary bypass time were independently associated with increased bleeding. CONCLUSION Male sex, lower BMI, low platelet count, and longer cardiopulmonary bypass time are associated with extensive bleeding after elective coronary artery bypass surgery (CABG). Patients with higher bleeding risk should be identified preoperatively to account for adverse outcomes after CABG.
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Affiliation(s)
- Murat Bastopcu
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Abdulkerim Özhan
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sevinç B Erdoğan
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Tamer Kehlibar
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Fujisaki A, Takayama T, Yamazaki M, Komatsubara M, Kamei J, Sugihara T, Ando S, Fujimura T. Postoperative Hemorrhagic Shock 7 Days After Robot-Assisted Radical Prostatectomy. J Endourol Case Rep 2021; 6:448-450. [PMID: 33457698 DOI: 10.1089/cren.2020.0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Delayed postoperative bleeding after robot-assisted radical prostatectomy (RARP) is a rare life-threatening condition. We present such a case wherein a patient developed hemorrhagic shock from a ruptured pseudoaneurysm arising from the epigastric artery and discuss its management. Case Presentation: A 71-year-old man with prostate cancer underwent RARP. The urethral catheter was removed on postoperative day 7; 80 minutes later, the patient suddenly lost consciousness and went into shock. Enhanced CT revealed intra-abdominal bleeding; however, the cause was unknown. Intraoperatively, bleeding was observed from the anterior abdominal wall, which likely corresponded to the epigastric artery. However, this was controlled with monopolar electrocautery. Because of unstable hemodynamics, hemostasis was immediately performed by laparotomy, and bleeding was noted from the previously coagulated right inferior epigastric artery. Therefore, the cause was considered to be the rupture of a pseudoaneurysm. Conclusion : Our experience suggests that monopolar electrocautery may be inadequate for controlling bleeding that may be encountered during RARP, possibly leading to pseudoaneurysm formation, which may cause a delayed life-threatening hemorrhage. Meticulous and precise hemostasis is key to avoiding this complication.
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Affiliation(s)
- Akira Fujisaki
- Department of Urology, Jichi Medical University, Shimotsuke-shi, Japan
| | - Tatsuya Takayama
- Department of Urology, Jichi Medical University, Shimotsuke-shi, Japan
| | - Masahiro Yamazaki
- Department of Urology, Jichi Medical University, Shimotsuke-shi, Japan
| | - Maiko Komatsubara
- Department of Urology, Jichi Medical University, Shimotsuke-shi, Japan
| | - Jun Kamei
- Department of Urology, Jichi Medical University, Shimotsuke-shi, Japan
| | - Toru Sugihara
- Department of Urology, Jichi Medical University, Shimotsuke-shi, Japan
| | - Satoshi Ando
- Department of Urology, Jichi Medical University, Shimotsuke-shi, Japan
| | - Tetsuya Fujimura
- Department of Urology, Jichi Medical University, Shimotsuke-shi, Japan
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Abstract
Surgical treatment of pancreatic diseases is always associated with a large number of complications. Postoperative hemorrhage is a specific complication of pancreatic surgery requiring a clear classification and surgical strategy. According to literature data, postoperative hemorrhage occurs in 3-30% of cases. Incidence of hemorrhages depends on intraoperative, anamnestic, histological and postoperative factors. Early postoperative hemorrhage (within 24 hours after surgery) is usually a consequence of technical errors in intraoperative hemostasis, perioperative coagulation disorders. The mechanism of delayed bleeding is more complex and often associated with various arrosive factors: pancreatic fistula, biliary fistula, abscess. Currently, there is no a single treatment algorithm for patients with postpancreatectomy hemorrhage. According to various researchers, contrast-enhanced CT is preferred for diagnosis. In recent years, the role of endovascular hemostasis has significantly increased. This problem requires further study and development of a single treatment and diagnostic algorithm that will reduce mortality in these patients.
