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The Future of Aspirin Therapy in Cardiovascular Disease
Am J Cardiol. 2021 Apr 1;144 Suppl 1:S40-S47. doi: 10.1016/j.amjcard.2020.12.019.ABSTRACTMuch has been written about the demise of aspirin (ASA) but reports of its death are premature. The drug remains one of the most widely prescribed by physicians worldwide. It is cheap, familiar, and effective for a variety of uses, including in patients with acute or prior myocardial infarction, ischemic stroke, peripheral artery disease, and percutaneous or surgical revascularization procedures, as well as for use for pain and fever relief. Beyond physician prescription or recommendation, over the counter use of ASA is common, includi...
Source: Pain Physician - March 12, 2021 Category: Anesthesiology Authors: Deepak L Bhatt Charles V Pollack 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

Idarucizumab for dabigatran reversal in daily clinical practice: A case series
CONCLUSION Our first experiences with idarucizumab use in daily-care settings support a rapid and efficient decrease in the anticoagulant effect of dabigatran in emergency situations. Late re-occurrence of dabigatran effect was noted in a subset of patients with severe renal failure.
Source: European Journal of Anaesthesiology - September 12, 2020 Category: Anesthesiology Tags: Coagulation Source Type: research

Viable Hemostasis Obtained With Prothrombin Complex Concentrate in Patients Who Refuse Standard Allogeneic Blood Transfusion and Undergo Complex Cardiac Surgery: A Case Series
Human 4-factor prothrombin complex concentrate (4F-PCC) may reduce blood loss during surgery. This case series described perioperative outcomes among 9 patients who refused standard allogeneic blood transfusion, underwent complex cardiac surgery with aortic involvement, and received intraoperative 4F-PCC. Additional intraoperative cointerventions included protamine (n = 9), aminocaproic acid (n = 8), fibrinogen concentrate (n = 6), desmopressin (n = 6), factor VIIa (n = 2), and tranexamic acid (n = 1). Outcomes included postoperative death (n = 1), major postoperative bleeding (n = 1), deep vein thrombosis (n = 2), and isc...
Source: A&A Case Reports - July 1, 2020 Category: Anesthesiology Tags: Case Series Source Type: research

Diagnostic accuracy of physician-staffed emergency medical teams: a retrospective observational cohort study of prehospital versus hospital diagnosis in a 10-year interval.
CONCLUSIONS: The overall prehospital diagnostic accuracy of PEMTs improved between the year 2004 and 2014 respectively. Our findings suggest that the incidence of common diseases (ACS, dyspnea stroke/intracerebral bleeding, sepsis) increased over a 10-year period. Diagnostic accuracy of different diseases varied but generally decreased in the elderly patient. Regular training of EMS personnel and public campaigns should be implemented to improve the diagnostic accuracy in the future. PMID: 30940205 [PubMed - in process]
Source: Pain Physician - April 1, 2019 Category: Anesthesiology Authors: Schewe JC, Kappler J, Dovermann K, Graeff I, Ehrentraut SF, Heister U, Hoeft A, Weber SU, Muenster S Tags: Scand J Trauma Resusc Emerg Med 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

Anesthetic Management of a Patient With Ongoing Thrombolytic Therapy During Decompressive Craniectomy: A Case Report
We describe a case in which DC was performed on a 38-year-old man who received thrombolytic therapy for an ischemic stroke involving the middle cerebral artery. His neurological and hemodynamic status worsened during its administration, and DC was performed 6 hours after thrombolysis was performed. Fibrinolytic coagulopathy was successfully managed by monitoring fibrinogen levels and with the administration of cryoprecipitate and tranexamic acid.
Source: A&A Case Reports - December 1, 2018 Category: Anesthesiology Tags: Case Reports 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

