Management of Bleeding Disorders in the Neurosurgical Patient

2019 ◽  
pp. 103-122
Author(s):  
Vedavyas Gannamani ◽  
Sanaa Rizk
Keyword(s):  
Postoperative Bleeding ◽  
Perioperative Period ◽  
Antiplatelet Agents ◽  
Bleeding Disorders ◽  
Related Risk ◽  
Perioperative Bleeding ◽  
Neurosurgical Patient ◽  
Risk Patients ◽  
Major Factors ◽  
Nonsurgical Patients

Postoperative patients are carefully monitored for bleeding due to its potential to result in dire situations, including death. Patients undergoing neurological surgeries are at heightened risk of morbidity and mortality from postsurgical bleeding due to compact neuroanatomical spaces and flow-sensitive organs. Hospitalists are regularly involved in the management of neurosurgery patients for preoperative risk assessment and medical co-management and must therefore have a good understanding of the predisposing factors that identify at-risk patients to avoid or minimize postoperative bleeding. The major factors to consider while assessing the risk of postoperative bleeding can be broadly divided into surgical and patient-related (nonsurgical). Patients on antiplatelet or anticoagulant agents pose a special management challenge in the perioperative period because interruption of these medications can increase the risk of cardiovascular or thromboembolic events postoperatively. This chapter outlines the general principles of perioperative management of bleeding disorders and postsurgical bleeding in neurosurgery patients admitted for elective or emergent surgeries. Management of patients primarily admitted for intracranial hemorrhage, spinal cord hematoma, or trauma will be discussed separately. This chapter also discusses interventions and therapies to reduce chances of perioperative bleeding in those with patient-related risk factors and reviews current practice guidelines on perioperative adjustment of anticoagulant or antiplatelet agents in patients undergoing neurosurgery.

scholarly journals The Impact of the Menstrual Cycle on Perioperative Bleeding in Vitreoretinal Surgery

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Zhong Lin ◽  
Nived Moonasar ◽  
Rong Han Wu ◽  
Robin R. Seemongal-Dass
Keyword(s):  
Menstrual Cycle ◽  
Postoperative Bleeding ◽  
Vitreoretinal Surgery ◽  
Vitreous Hemorrhage ◽  
Antiplatelet Agents ◽  
Vitreous Opacity ◽  
Perioperative Bleeding ◽  
Phase Group ◽  
History Of ◽  
The Impact

Purpose.To investigate the effect of menstrual cycle on perioperative bleeding of primary vitreoretinal surgery.Methods.Data on female patients who had vitrectomy surgery was retrospectively collected. Exclusion criteria were history of trauma, vitreous hemorrhage, previous vitreoretinal surgery, diabetic retinopathy, endophthalmitis, acute retinal necrosis, single vitreous opacity, and use of antiplatelet agents. Perioperative bleeding was defined as hemorrhage in the iris, vitreous, choroidal, retina, or subretina during surgery or up to one day postoperatively. 69 patients had surgery during the perimenstrual phase (group M, days 1–7 and days 21–28) and 86 during periovulatory phase (group O, days 8–20) were enrolled.Results.The proportion of operative bleeding in group M (14.5%) and group O (10.5%) was not found to be significantly different (p=0.45). No postoperative bleeding was recorded in both groups. The univariate odds ratio (OR) and 95% confidence interval (CI) of perimenstrual phase for operative bleeding were 0.69 (0.26–1.81). After adjusting for patients’ age, vitreoretinal diseases, and surgeons, the multivariate OR and 95% CI were 0.71 (0.27–1.86).Conclusion.This study suggests that the timing of the menstrual period does not affect perioperative bleeding for primary vitreoretinal surgery. Menstruation appears not to be a contraindication for vitreoretinal surgery.

Transfusion-related Acute Lung Injury in the Perioperative Patient

2019 ◽  
Vol 131 (3) ◽  
pp. 693-715
Author(s):  
Mark J. McVey ◽  
Rick Kapur ◽  
Christine Cserti-Gazdewich ◽  
John W. Semple ◽  
Keyvan Karkouti ◽  
...  
Keyword(s):  
At Risk ◽  
Acute Lung Injury ◽  
Lung Injury ◽  
Cause Of Death ◽  
Perioperative Period ◽  
Blood Products ◽  
Early Signs ◽  
Prevention And Treatment ◽  
Risk Patients ◽  
Nonsurgical Patients

Abstract Transfusion-related acute lung injury is a leading cause of death associated with the use of blood products. Transfusion-related acute lung injury is a diagnosis of exclusion which can be difficult to identify during surgery amid the various physiologic and pathophysiologic changes associated with the perioperative period. As anesthesiologists supervise delivery of a large portion of inpatient prescribed blood products, and since the incidence of transfusion-related acute lung injury in the perioperative patient is higher than in nonsurgical patients, anesthesiologists need to consider transfusion-related acute lung injury in the perioperative setting, identify at-risk patients, recognize early signs of transfusion-related acute lung injury, and have established strategies for its prevention and treatment.

