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Source: Journal of Cardiothoracic and Vascular Anesthesia
Condition: Bleeding
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Total 19 results found since Jan 2013.
The Price of Keeping the Rhythm: Increased Bleeding Risk in Patients with Atrial Fibrillation Concurrently Prescribed Amiodarone and Factor Xa Inhibitors
Atrial fibrillation is the most common sustained cardiac arrhythmia affecting nearly 2% of the population of the United States.1 Patients with atrial fibrillation are twice as likely to have a myocardial infarction and five-times as likely to have a stroke.1 Current guidelines recommend antiarrhythmic pharmacotherapy in patients with symptomatic atrial fibrillation as first-line management.2-4 Amiodarone is a very effective, and therefore, a commonly prescribed agent for this purpose.5 Anticoagulation is a key tenet in the management of atrial fibrillation due to the increased tendency of left atrial appendage clot formati...
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 10, 2023 Category: Anesthesiology Authors: Nicolas Kumar, Manoj H. Iyer, Adam Dalia, Amit Bardia Tags: Editorial Source Type: research
Opioid-Free Cardiac Surgery: A Multimodal Pain Management Strategy With a Focus on Bilateral Erector Spinae Plane Block Catheters
CARDIAC SURGERY REQUIRING STERNOTOMY presents unique challenges for perioperative and postoperative analgesia. Intraoperatively, the sympathetic response to surgical stimulation must be modulated carefully to prevent excessive bleeding, maintain the integrity of surgical repairs, and decrease the risk of stroke or iatrogenic aortic injury without compromising myocardial and systemic perfusion. This must be achieved in patients whose underlying abnormal physiology, coupled with the effects of the surgical procedure, often result in tenuous hemodynamics.
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 7, 2022 Category: Anesthesiology Authors: Nabil K. Thalji, Saumil Jayant Patel, John G. Augoustides, Robin J Schiller, Adam A. Dalia, Yinghui Low, Rawad I. Hamzi, Rohesh J. Fernando Tags: Case Conference Source Type: research
Opioid Free Cardiac Surgery: A Multimodal Pain Management Strategy with a Focus on Bilateral Erector Spinae Plane Block Catheters
Cardiac surgery requiring sternotomy presents unique challenges for perioperative and postoperative analgesia. Intraoperatively, the sympathetic response to surgical stimulation must be carefully modulated to prevent excessive bleeding, maintain the integrity of surgical repairs, and decrease the risk of stroke or iatrogenic aortic injury without compromising myocardial and systemic perfusion. This must be achieved in patients whose underlying abnormal physiology coupled with the effects of the surgical procedure often result in tenuous hemodynamics.
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 7, 2022 Category: Anesthesiology Authors: Nabil K. Thalji, Saumil Jayant Patel, John G. Augoustides, Robin J Schiller, Adam A Dalia, Yinghui Low, Rawad I. Hamzi, Rohesh J. Fernando Tags: Case Conference Source Type: research
Perioperative Bleeding Requiring Blood Transfusions Is Associated with Increased Risk of Stroke after Transcatheter and Surgical Aortic Valve Replacement
We aimed to investigate the impact of severe bleeding and use of red blood cell (RBC) transfusion on the development of postoperative stroke after surgical (SAVR) and transcatheter aortic valve replacement (TAVR) from the FinnValve registry.
Source: Journal of Cardiothoracic and Vascular Anesthesia - April 26, 2022 Category: Anesthesiology Authors: Tuomas Tauriainen, Tatu Juvonen, Vesa Anttila, Pasi Maaranen, Matti Niemel ä, Markku Eskola, Tuomas Ahvenvaara, Annastiina Husso, Marko P.O. Virtanen, Eeva-Maija Kinnunen, Sebastian Dahlbacka, Maina Jalava, Mika Laine, Antti Valtola, Peter Raivio, Antti Tags: Original Article Source Type: research
Neurological Injury in COVID-19 Patients Who Receive VV-ECMO Therapy: A Cohort Study
Both thrombotic and bleeding events have been implicated in the progression of Coronavirus disease 2019 (COVID-19).1,2 Such dysregulation of coagulation has been associated with poor prognosis.3,4 Neurologic sequelae, such as ischemic stroke and intracranial hemorrhage (ICH), have been reported in COVID-19 patients at rates of 0.9%-2.3% and 0.9%, respectively.5,6,7,8 Limited data exists on neurological events in COVID-19 patients in the intensive care unit (ICU) who require extracorporeal membrane oxygenation (ECMO) due to severe acute respiratory distress syndrome (ARDS).