Stroke volume variation and intraoperative bleeding during functional endoscopic sinus surgery.
Authors: Dauri M, Di Mauro R, Lucci F, Martino F, Silvi MB, Gidaro E, Di Lorenzo S, Toschi N, Di Girolamo S PMID: 30226345 [PubMed - as supplied by publisher]
Source: Minerva Anestesiologica - September 20, 2018 Category: Anesthesiology Tags: Minerva Anestesiol Source Type: research

Management of antiplatelet therapy in patients undergoing elective invasive procedures. Proposals from the French Working Group on perioperative haemostasis (GIHP) and the French Study Group on thrombosis and haemostasis (GFHT). In collaboration with the French Society for Anaesthesia and Intensive Care Medicine (SFAR)
Publication date: Available online 5 January 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Anne Godier, Pierre Fontana, Serge Motte, Annick Steib, Fanny Bonhomme, Sylvie Schlumberger, Thomas Lecompte, Nadia Rosencher, Sophie Susen, André Vincentelli, Yves Gruel, Pierre Albaladejo, Jean-Philippe Collet, P. Albaladejo, S. Belisle, N. Blais, F. Bonhomme, A. Borel-Derlon, J.Y. Borg, J.-L. BossonAbstractThe French Working Group on Perioperative Haemostasis (GIHP) and the French Study Group on Haemostasis and Thrombosis (GFHT) in collaboration with the French Society for Anaesthesia and Intensive Care Medicine...
Source: Anaesthesia, Critical Care and Pain Medicine - July 10, 2018 Category: Anesthesiology Source Type: research

Postoperative care of the adult cardiac surgical patient
Publication date: June 2018Source: Anaesthesia & Intensive Care Medicine, Volume 19, Issue 6Author(s): Patrick Markey, Palanikumar SaravananAbstractAdult cardiac surgical patients are managed by standardized protocols after surgery. For most of the patients this is an extended recovery period following elective major surgery, and communication is crucial in the management of early postoperative period. Some patients are critically ill before surgery and undergo complex and emergency cardiac procedures. These patients are more likely to experience complications such as bleeding, cardiac tamponade, arrhythmias, infection, st...
Source: Anaesthesia and intensive care medicine - July 10, 2018 Category: Anesthesiology Source Type: research

Management of antiplatelet therapy in patients undergoing elective invasive procedures. Proposals from the French Working Group on perioperative haemostasis (GIHP) and the French Study Group on thrombosis and haemostasis (GFHT). In collaboration with the French Society for Anaesthesia and Intensive Care Medicine (SFAR)
Publication date: Available online 5 January 2018Source: Anaesthesia Critical Care & Pain MedicineAuthor(s): Anne Godier, Pierre Fontana, Serge Motte, Annick Steib, Fanny Bonhomme, Sylvie Schlumberger, Thomas Lecompte, Nadia Rosencher, Sophie Susen, André Vincentelli, Yves Gruel, Pierre Albaladejo, Jean-Philippe Collet, P. Albaladejo, S. Belisle, N. Blais, F. Bonhomme, A. Borel-Derlon, J.Y. Borg, J.-L. BossonAbstractThe French Working Group on Perioperative Haemostasis (GIHP) and the French Study Group on Haemostasis and Thrombosis (GFHT) in collaboration with the French Society for Anaesthesia and Intensive Care Medicine...
Source: Anaesthesia, Critical Care and Pain Medicine - July 5, 2018 Category: Anesthesiology Source Type: research

Postoperative care of the adult cardiac surgical patient
Publication date: June 2018Source: Anaesthesia & Intensive Care Medicine, Volume 19, Issue 6Author(s): Patrick Markey, Palanikumar SaravananAbstractAdult cardiac surgical patients are managed by standardized protocols after surgery. For most of the patients this is an extended recovery period following elective major surgery, and communication is crucial in the management of early postoperative period. Some patients are critically ill before surgery and undergo complex and emergency cardiac procedures. These patients are more likely to experience complications such as bleeding, cardiac tamponade, arrhythmias, infection, st...
Source: Anaesthesia and intensive care medicine - July 5, 2018 Category: Anesthesiology Source Type: research

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