scholarly journals Identification of RAGE and OSM as new prognosis biomarkers of severe pneumonia

2020 ◽  
Author(s):  
Li Wang ◽  
Yan Tan ◽  
Jiangnan Zhao ◽  
Lin Gao ◽  
Jing Lei ◽  
...  
Keyword(s):  
Risk Factors ◽  
Oxygenation Index ◽  
Severe Pneumonia ◽  
Final Analysis ◽  
Apache Ii Score ◽  
Reactive Protein ◽  
Related Risk ◽  
Diabetes Mellitus Status ◽  
Jinling Hospital ◽  
Risk Patients

Abstract BackgroundPatients with severe pneumonia complicated with hypoxic respiratory failure often associated with increased morbidity and mortality rates. It is critical to discover more sensitive and specific markers for early identification of such high risk patients thus specific and timely treatment can be adjusted.MethodsThis retrospective study was performed in the respiratory intensive care unit (RICU) of Nanjing First Hospital and Jinling Hospital, Nanjing Medical University. Clinical data of patients admitted to the RICU and diagnosed with pneumonia from January 2017 to October 2019 was retrospectively reviewed. The eligible patients were classified into hypoxemia and non hypoxemia groups according to oxygenation index of 250 mmHg. In the meantime, the same cohort was separated into survival and deceased groups after 30 days post hospital admission. The related risk factors in these two classifications were examined separately.ResultsA total of 828 patients were screened for eligibility, and eventually 130 patients with pneumonia were included in our final analysis. Among the patients, 16 passed away despite exhausting standard treatments. The comparison between hypoxemia and non hypoxemia groups suggested that gender, diabetes mellitus status, count of white blood cell(WBC), neutrophils, neutrophils/Lymphocyte, lactic acid, creatinine, D-dimer, procalcitonin (PCT), C-reactive protein (CRP), PH, Lymphocyte, albumin and RAGE were significantly different.ConclusionsPrevious studies have suggested that the APACHE II score, LIS, SOFA, Nutric scores, WBC, neutrophils, lymphocyte counts and albumin levels were independent risk factors for severe pneumonia. Our study indicated that RAGE should be a new biomarker to predict poor prognosis in pneumonia. In addition, we also showed that LIS, SOFA, lactate, lymphocyte, platelet, BUN, total bilirubin, and PCT levels before treatment were independent factors that associated with 30 days survival rate. In addition, we proposed that OSM should be considered as a new prognosis marker for pneumonia patients.

Abstract TMP23: Third International Stroke Trial (IST-3): Subgroup Effects of iv rt-PA < 6 hrs in Acute Ischaemic Stroke on Symptomatic Intracranial Haemorrhage and Outcome at 6 Months

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Richard I Lindley ◽  
Peter A Sandercock ◽  
Joanna M Wardlaw ◽  
Martin S Dennis ◽  
Goeff Cohen ◽  
...  
Keyword(s):  
Intracranial Haemorrhage ◽  
Absolute Risk ◽  
Randomised Trial ◽  
Recombinant Tissue Plasminogen Activator ◽  
Antiplatelet Agents ◽  
Postal Questionnaire ◽  
Positive Interaction ◽  
Significant Treatment ◽  
Predicted Probability ◽  
Related Risk

Aim: In IST-3 patients, our aim was to assess whether effects of iv thrombolysis with recombinant tissue plasminogen activator (rt-PA) on symptomatic intracranial haemorrhage (SICH) within 7 days & Oxford Handicap Score (OHS) at 6 months were modified by baseline characteristics. Methods: Randomised trial of iv rt-PA (0.9mg/kg) (n=1515) versus control (n=1520). SICH within 7 days was identified by blinded central review by an expert panel. Functional status was assessed by the OHS at six months by postal questionnaire or blinded telephone interview. OHS was analysed by logistic ordinal regression, and all analyses were adjusted for key baseline prognostic factors (age, NIHSS, hours delay from onset to randomisation, and presence of visible ischaemia on the baseline scan). The trial is registered: ISRCTN25765518 . Results: Fatal or non-fatal SICH within 7 days occurred in 104 (7%) vs 16 (1%), adjusted OR 6·96 (95% CI 3·45-14·0). Among patients allocated rt-PA, the absolute risk of SICH was higher with increasing age, NIHSS, predicted probability of poor outcome, ischaemic change on baseline imaging, systolic or diastolic blood pressure, blood glucose and treatment with antiplatelet agents in the 48 hours before randomisation, but not with time delay to randomisation or presence of AF. However, there were no significant interactions of the adjusted effect of rt-PA on SICH with any of the measured baseline variables except the use of antiplatelet agents. Ordinal analysis of OHS at 6 months favoured rt-PA (adjusted common odds ratio 1·27,95% CI 1·10- 1·47 p=0·001). There were no significant treatment interactions except for a positive interaction with NIHSS (p=0.018). Conclusion: Of baseline factors associated with a higher risk of SICH among controls, only prior antiplatelet therapy significantly modified the treatment-related risk of SICH. None of the measured variables significantly modified the favourable shift in OHS score at six months with treatment, except for an unanticipated positive interaction, suggesting that benefit was greater in more severe strokes.