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Affiliation(s)
- A A Goev
- Vishnevsky Institute of Surgery, Moscow, Russia
| | | | | | - G V Galkin
- Vishnevsky Institute of Surgery, Moscow, Russia
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Matkovic M, Novakovic T, Bilbija I, Lazovic JM, Tutus V, Cubrilo M, Aleksic N, Mikic A, Petrovic E, Peric V, Milojevic A, Putnik S. The routine use of platelet function tests in elective coronary artery bypass grafting: A prospective observational trial. J Card Surg 2021; 36:629-636. [PMID: 33403686 DOI: 10.1111/jocs.15284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/30/2020] [Accepted: 12/16/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Preoperative use of platelet function tests contributes to the decrease of re-intervention rate due to bleeding and the necessity of transfusion in coronary artery bypass grafting (CABG) patients. The aim was to investigate the predictive value and to justify routine preoperative use of multiple electrode aggregometry in these patients. METHODS A prospective observational trial which included 416 consecutive patients subjected to elective isolated CABG was conducted. The Multiplate® test was used to assess platelet function. Platelet function test results, postoperative blood loss, and transfusion requirements were compared between high and low bleeding risk patients. Receiver operating characteristic analysis was performed to assess the sensitivity and specificity of the arachidonic acid (ASPI) and adenosine di-phosphate high sensitive (ADPHS) tests. RESULTS ADPHS and ASPI test results significantly predicted total bleeding > 1000 ml (AUC, 0.685, p < .001; 0.695, p = .039). Sensitivity and specificity were 62.9% and 40.0%, for ADPHS ≤602, and 70.8% and 41.8%, for ASPI ≤ 453. The sensitivity and specificity of cut-off values recommended by the manufacturer were 84.2% and 40.0% for ADPHS ≤ 500, while for ASPI < 600 the values were 54.7% and 62.2%. More platelets and cryoprecipitate were transfused in patients with ADPHS ≤ 602.5 (p < .001; p = .035). Patients with ADPHS ≤ 500 had a higher rate of red blood count, platelet and cryoprecipitate transfusion (p<.001p<.001; p = .013). The manufacturer's ASPI test cut-off values showed no statistically significant prediction for a higher transfusion rate. CONCLUSION Preoperative platelet function tests should be conducted systematically for all elective CABG patients who were on dual antiplatelet therapy after adjusting test cut-off values for each population.
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Affiliation(s)
- Milos Matkovic
- Department for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tina Novakovic
- Department for Biostatistics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ilija Bilbija
- Department for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Milin Lazovic
- Department for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Vladimir Tutus
- Department for Anesthesiology and Intensive Care, Clinical Center of Serbia, Belgrade, Serbia
| | - Marko Cubrilo
- Department for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Nemanja Aleksic
- Department for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandar Mikic
- Department for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Emilija Petrovic
- Department for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Valerija Peric
- Department for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Svetozar Putnik
- Department for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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47
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Feih JT, Juul JJ, G Rinka JR, Baumann Kreuziger LM, Pagel PS, Tawil JN. Adequacy of hemostatic resuscitation improves therapeutic efficacy of recombinant activated factor VII and reduces reexploration rate for bleeding in postoperative cardiac surgery patients with refractory hemorrhage. Ann Card Anaesth 2020; 22:388-393. [PMID: 31621674 PMCID: PMC6813715 DOI: 10.4103/aca.aca_108_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Excessive bleeding and surgical reexploration are common complications that increase the risk of multi-organ failure and prolonged hospitalization after cardiac surgery. Off-label use of recombinant activated factor VII (rFVIIa) is a recommended treatment for refractory bleeding. Objective: The objective of the study is to determine if the adequacy of hemostatic resuscitation enhances the efficacy of rFVIIa. Methods: This retrospective, observational, cohort study included patients who received rFVIIa for refractory postoperative bleeding after cardiac surgery. Patients were divided into two groups based on the presence or absence of adequate coagulation resuscitation before rFVIIa administration, defined as international ratio (INR) ≤1.5, platelet count ≥100 K/mL, and fibrinogen ≥200 mg/dL. The failure of rFVIIa treatment was defined as surgical reexploration within 24 h, thoracostomy drainage >400 mL/h within 6 h or transfusion of additional blood products or another rFVIIa dose within 6 h after initial rFVIIa dose. Results: Of the 3833 patients, screened who underwent cardiothoracic surgery procedures, 58 patients received rFVIIa for refractory postoperative bleeding. Successful hemostasis with rFVIIa was more likely in patients who were adequately resuscitated compared with those who were not (20 [71.4%] vs. 10 [33.3%], respectively; P = 0.0046). Multiple logistic regression analysis indicated that patients who were adequately resuscitated before rFVIIa were less likely to fail treatment (odds ratio, 0.16; 95% confidence interval [0.04–0.62]; P = 0.007). Conclusions: The therapeutic efficacy of rFVIIa is dependent on the adequacy of hemostatic resuscitation; restoration of normal serum fibrinogen, INR, and platelet counts >100 K/mL may provide an adequate substrate for rFVIIa to be effective in managing refractory postoperative cardiac surgical bleeding.
