• Filter By:
• Specialty
• Source
• Condition
• Cancer
• Infectious Disease
• Drug
• Training
• Management
• Procedure
• Therapy
• Vaccine
• Nutrition
• Country

Risk of Bleeding Complications With Different Peri-Operative Antithrombotic Regimens During Carotid Endarterectomy: a National Registry Analysis
Antithrombotic therapy is one of the cornerstones of the prevention of (recurrent) ocular or cerebral ischaemic events in patients with carotid artery stenosis. Randomised controlled trials on antithrombotic therapy for patients with minor ischaemic stroke and transient ischaemic attack (TIA) have recommended dual antiplatelet therapy (DAPT) in the three weeks following the index event. However, these trials excluded patients undergoing carotid revascularisation. To date, the optimal antithrombotic therapy during the peri-operative period of carotid endarterectomy (CEA) remains unclear.
Source: Journal of Vascular Surgery - January 19, 2023 Category: Surgery Authors: S.J.A. Donners, J.M. Mekke, E.S. van Hattum, R.J. Toorop, G.J. de Borst, Dutch Audit for Carotid Interventions (DACI) Collaborators Source Type: research

Ticagrelor or clopidogrel for dual antiplatelet therapy after transcarotid and transfemoral stenting of the carotid artery: are we ready for a randomized controlled trial?
In the work by Marcaccio et  al,1 the efficacy and safety of perioperative dual antiplatelet therapy (DAPT) with aspirin/ticagrelor vs aspirin/clopidogrel in patients undergoing carotid artery stenting (CAS) or transcarotid artery revascularization (TCAR) was examined using data collected from the Vascular Quality Initiative. Compared with aspirin/clopidogrel, aspirin/ticagrelor was associated with a potentially lower risk of stroke/death and bleeding complications after CAS in cases in which protamine was used but a higher risk of these outcomes in the absence of protamine.
Source: Journal of Vascular Surgery - June 20, 2022 Category: Surgery Authors: Mario D'Oria, Sandro Lepidi Tags: Letter to the Editor Source Type: research

Protamine use in transcarotid artery revascularization is associated with lower risk of bleeding complications without higher risk of thromboembolic events
Recent studies have found that transcarotid artery revascularization (TCAR) is associated with lower risk of stroke or death compared with transfemoral carotid artery stenting but higher risk of bleeding complications, presumably associated with the need for an incision. Heparin anticoagulation is universally used during TCAR, so protamine use may reduce bleeding complications. However, the safety and effectiveness of protamine use in TCAR are unknown. We therefore evaluated the impact of protamine use on perioperative outcomes after TCAR in the Vascular Quality Initiative TCAR Surveillance Project.
Source: Journal of Vascular Surgery - April 5, 2020 Category: Surgery Authors: Patric Liang, Raghu L. Motaganahalli, Mahmoud B. Malas, Grace J. Wang, Jens Eldrup-Jorgensen, Jack L. Cronenwett, Brian W. Nolan, Vikram S. Kashyap, Marc L. Schermerhorn Source Type: research

Drain placement confers no benefit after carotid endarterectomy in the Vascular Quality Initiative
Whereas bleeding complications requiring a return to the operating room (OR) after carotid endarterectomy (CEA) are infrequent (1%), they are associated with an increased 30-day combined postoperative stroke or death rate. Drain placement after CEA varies among vascular surgeons, and there are limited data to support the practice. The goal of this study was to evaluate factors leading to drain placement and the effect of drains on postoperative outcomes including return to OR for bleeding, stroke, and death.
Source: Journal of Vascular Surgery - February 11, 2020 Category: Surgery Authors: Christopher J. Smolock, Katherine L. Morrow, Jeanwan Kang, Rebecca L. Kelso, James F. Bena, Daniel G. Clair Source Type: research

LEA 24. Synthetic Marijuana and Acute Lower Limb Thromboembolism and Ischemia —A Case Report
Synthetic marijuana use has been reported in the last years as a possible causative factor of different cardiovascular events, including myocardial infarction, ischemic stroke, intracranial bleeding, and cerebral vasospasm. One case of aortic thrombosis was also reported, but that was in a patient using cocaine and synthetic marijuana together. A case of lower limb thromboembolism and synthetic marijuana use has not been reported to date. Intoxication, material impurity, blood vessel reactivity, and chemical interaction with other drugs have been proposed as possible mechanisms of these events.
Source: Journal of Vascular Surgery - October 21, 2019 Category: Surgery Authors: Asaf Rabin Source Type: research

A critical note on protamine use in carotid endarterectomy
Two recent meta-analyses investigated the risks and benefits of heparin reversal by protamine after carotid endarterectomy (CEA).1,2 They found that heparin reversal with protamine reduces the risk for reoperation due to bleeding without an increased risk of stroke, myocardial infarction, or death. Yet, we would like to address the hemostatic and hemodynamic effects of protamine.
Source: Journal of Vascular Surgery - August 22, 2017 Category: Surgery Authors: Michael I. Meesters, Christa Boer Tags: Letter to the Editor Source Type: research