Preemptive analgesia for endoscopic sinus surgery: a retrospective study

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
D. Nakashima ◽  
E. Mori ◽  
T. Takeda ◽  
Y. Hosokawa ◽  
S. Takaishi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Postoperative Pain ◽  
Endoscopic Sinus Surgery ◽  
Pain Control ◽  
Postoperative Bleeding ◽  
Perioperative Period ◽  
Preemptive Analgesia ◽  
Sinus Surgery ◽  
Common Disease ◽  
Postoperative Pain Control

Background: Chronic rhinosinusitis (CRS) is a common disease, and endoscopic sinus surgery (ESS) is widely performed. However, there is no consensus regarding postoperative pain control after ESS, and postoperative opioid abuse is a problem in many countries. Acetaminophen is reportedly effective for postoperative pain control. Preemptive analgesia has received more attention lately, wherein pain is prevented before it occurs. In this study, we assessed the use of acetaminophen for preemptive analgesia during the perioperative period in ESS. Methodology: This is a retrospective study of 175 patients who underwent ESS, septoplasty, and bilateral inferior turbinate mucosal resection at our hospital from April 2016 to February 2018. In total, 82 patients received 1,000 mg of acetaminophen during surgery and 4 hours after the first dose, while 93 patients did not receive it routinely. We compared these two groups. The primary outcome was the need to use additional analgesics prescribed by the ward physician and the secondary outcomes included postoperative pain, postoperative bleeding, reoperation, blood pressure, and body temperature. Results: The use of additional oral and intravenous analgesics was significantly reduced in the patients who received acetaminophen perioperatively. Conclusion: Preemptive analgesia during the perioperative period of ESS could lead to satisfactory postoperative pain control.

scholarly journals In-hospital and mid-term outcomes in patients reoperated on due to bleeding following coronary artery surgery (from the KROK Registry)

2019 ◽  
Vol 29 (2) ◽  
pp. 237-243 ◽  
Author(s):  
Piotr Knapik ◽  
Małgorzata Knapik ◽  
Michał O Zembala ◽  
Piotr Przybyłowski ◽  
Paweł Nadziakiewicz ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Postoperative Complications ◽  
Hospital Mortality ◽  
Hospital Discharge ◽  
Postoperative Bleeding ◽  
Low Risk ◽  
Coronary Surgery ◽  
Coronary Artery Surgery ◽  
Starting Point ◽  
Risk Patients

Abstract OBJECTIVES Surgical re-exploration due to postoperative bleeding that follows coronary artery surgery is associated with significant morbidity and mortality. The aim of this study was to assess a relationship between re-exploration, major postoperative complications, in-hospital mortality and mid-term outcomes in patients following coronary surgery, on the basis of nationwide registry data. METHODS We identified all consecutive patients enrolled in Polish National Registry of Cardiac Surgical Procedures (KROK Registry) who underwent isolated coronary surgery between January 2012 and December 2014. Preoperative data, major postoperative complications, hospital mortality and mid-term all-cause mortality were, respectively, analysed. Comparisons were performed in all patients, low-risk patients (EuroSCORE II < 2%, males, aged 60–70 years) and propensity-matched patients. The starting point for follow-up was the date of hospital discharge. RESULTS Among 41 353 analysed patients, 1406 (3.4%) underwent re-exploration. Reoperated patients had more comorbidities, more frequent major postoperative complications, higher in-hospital mortality (13.2% vs 1.8%, P < 0.001) and higher mid-term mortality in survivors (P < 0.001). In the low-risk population, 3.0% of patients underwent re-exploration. Reoperated low-risk patients and propensity-matched patients also had more frequent major postoperative complications and higher in-hospital mortality, but mid-term mortality in survivors was similar. In a multivariable analysis, re-exploration was an independent predictor of death and all major postoperative complications. CONCLUSIONS Surgical re-exploration due to postoperative bleeding following coronary artery surgery carries a high risk of perioperative mortality and is linked to major postoperative complications. Among patients who survive to hospital discharge, mid-term mortality is associated primarily with preoperative comorbidities.