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Affiliation(s)
- Joel T Feih
- Department of Pharmacy, Froedtert and the Medical College of Wisconsin; Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Janelle J Juul
- Department of Pharmacy, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joseph R G Rinka
- Department of Pharmacy, Froedtert and the Medical College of Wisconsin, Milwaukee; Department of Pharmacy Practice, Concordia University Wisconsin School of Pharmacy, Mequon, Wisconsin, USA
| | - Lisa M Baumann Kreuziger
- Department of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin; The Blood Center of Wisconsin, Blood Research Institute, Milwaukee, Wisconsin, USA
| | - Paul S Pagel
- Department of Anesthesiology, Medical College of Wisconsin; Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Justin N Tawil
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Sun N, Zhang D, Zheng S, Fu L, Li L, Liu S, Li H, Qiu X. Incidence and Risk Factors of Postoperative Bleeding in Patients Undergoing Total Thyroidectomy. Front Oncol 2020; 10:1075. [PMID: 32850311 PMCID: PMC7396519 DOI: 10.3389/fonc.2020.01075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/29/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose: Our goal was to analyze postoperative bleeding in patients undergoing total thyroidectomy and to explore the possible risk factors. Materials and Methods: Patients undergoing total thyroidectomy were retrospectively enrolled, and the main study outcomes were postoperative bleeding and 30-day mortality. Univariate and multivariate analyses were used to determine the independent risk factors for postoperative bleeding. Results: A total of 31,706 patients were enrolled for analysis during January 2010 and December 2018 from the Affiliated First Hospital of Zhengzhou University. Benign and malignant disease was reported in 4,521 and 27,185 patients, respectively. Postoperative bleeding occurred in 48 patients with benign disease and in 263 patients with malignant disease. There was one bleeding site in 243 patients. The branch of the superior thyroid artery was the most common arterial bleeding site, occurring in 124 patients, and the anterior jugular vein was the most common venous bleeding site, occurring in 85 patients. Multivariable analysis confirmed that hypertension, diabetes, BMI, and disease pathology were independent factors affecting postoperative bleeding in patients with benign disease and that hypertension, diabetes, BMI, operation time, tumor stage, and tracheotomy were independent factors affecting postoperative bleeding in patients with malignant disease. In patients with postoperative bleeding, there were 5 deaths; in patients without postoperative bleeding, there were 42 deaths, and the difference was significant (p < 0.001). Conclusions: Compared with malignant disease patients, benign disease patients have a similar postoperative bleeding rate. A previous history of chemotherapy or radiotherapy has no significant effect on postoperative bleeding.
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Affiliation(s)
- Ning Sun
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Danhua Zhang
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shouhua Zheng
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lijun Fu
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liwen Li
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Senyuan Liu
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongting Li
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinguang Qiu
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Gunn TM, London TE, Saha SP. Contemporary Surgical Management of Atrial Fibrillation. Int J Angiol 2020; 29:123-130. [PMID: 32476812 DOI: 10.1055/s-0040-1705111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Atrial fibrillation is a common arrhythmia which may cause symptoms that significantly impact quality of life and is associated with increased risk of stroke, heart failure, and sudden death. Over the past three decades many surgical techniques as well as catheter-bases procedures have been developed to treat atrial fibrillation. In this review we describe the indications, treatments, outcomes, surgical techniques, and technical advances reported in the literature.