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 13, 2021 Category: Anesthesiology Authors: Nivedha V. Kannapadi, Meghana Jami, Lavienraj Premraj, Eric W. Etchill, Katherine Giuliano, Errol L. Bush, Bo Soo Kim, Stella Seal, Glenn Whitman, Sung-Min Cho Tags: Letter to the Editor Source Type: research
Neurologic Injury in Patients With COVID-19 Who Receive VV-ECMO Therapy: A Cohort Study
THROMBOTIC AND BLEEDING events have been implicated in the progression of coronavirus disease 2019 (COVID-19).1,2 This dysregulation of coagulation has been associated with poor prognoses.3,4 Neurologic sequelae, such as ischemic stroke and intracranial hemorrhage (ICH), have been reported in patients with COVID-19 at rates of 0.9%-to-2.3% and 0.9%, respectively.5,6,7,8 Limited data exist on neurologic events in patients with COVID-19 in the intensive care unit who require extracorporeal membrane oxygenation (ECMO) due to severe acute respiratory distress syndrome (ARDS).
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 13, 2021 Category: Anesthesiology Authors: Nivedha V. Kannapadi, Meghana Jami, Lavienraj Premraj, Eric W. Etchill, Katherine Giuliano, Errol L. Bush, Bo Soo Kim, Stella Seal, Glenn Whitman, Sung-Min Cho Tags: Letters to the Editor Source Type: research
Impact of Early, Low-Dose Factor VIIa on Subsequent Transfusions and Length of Stay in Cardiac Surgery
OFF-LABEL USE of recombinant activated factor VII (rFVIIa; NovoSeven, Novo Nordisk, Bagsvaerd, Denmark) for perioperative cardiac surgical bleeding has been shown to reduce bleeding,1-4 blood product administration,1,5,6 and the rate of reoperations.4,6,7 However, there also has been an association with increased mortality,8 thrombosis,9-11 stroke,7,11,12 and renal morbidity.8,9 These inconsistent outcomes may be a function of variations in both timing and dosing of rFVIIa.
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 6, 2021 Category: Anesthesiology Authors: Lauren Sutherland, Abigail Houchin, Tian Wang, Shuang Wang, Vivek Moitra, Akshit Sharma, Trip Zorn, Brigid C. Flynn Tags: Original Article Source Type: research
How to Manage the Perioperative Patient on Combined Anticoagulant and Antiplatelet Therapy: Comments on the 2020 ACC Consensus Decision Pathway
Antithrombotic drugs are frequently used to prevent or treat various common cardiovascular disorders like acute coronary syndrome (ACS), stroke, atrial fibrillation (AF), and venous thromboembolism (VTE). Mainly, two classes of oral antithrombotic drugs are on market: anticoagulants, which slow down clot formation by reduced thrombin generation and fibrin formation; and antiplatelet drugs, which prevent platelet activation and formation of stable clots. Combined anticoagulant and antiplatelet therapy might be indicated in some patients, but it is associated with increased risk of critical bleeding.