Thrombotic Complications in Gliomas

2019 ◽  
Vol 45 (04) ◽  
pp. 326-333
Author(s):  
Alexandra L. Czap ◽  
Ashley Becker ◽  
Patrick Y. Wen
Keyword(s):  
Perceived Risk ◽  
Perioperative Period ◽  
High Grade Glioma ◽  
Term Treatment ◽  
Long Term Treatment ◽  
High Incidence ◽  
Risk Patients ◽  
Thrombotic Complications ◽  
Recurrent Nature

AbstractArterial and venous thromboses are common in glioma patients, both in the perioperative period and throughout the course of the disease. High-grade glioma patients harbor underlying hypercoagulability, which predisposes these high-risk patients with prolonged immobility and neurologic deficits to thrombotic events. Despite the high incidence and recurrent nature of these complications, there is no standardized approach to the management of glioma patients, and many challenges remain. Historically, the perceived risk of intracranial and intratumoral hemorrhage limited the use of anticoagulation, favoring nonpharmacological prophylaxis and treatment. Multiple studies have demonstrated the safety and efficacy of anticoagulation when indicated, with low molecular weight heparin as the preferred short- or long-term treatment. This review will discuss the epidemiology, risk factors, and therapeutic management of both venous and arterial thrombotic complications in glioma.

scholarly journals Current Advances in the Diagnostic Imaging of Atherosclerosis: Insights into the Pathophysiology of Vulnerable Plaque

2020 ◽  
Vol 21 (8) ◽  
pp. 2992
Author(s):  
Nataliya V. Mushenkova ◽  
Volha I. Summerhill ◽  
Dongwei Zhang ◽  
Elena B. Romanenko ◽  
Andrey V. Grechko ◽  
...  
Keyword(s):  
High Risk ◽  
Vulnerable Plaque ◽  
Plaque Rupture ◽  
Inflammatory Disorder ◽  
Arterial Tree ◽  
Non Invasive ◽  
Vulnerable Plaques ◽  
Risk Patients ◽  
Coronary Syndromes ◽  
Major Factors

Atherosclerosis is a lipoprotein-driven inflammatory disorder leading to a plaque formation at specific sites of the arterial tree. After decades of slow progression, atherosclerotic plaque rupture and formation of thrombi are the major factors responsible for the development of acute coronary syndromes (ACSs). In this regard, the detection of high-risk (vulnerable) plaques is an ultimate goal in the management of atherosclerosis and cardiovascular diseases (CVDs). Vulnerable plaques have specific morphological features that make their detection possible, hence allowing for identification of high-risk patients and the tailoring of therapy. Plaque ruptures predominantly occur amongst lesions characterized as thin-cap fibroatheromas (TCFA). Plaques without a rupture, such as plaque erosions, are also thrombi-forming lesions on the most frequent pathological intimal thickening or fibroatheromas. Many attempts to comprehensively identify vulnerable plaque constituents with different invasive and non-invasive imaging technologies have been made. In this review, advantages and limitations of invasive and non-invasive imaging modalities currently available for the identification of plaque components and morphologic features associated with plaque vulnerability, as well as their clinical diagnostic and prognostic value, were discussed.

PERIOPERACINIS MIOKARDO INFARKTAS

2013 ◽  
Vol 23 (6) ◽  
pp. 29-34
Author(s):  
Andrius Macas ◽  
Giedrė Bakšytė ◽  
Laura Šilinskytė ◽  
Jūratė Petrauskaitė
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Oxygen Supply ◽  
Plaque Rupture ◽  
Perioperative Period ◽  
Vascular Complication ◽  
Early Postoperative Period ◽  
Hospital Length Of Stay ◽  
Perioperative Myocardial Infarction ◽  
Risk Patients

Perioperative myocardial infarction (PMI) is defined as myocardial infarction (MI) during perioperative period (24-72 hours after non cardiac surgery). Worldwide, over 200 million adults have major non-cardiac surgery each year, and several million experience a major vascular complication (e.g.: nonfatal myocardial infarction). The prevalence of PMI for low risk patients without ischemic heart disease is from 0.3 to 3%, while for medium and high risk patients with coronary artery disease increases to 30%. It is believed that plaque rupture and myocardial oxygen supply-demand imbalance is the main reason of perioperative myocardial infarction. Mostly oxygen supply-demand imbalance predominates in the early postoperative period. Plaque rupture appears to be a more random event, distributed over the entire perioperative admission. Most patients with a perioperative MI do not experience ischemic symptoms, because of sedation and analgesia during surgery procedure. This is the reason why routine monitoring of troponin levels and electrocardiography in at-risk patients are needed after surgery to detect most MI. In 90% of cases troponin level inceases during the first 24 hours after surgery. Risk factors detection, serial troponin evaluation and specialised treatment can reduce hospital length of stay, treatment costs and PMI mortality.

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