scholarly journals Regional anaesthesia in patients at risk of bleeding

BJA Education ◽  
2021 ◽  
Vol 21 (3) ◽  
pp. 84-94
Author(s):  
T. Ashken ◽  
S. West
TH Open ◽  
2021 ◽  
Vol 05 (01) ◽  
pp. e84-e88
Author(s):  
Krishnan Shyamkumar ◽  
Jack Hirsh ◽  
Vinai C. Bhagirath ◽  
Jeffrey S. Ginsberg ◽  
John W. Eikelboom ◽  
...  

Abstract Introduction Dose adjustment based on laboratory monitoring is not routinely recommended for patients treated with rivaroxaban but because an association has been reported between high drug level and bleeding, it would be of interest to know if measuring drug level once could identify patients at risk of bleeding who might benefit from a dose reduction. Objective This study was aimed to investigate the reliability of a single measurement of rivaroxaban level to identify clinic patients with persistently high levels, defined as levels that remained in the upper quintile of drug-level distribution. Methods In this prospective cohort study of 100 patients with atrial fibrillation or venous thromboembolism, peak and trough rivaroxaban levels were measured using the STA-Liquid Anti-Xa assay at baseline and after 2 months. Values of 395.8 and 60.2 ng/mL corresponded to the 80th percentile for peak and trough levels, respectively, and levels above these cut-offs were categorized as high for our analyses. Results Among patients with a peak or trough level in the upper quintile at baseline, only 26.7% (95% confidence interval [CI]: 10.9–52.0%), and 13.3% (95% CI: 2.4–37.9%), respectively, remained above these thresholds. Conclusion Our findings do not support the use of a single rivaroxaban level measurement to identify patients who would benefit from a dose reduction because such an approach is unable to reliably identify patients with high levels.


PLoS ONE ◽  
2014 ◽  
Vol 9 (5) ◽  
pp. e97187 ◽  
Author(s):  
Bruno Guéry ◽  
Corinne Alberti ◽  
Aude Servais ◽  
Elarbi Harrami ◽  
Lynda Bererhi ◽  
...  

2010 ◽  
Vol 28 (15_suppl) ◽  
pp. TPS291-TPS291
Author(s):  
E. M. Bertino ◽  
G. A. Otterson ◽  
M. A. Villalona-Calero ◽  
S. P. Nana-Sinkam ◽  
A. M. Ghany ◽  
...  

2017 ◽  
Vol 41 (4) ◽  
pp. 209-215 ◽  
Author(s):  
P. García-Soler ◽  
J.M. Camacho Alonso ◽  
J.M. González-Gómez ◽  
G. Milano-Manso

Injury ◽  
2006 ◽  
Vol 37 (2) ◽  
pp. 128-133 ◽  
Author(s):  
E.T. Davis ◽  
A. Harris ◽  
D. Keene ◽  
K. Porter ◽  
M. Manji

1995 ◽  
Vol 29 (12) ◽  
pp. 1228-1232 ◽  
Author(s):  
Colleen C Harrell ◽  
Sandra S Kline

Objective: To report 6 patients taking oral vitamin K1 (phytonadione) to reduce warfarin's activity. Case Summary: Six patient cases are summarized in which oral vitamin K1 was used to reduce the international normalized ratio (INR) in patients at risk of bleeding. Discussion: The use of oral vitamin K1 to antagonize warfarin's effects is discussed, as well as the benefits of oral vitamin K1 administration and the disadvantages of parenteral vitamin K1 administration. In addition, an extensive literature review of the discovery and clinical development of warfarin and vitamin K1 is described. Conclusions: In patients receiving warfarin therapy who have an increased INR and are at risk of bleeding, oral vitamin K1 therapy may be safer, less painful, and more cost-effective than the traditional parenteral route of administration.


2018 ◽  
Vol 53 (2) ◽  
pp. 186-194 ◽  
Author(s):  
Alexandra L. Bixby ◽  
Amy VandenBerg ◽  
Jolene R. Bostwick

Objective: This nonsystematic review describes risk of bleeding in treatment with serotonin reuptake inhibitors (SRIs) and provide recommendations for the management of patients at risk of bleeding. Data Sources: Articles were identified by English-language MEDLINE search published prior to June 2018 using the terms SRI, serotonin and noradrenaline reuptake inhibitors, OR antidepressive agents, AND hemorrhage OR stroke. Study Selection and Data Extraction: Meta-analyses were utilized to identify information regarding risk of bleeding with antidepressants. Individual studies were included if they had information regarding bleeding risk with specific SRIs, timing of risk, or risk with medications of interest. Data Synthesis: SRIs increase risk of bleeding by 1.16- to 2.36-fold. The risk is synergistic between SRIs and nonsteroidal anti-inflammatory drugs (NSAIDs; odds ratio [OR] range between studies 3.17-10.9). Acid-reducing medications may mitigate risk of gastrointestinal bleeds in chronic NSAIDs and SRI users (OR range between studies 0.98-1.1). Antidepressants with low or no affinity for the serotonin transporter, such as bupropion or mirtazapine, may be appropriate alternatives for patients at risk of bleeding. Relevance to Patient Care and Clinical Practice: This review includes data regarding bleeding risk for specific antidepressants, concomitant medications, and risk related to duration of SRI use. Considerations and evidence-based recommendations are provided for management of SRI users at high bleeding risk. Conclusions: Clinicians must be aware of the risk of bleeding with SRI use, especially for patients taking NSAIDs. Patient education is prudent for those prescribed NSAIDs and SRIs concurrently.


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