Source: Journal of Cardiothoracic and Vascular Anesthesia - January 28, 2021 Category: Anesthesiology Authors: Daniel Bolliger, Jens Fassl, Gabor Erdoes Tags: Editorial Commentary Source Type: research
Left Atrial Appendage Occlusion: A Narrative Review
Left atrial appendage occlusion (LAAO) is a proposed alternative to oral anticoagulation in reducing stroke in patients with atrial fibrillation. It is suggested that LAAO is most suitable in patients at increased risk of stroke or bleeding or with contraindication to pharmacologic intervention. Despite the increase in evidence evaluating LAAO, the relative safety and efficacy of the procedure remains uncertain. Presently, several ongoing randomized trials are comparing various devices to each other and to pharmacologic anticoagulation.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 8, 2019 Category: Anesthesiology Authors: Ali Alsagheir, Alex Koziarz, Emilie P. Belley-C ôté, Richard P. Whitlock Tags: Review Article Source Type: research
The HAS-BLED Score is Associated With Major Bleeding in Patients After Cardiac Surgery
The Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly, Drugs/alcohol (HAS-BLED) score has been developed to predict the risk of potential bleeding in anticoagulated patients affected by atrial fibrillation. The aim of this study was to test the hypothesis that the HAS-BLED score is associated with major bleeding also in patients after cardiac surgery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - February 4, 2019 Category: Anesthesiology Authors: Gianluca Santise, Saverio Nardella, Francesco Migliano, Alessandro Testa, Daniele Maselli Tags: Original Article Source Type: research
Decannulation of a Ventricular Assist Device
BECAUSE OF the donor organ shortage, an increasing number of patients with advanced heart failure are receiving ventricular assist devices (VADs) as a bridge to transplantation or as a destination therapy.1 Patients with advanced heart failure who receive a VAD have significantly greater survival rates compared with those who are treated with only medication.2 However, short- and long-term complications of VADs still are a major concern.3 There are perioperative risks attributed to patient comorbidities; risks of surgery and anesthesia; and postoperative risks such as bleeding, thrombosis, stroke, infection, right ventricu...
Source: Journal of Cardiothoracic and Vascular Anesthesia - October 4, 2018 Category: Anesthesiology Authors: Tuan-Yen Wu Tags: Case Report Source Type: research
Inefficacy of Platelet Transfusion in a Heart Transplant Patient Under Continuous Ticagrelor
Antiplatelet agents have a predominant role in the therapeutic treatment of acute coronary syndrome (ACS) and myocardial infarction. Recently, ticagrelor has been incorporated in the European Society of Cardiology guidelines for the management of ACS with ST elevation and non-ST elevation.1 The AHA/ACC guidelines further advocate the choice of ticagrelor over clopidogrel in patients with ACS with non-ST elevation treated with an early invasive strategy.2 In fact, major studies have proven the benefits of ticagrelor on cardiovascular death, myocardial infarction, and stroke without an increase in major bleeding risk.
Source: Journal of Cardiothoracic and Vascular Anesthesia - June 15, 2017 Category: Anesthesiology Authors: Laura Filaire, Dat T. Pham, Nicolas d ’Ostrevy, Huyen T. Tran, Lionel Camilleri, Kasra Azarnoush Tags: Case Report Source Type: research
Old Drug, New Route: A Systematic Review of Intravenous Acetaminophen After Adult Cardiac Surgery
THE MANAGEMENT OF postoperative pain after cardiac surgery remains clinically challenging. Well-controlled pain is critical to maintaining the physical and psychologic well-being of each patient and can help facilitate timely extubation, comfortable breathing, and early postoperative ambulation. On the other hand, left poorly managed, postoperative pain can lead to rising catecholamine levels, ultimately triggering myocardial ischemia, stroke, or bleeding complications.1-3 Insufficient pain control also can limit patient mobility, increasing the risk of deep vein thrombosis and pneumonia, in addition to the harmful psychol...
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 2, 2016 Category: Anesthesiology Authors: Daniel J. Douzjian, Alexander Kulik Tags: Review ArticleGiovanni Landoni, MDSection Editors? > Source Type: research
A Case of Fatal Bleeding Following Emergency Surgery on an Ascending Aorta Intramural Hematoma in a Patient Taking Dabigatran
INTRAMURAL HEMATOMA (IMH) is an acute aortic syndrome. More frequently—in 60% to 70% of cases—IMH involves the descending aorta (type B), whereas the involvement of the ascending aorta and aortic arch accounts for 30% and 10% of the cases, respectively. Hospital mortality of type-A IMH is similar to type-A aortic dissection. Cardiocirculatory shock secondary to cardiac tamponade, together with stroke, coma, and impaired coronary perfusion, are important predictive factors of postoperative mortality.
Source: Journal of Cardiothoracic and Vascular Anesthesia - January 13, 2016 Category: Anesthesiology Authors: Giulia Beatrice Crapelli, Paolo Bianchi, Giuseppe Isgrò, Andrea Biondi, Carlo de Vincentiis, Marco Ranucci Tags: Case Report Source Type: research
