Controversies in anticoagulation therapy in patients with cirrhosis
This article aims to review the latest literature on prophylactic and therapeutic anticoagulation and the safety profile of anticoagulants in patients with cirrhosis. Recent findings The understanding of hematological hemostasis is cirrhotic patients has changed drastically in recent years. Although in the past, cirrhotic patients were often considered to be ‘auto-anticoagulated’ and at higher risk of bleeding, recent studies have demonstrated that there may be a rebalance in procoagulation and anticoagulation factors in patients with cirrhosis. This, and clinical experience, suggest that cirrhotic patients are at risk of development of venous thrombosis, pulmonary embolism and ischemic strokes and as such, the best management approaches in these patients remains controversial. The bulk of the data suggest that patients with cirrhosis who are at risk for thrombotic or embolic complications should be anticoagulated. However, it is imperative that they be closely monitored. Summary The medical literature on anticoagulation in patients with liver cirrhosis is conflicting and limited to small sample observational studies. However, most studies suggest that in patients with early stages of liver cirrhosis and no history of varices, anticoagulation appears to be well tolerated.
CONCLUSION: Splenic fibrosis progresses along with advancement of PH. Cygb-expressing cells in the splenic cord possibly participate in this process through mechanisms including oxidative stress. PMID: 32945524 [PubMed - as supplied by publisher]
Publication date: Available online 19 September 2020Source: Journal of Vascular and Interventional RadiologyAuthor(s): Jihoon Hong, Sang Yub Lee, Jung Guen Cha, Jae-Kwang Lim, Seung-Ick Cha, Young Woo Do
Authors: Signorelli F, Montano N Abstract Hemostasis plays a central role throughout neurosurgery. In microneurosurgery, a bloodless operating field under an operating microscope allows fast and effective surgery, thereby reducing the risk of postoperative hemorrhage. Apart from mechanical methods, such as positioning of the patient's head and body, bone plugging, suction, and metal clips, neurosurgical hemostasis is achieved mainly with bipolar coagulation, which permits optimal control of hemorrhage, allows for fine coagulation of small vessels and is safe in patients with pacemakers and defibrillators. Gelatin s...
Authors: Shen L, Li Y, Ding J, Yang J, Jiang G, Sihoe ADL Abstract Background: Most studies on prophylaxis against pulmonary embolism (PE) after lung surgery have come from the West. Whether such prophylactic programs can be successfully developed in China has not been fully studied. Methods: A prospective observational trial included 581 Chinese patients receiving lung resection surgery between August 8 and September 12 of 2017. The Caprini score was assessed on the first postoperative day (POD1). For PE prophylaxis, patients with a low score (0-4, n=55) received early ambulation, and those with a high score (...
Conclusions: The ultrasound sliding lung sign could be used to predict severe intrathoracic adhesions before surgery. Preoperative confirmation of the ultrasound sliding lung sign is important for planning surgical approaches and implementing appropriate safety management. PMID: 32944334 [PubMed]
Conclusions: Both 3D image reconstruction and thin-section MDCT provided precise preoperative information about SA. The 3D image reconstruction software "Exoview" could visualize SA for surgeons. However, the thin-section MDCT provided a better evaluation of small SA branches. PMID: 32944331 [PubMed]
Conclusions: The two-staged procedure for the repair of chronic type A dissection with small true lumen at the descending aorta is adaptable with low prevalence of mortality and complication. PMID: 32944324 [PubMed]
Conclusions: ESL is a safe and effective procedure that should be considered a favorable alternative to PN whenever it may guarantee a complete resection. PMID: 32944320 [PubMed]
Authors: Liu Y, Yu Z, Yu P, Ito A, Gonzalez M, Hirai K, Polaczek M, Liu H Abstract Video-assisted thoracoscopic surgery (VATS) lobectomy, especially uniportal VATS, is increasingly used for pulmonary sequestration (PS). However, there are few descriptions of safe handling of the aberrant artery with atherosclerosis, especially the diameter of arteries exceeds than 2.0 cm, under uniportal VATS approach. Here we report a 56-year-old man who was diagnosed with pulmonary sequestration following trauma. The patient had a long history of cough with purulent sputum. One month before the trauma, he had copious expectoratio...
ConclusionsKcentra was used in several off-label clinical settings, with comparable mortality among the coumadin, rivaroxaban and apixaban groups and no identifiable benefit in the setting of cirrhosis, DIC or antiplatelet medications, but with an increased incidence of deep vein thrombosis and stroke.DisclosuresNo relevant conflicts of interest to declare.