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Affiliation(s)
- Tyler M Gunn
- Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky
| | - Tessa E London
- Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky
| | - Sibu P Saha
- Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky
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50
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von Stumm M, Subbotina I, Biermann D, Gottschalk U, Mueller G, Kozlik-Feldmann R, Reichenspurner H, Riso A, Sachweh JS. Impact of delayed systemic heparinization on postoperative bleeding and thromboembolism during post-cardiotomy extracorporeal membrane oxygenation in neonates. Perfusion 2020; 35:626-632. [PMID: 32072861 DOI: 10.1177/0267659120906046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Veno-arterial extracorporeal membrane oxygenation is well-established for pediatric patients with post-cardiotomy heart failure. However, extracorporeal membrane oxygenation support is associated with major complications, that is, hemorrhage and thromboembolism. We seek to report our experience with delayed systemic heparinization during neonatal cardiac extracorporeal membrane oxygenation and its impact on bleeding and thromboembolism. METHODS We retrospectively identified 15 consecutive neonates who were placed on extracorporeal membrane oxygenation after congenital heart surgery during a period of 3 years (2015-2017). Our anticoagulation protocol consisted of full heparin reversal by protamine after switching from cardiopulmonary bypass to extracorporeal membrane oxygenation (target activated clotting time: 120 ± 20 seconds). Administration of systemic heparinization was delayed until postoperative drainage volume declined to <1 mL/kg/h. Primary study endpoints were thromboembolism, bleeding, and requirement of blood products on extracorporeal membrane oxygenation. RESULTS Our cohort (mean age: 13 ± 2.6 days; mean weight: 3.1 ± 0.3 kg; 66.7% male) required post-cardiotomy extracorporeal membrane oxygenation with a mean support time of 4.5 ± 2.2 days. Systemic heparinization was delayed averagely for 18.1 ± 9.3 hours. No thromboembolic events were observed on extracorporeal membrane oxygenation or after weaning. Relevant surgical site bleeding occurred in two patients (13.3%) requiring re-thoracotomy on the first postoperative day. Analysis of transfusion volumes revealed 24.5 ± 21.9 mL/kg/d mean packed red blood cells, 9.6 ± 7.1 mL/kg/d mean fresh frozen plasma, and 7.5 ± 5.7 mL/kg/d mean platelets. In-hospital survival was 86.6% (n = 13). CONCLUSION In this retrospective analysis, the results of delayed systemic heparinization in neonatal post-cardiotomy extracorporeal membrane oxygenation could lead one to conclude that this routine is safe and favorable with low risk for thromboembolic events, reduced postoperative hemorrhage, and reduced blood product utilization.
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Affiliation(s)
- Maria von Stumm
- Department of Cardiovascular Surgery, University Heart & Vascular Center, Hamburg, Germany
| | - Irina Subbotina
- Department of Cardiovascular Surgery, University Heart & Vascular Center, Hamburg, Germany
| | - Daniel Biermann
- Department of Cardiac Surgery for Congenital Heart Disease, University Heart & Vascular Center, Hamburg, Germany
| | - Urda Gottschalk
- Department of Paediatric Cardiology, University Heart & Vascular Center, Hamburg, Germany
| | - Goetz Mueller
- Department of Paediatric Cardiology, University Heart & Vascular Center, Hamburg, Germany
| | - Rainer Kozlik-Feldmann
- Department of Paediatric Cardiology, University Heart & Vascular Center, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center, Hamburg, Germany
| | - Arlindo Riso
- Department of Cardiac Surgery for Congenital Heart Disease, University Heart & Vascular Center, Hamburg, Germany
| | - Joerg S Sachweh
- Department of Cardiac Surgery for Congenital Heart Disease, University Heart & Vascular Center, Hamburg, Germany
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