PC164 Fast-Track Thrombolysis for Acute Lower Extremity In-Stent Occlusions: A Novel Approach to Minimize Complications of Standard Thrombolytic Therapy
The role of catheter-directed thrombolysis (CDT) in the treatment of acute lower extremity ischemia may require prolonged periods of time to achieve successful lysis. Prolonged thrombolysis infusion has demonstrated increased incidence of intracranial bleeding, stroke, and local complications. It is expensive and increases hospital length of stay. To minimize these potentially negative outcomes, we developed a fast track approach (FTA) that included the use of aggressive balloon angioplasty and stenting before the thrombus was completely lysed.
Source: Journal of Vascular Surgery - May 17, 2017 Category: Surgery Authors: Syed Ali Rizvi, Anil Hingorani, Enrico Ascher, Natalie Marks Tags: C10: Poster Competition Source Type: research

Systematic Review and Meta-Analysis of Dual Versus Single Antiplatelet Therapy in Carotid Interventions
Dual antiplatelet therapy demonstrates advantages over single therapy only in patients treated with a carotid artery stent as determined by a decrease risk of transient ischemia attack. Dual therapy was associated with an increased risk of major bleeding, neck hematoma and MI in those undergoing carotid endarterectomy with no benefit regarding protection from transient ischemic attack (TIA)/stroke/mortality.
Source: Journal of Vascular Surgery - February 22, 2017 Category: Surgery Authors: M. Barkat, S. Hajibandeh, S. Hajibandeh, F. Torella, G.A. Antoniou Tags: Abstract Source Type: research

Prevention of Stroke With Ticagrelor in Patients With Prior Myocardial Infarction: Insights from PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction)
In patients with prior myocardial infarction, ticagrelor 60  mg twice daily reduces risk of stroke without an excess of hemorrhagic stroke but with more major bleeding.
Source: Journal of Vascular Surgery - December 20, 2016 Category: Surgery Authors: M.P. Bonaca, S. Goto, D.L. Bhatt Tags: Abstract Source Type: research

Protamine Reduces Bleeding Complications without Increasing the Risk of Stroke after Carotid Endarterectomy: A Meta-analysis
The aim was to evaluate the safety and efficacy of heparin reversal with protamine after completion of carotid endarterectomy (CEA), summarising the available data from both randomised and non-randomised studies.
Source: Journal of Vascular Surgery - September 22, 2016 Category: Surgery Authors: J.D. Kakisis, C.N. Antonopoulos, K.G. Moulakakis, F. Schneider, G. Geroulakos, J.B. Ricco Tags: Selected abstract from the September issue of the European Journal of Vascular and Endovascular Surgery Source Type: research

Drain Placement Confers No Benefit Following Carotid Endarterectomy in the Vascular Quality Initiative
Whereas bleeding complications requiring a return to the operating room (OR) after carotid endarterectomy (CEA) are infrequent (1%), they are associated with increased 30-day combined postoperative stroke/death rate. Drain placement (DR) after CEA varies among vascular surgeons, and there are limited data to support the practice. The goal of this study was to evaluate factors leading to DR and the effect of DR on postoperative outcomes including return to OR for bleeding, stroke, and death.
Source: Journal of Vascular Surgery - August 23, 2016 Category: Surgery Authors: Christopher J. Smolock, Jeanwan Kang, James F. Bena, Nayara Cioffi Batagini, Rebecca Kelso, Daniel Clair Tags: Abstract from the 2016 Eastern Vascular Society Annual Meeting Source Type: research

Use of Protamine for Anticoagulation During Carotid Endarterectomy: A Meta-Analysis
Use of protamine following carotid endarterectomy (CEA) is associated with a reduction in bleeding complications without increasing major thrombotic outcomes of stroke, myocardial infarction or death.
Source: Journal of Vascular Surgery - May 23, 2016 Category: Surgery Authors: K.A. Newhall, E.C. Saunders, R.J. Larson Tags: Abstract Source Type: research

Invited commentary
The key findings were that adding clopidogrel to regular aspirin therapy ≤48 hours of carotid endarterectomy (CEA) was associated with significant reductions in postoperative stroke, at the expense of increased bleeding complications.1 The latter will, inevitably, reinforce certain prejudices regarding dual-antiplatelet therapy (DAPT), even though the rate of bleeding complications was only 1.2% (DAPT) vs 0.7% (monotherapy). However, before uncritically disregarding any role for DAPT, it is worth considering why this debate is so important.
Source: Journal of Vascular Surgery - April 21, 2016 Category: Surgery Authors: A. Ross Naylor Tags: Clinical research study Source Type: research

Dual antiplatelet therapy reduces stroke but increases bleeding at the time of carotid endarterectomy
This study examined the effect of preoperative dual antiplatelet therapy (aspirin and clopidogrel) on in-hospital CEA outcomes.
Source: Journal of Vascular Surgery - February 28, 2016 Category: Surgery Authors: Douglas W. Jones, Philip P. Goodney, Mark F. Conrad, Brian W. Nolan, Eva M. Rzucidlo, Richard J. Powell, Jack L. Cronenwett, David H. Stone Tags: Clinical paper Source Type: research

Dual antiplatelet therapy (clopidogrel and aspirin) is associated with increased all-cause mortality after carotid revascularization for asymptomatic carotid disease
Conclusions: In this retrospective, single-institution study, the use of dual antiplatelet therapy (aspirin plus clopidogrel) in patients intervened for asymptomatic carotid disease was related to increased all-cause mortality, whereas it did not significantly influence the outcome in patients with symptomatic carotid disease.
Source: Journal of Vascular Surgery - February 3, 2014 Category: Surgery Authors: Francisco Alcocer, Zdenek Novak, Bart R. Combs, Bruce Lowman, Marc A. Passman, Marjan Mujib, William D. Jordan Tags: Clinical research studies Source Type: research

Pages: 1  2