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Ischemic Stroke Management: Posthospitalization and Transition of Care
Am Fam Physician. 2023 Jul;108(1):70-77.ABSTRACTIschemic stroke is a major cause of morbidity and mortality worldwide. Ischemic stroke and transient ischemic attack exist on a continuum of the same disease process. Ischemic stroke is common, and more than 85% of stroke risk is attributed to modifiable risk factors. The initial management of acute stroke is usually performed in the emergency department and hospital settings. Family physicians have a key role in follow-up, ensuring that a complete diagnostic evaluation has been performed, addressing modifiable risk factors, facilitating rehabilitation, and managing chronic s...
Source: Pain Physician - July 13, 2023 Category: Anesthesiology Authors: Scott T Larson Brigit E Ray Jason Wilbur Source Type: research

Neurosurgical intervention in children with ventricular assist devices: A single center case series review
CONCLUSIONS: Perioperative concerns for the anesthesiologist include VAD hemodynamic management, bleeding, VAD thrombosis, and prevention of secondary brain injury. A systematic, multidisciplinary approach to management is paramount to attain favorable outcomes.PMID:34478592 | DOI:10.1111/pan.14287
Source: Paediatric Anaesthesia - September 3, 2021 Category: Anesthesiology Authors: Jane Yu Jenna Murray Chandra Ramamoorthy Sharon Chen Sarah Lee Kathleen Ryan Katsuhide Maeda Manchula Navaratnam Source Type: research

Four-factor Prothrombin Complex Concentrate for the Management of Patients Receiving Direct Oral Activated Factor X Inhibitors
Direct oral anticoagulants (DOACs) have been approved for the prevention of stroke and systemic embolism in atrial fibrillation, treatment and secondary prevention of venous thromboembolism (VTE), and thromboprophylaxis after major orthopedic surgery. DOACs achieve anticoagulation by inhibiting specific coagulation factors; apixaban, betrixaban, edoxaban, and rivaroxaban inhibit activated factor X, whereas dabigatran inhibits thrombin (factor IIa). In contrast to vitamin K antagonists such as warfarin, DOACs have more predictable pharmacokinetics and pharmacodynamics and fewer interactions with other medications and food, ...
Source: Anesthesiology - October 15, 2019 Category: Anesthesiology Source Type: research

Perioperative Management of the Direct-Acting Oral Anticoagulants.
Abstract Since the 1950s, warfarin has been the most commonly prescribed anticoagulant in the prevention of stroke-related thromboembolism. Beginning in 2008, direct-acting oral anticoagulants (DOACs) began to replace warfarin. Although the DOACs had a greater safety profile, approved reversal agentsfor use in emergent/excessive hemorrhage did not exist. This course reviews the perioperative management of the DOACs. PMID: 31587718 [PubMed - in process]
Source: AANA Journal - July 31, 2019 Category: Anesthesiology Authors: Kane TD, Tubog TD Tags: AANA J Source Type: research

The Effect of Cardiopulmonary Bypass on Dabigatran Levels
DABIGATRAN IS a novel anticoagulant that is licensed for use for the prevention of stroke in the presence of atrial fibrillation. Its use has expanded rapidly in New Zealand, primarily due to there being no requirement for routine monitoring of its effect, as there is for warfarin. There are case reports in the literature describing management of patients coming for urgent cardiac surgery, which revolve mainly around the use of dialysis and massive transfusion of clotting factors to manage the bleeding associated with surgery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - December 31, 2015 Category: Anesthesiology Authors: Kelly Byrne Tags: CASE REPORT Source Type: research

Perioperative venous thromboembolic disease and the emerging role of the novel oral anticoagulants: An analysis of the implications for perioperative management.
Abstract Venous thromboembolism includes 2 inter-related conditions: Deep venous thrombosis and pulmonary embolism. Heparin and low-molecular-weight heparin followed by oral anticoagulation with vitamin K agonists is the first line and current accepted standard therapy with good efficacy. However, this therapeutic strategy has many limitations including the significant risk of bleeding and drug, food and disease interactions that require frequent monitoring. Dabigatran, rivaroxaban, apixaban, and edoxaban are the novel oral anticoagulants that are available for use in stroke prevention in atrial fibrillation and f...
Source: Annals of Cardiac Anaesthesia - October 1, 2015 Category: Anesthesiology Authors: Mookadam M, Shamoun FE, Ramakrishna H, Obeid H, Rife RL, Mookadam F Tags: Ann Card Anaesth Source Type: research

Case 4–2015
ATRIAL FIBRILLATION (AF) is the most common cardiac arrhythmia in the world and is estimated to affect more than 3 million people in the United States, with a projected increase to more than 5 million people in the US by the year 2050.1 AF is an independent risk factor for stroke and is associated with a four- to five-fold increased risk of embolic stroke compared with those individuals without AF. Oral anticoagulation therapy with warfarin or other agents (dabigatran, apixaban) significantly reduces the risk of stroke in this population; however, anticoagulation carries inherent risks.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 18, 2015 Category: Anesthesiology Authors: Megan J. Lanigan, Mark A. Chaney, Sandeep Nathan, Atman P. Shah, Andrew J. Feider Tags: Case Conference Source Type: research

Managing New Oral Anticoagulants in the Perioperative and Intensive Care Unit Setting
Managing patients in the perioperative setting receiving novel oral anticoagulation agents for thromboprophylaxis or stroke prevention with atrial fibrillation is an important consideration for clinicians. The novel oral anticoagulation agents include direct Factor Xa inhibitors rivaroxaban and apixaban, and the direct thrombin inhibitor dabigatran. In elective surgery, discontinuing their use is important, but renal function must also be considered because elimination is highly dependent on renal elimination. If bleeding occurs in patients who have received these agents, common principles of bleeding management as with an...
Source: Anesthesiology - April 23, 2013 Category: Anesthesiology Tags: Education: Review Article Source Type: research