PHARMACOLOGIC PROPHYLAXIS OF POST-ERCP PANCREATITIS: IS ALLOPURINOL THE ANSWER?

2008 ◽  
Vol 9 (4) ◽  
pp. 73-74
Author(s):  
Stuart Sherman
Keyword(s):  
Pharmacologic Prophylaxis

Transient Ischemic Attack in a Hemophilia Patient with Severe Preeclampsia after Preoperative Administration of Tranexamic Acid and Factor VIII Replacement for Cesarean Section

2021 ◽  
Vol 9 (2) ◽  
Author(s):  
D’Onofrio JD ◽  
◽  
Hoffman CR ◽  
Goldberg SF ◽  
◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Transient Ischemic Attack ◽  
Hemophilia A ◽  
Coagulation Factors ◽  
Background Information ◽  
Preoperative Administration ◽  
Increased Risk ◽  
Pharmacologic Prophylaxis ◽  
Ischemic Attack ◽  
Von Willebrand

Hemophilia A in females accounts for few cases due to hemophilia A and B having X-linked recessive inheritance patterns. Hemostatic changes in pregnancy include an increase in coagulation factors and von Willebrand activity, placing hemophilia patients at an increased risk for Postpartum Hemorrhage (PPH). General recommendations include considering pharmacologic prophylaxis, including tranexamic acid and factor replacement when necessary. The ultimate goal is to prevent uncontrolled bleeding during vaginal or operative delivery. Benefits of prophylactic therapies must be weighed with relevant risk profiles of each intervention. We present a case where a parturient with hemophilia prophylactically treated with TXA and FVIII experienced a transient ischemic attack. We discuss the background information known regarding tranexamic acid and factor replacement, and the subsequent recommendations for their use in this patient population. We consider recommendations to expand the multidisciplinary team incorporated in the assessment and planning for the peripartum care of such a patient.

Heparin-Induced Thrombocytopenia during Obstetric Hospital Admissions

2018 ◽  
Vol 35 (09) ◽  
pp. 898-903 ◽  
Author(s):  
Deepika Sagaram ◽  
Zainab Siddiq ◽  
Andrew Eisenberger ◽  
Cande Ananth ◽  
Jason Wright ◽  
...  
Keyword(s):  
Heart Failure ◽  
Arterial Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Hospital Admissions ◽  
The United States ◽  
Limb Amputation ◽  
Administrative Database ◽  
Low Molecular Weight ◽  
Heparin Induced Thrombocytopenia ◽  
Pharmacologic Prophylaxis

Introduction The rate of heparin-induced thrombocytopenia (HIT) on a population basis is unknown. The objective of this study was to characterize the risk for HIT during antepartum, delivery, and postpartum hospitalizations in the United States. Materials and Methods A large administrative database was used to determine the risk of HIT in hospitalized obstetric patients who received unfractionated heparin (UFH) or low molecular weight heparin (LMWH). Patients were presumed to have HIT if they were exposed to UFH or LMWH, received a diagnosis of HIT, and were administered a medication for the treatment of HIT including bivalirudin, argatroban, fondaparinux, or lepirudin. We queried severe complications of HIT including arterial thrombosis, limb amputation, heart failure, and death. Results We identified 66,468 antepartum hospitalizations, 66,741 delivery hospitalizations, and 16,325 postpartum readmissions where women received pharmacologic prophylaxis. Of these, 10 antepartum admissions, 1 delivery admission, and 14 postpartum readmissions involved a diagnosis of HIT with treatment of bivalirudin, argatroban, fondaparinux, or lepirudin. There were no deaths and no diagnoses of arterial thrombosis, limb amputation, heart failure, and death. Conclusion Risk for HIT among hospitalized obstetric patients is low. In this cohort, no cases of death or severe complications were noted in relation to the diagnosis.

Sequential Compression Device Adherence is Low in Hospitalized Antepartum Patients

2020 ◽  
Author(s):  
Kelly S. Yamasato ◽  
Nicole B. Kurata ◽  
Sara C. Harris ◽  
Marguerite L. Bartholomew
Keyword(s):  
Study Design ◽  
Patient Survey ◽  
Chi Square ◽  
Compression Device ◽  
Monitoring Technique ◽  
Key Points ◽  
Before And After ◽  
Adherence Data ◽  
Pharmacologic Prophylaxis ◽  
Series Compliance

Objective This study was aimed to describe sequential compression device (SCD) adherence and its associations with SCD education in hospitalized antepartum women. Study Design This study included antepartum, nonlaboring women admitted from 2016 to 2018, 1 year before and after an SCD education intervention. SCD use was assessed through the Kendall SCD 700 series compliance meter, which tracks the time the SCD machine takes within the monitoring interval. Recruitment occurred after 60 to 80 hours of monitoring, at which time a patient survey was completed. SCD use was the percentage of time the machine was on during monitoring. Mann–Whitney U and Chi-square tests were used to compare associations between SCD use, education, and pharmacologic prophylaxis. Results Among 125 recruited women, 123 provided adherence data, 69 before and 54 after the education. Median SCD use was 17.3% before and 20.7% after (p = 0.71). Pharmacologic prophylaxis use was similar between the two periods and was not associated with SCD use. Among 121 surveys, the most common reason as to why SCDs were not worn was prevention of walking (52/121 [43.0%]). Conclusion Using a novel monitoring technique, we found low-SCD use among antepartum inpatients, which was neither affected by education nor concurrent pharmacologic prophylaxis. Improving mobility with SCDs may improve use in this population. Key Points

scholarly journals Efficacy of pre-operative pharmacologic thromboprophylaxis on incidence of venous thromboembolism following major gynecologic and gynecologic oncology surgery: a systematic review and meta-analysis

2020 ◽  
pp. ijgc-2020-001991
Author(s):  
Steven Bisch ◽  
Rachelle Findley ◽  
Christina Ince ◽  
Maria Nardell ◽  
Gregg Nelson
Keyword(s):  
Systematic Review ◽  
Venous Thromboembolism ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Gynecologic Oncology ◽  
Quality Data ◽  
Gynecologic Surgery ◽  
Cochrane Central Register ◽  
Pharmacologic Prophylaxis ◽  
Pharmacologic Thromboprophylaxis

IntroductionVenous thromboembolism remains a significant complication following major gynecologic surgery. Evidence is lacking on whether it is beneficial to give pharmacologic thromboprophylaxis pre-operatively. The aim of this meta-analysis was to assess the role of pre-operative pharmacologic thromboprophylaxis in preventing post-operative venous thromboembolism.MethodsPubMed, EMBASE, and the Cochrane Central Register of Clinical Trials were searched to find randomized controlled, cohort, and case–control trials comparing pre-operative pharmacologic thromboprophylaxis to no prophylaxis, mechanical prophylaxis, or only post-operative pharmacologic thromboprophylaxis for open and minimally invasive major gynecologic surgery (benign and malignant conditions). Two authors independently assessed abstracts, full-text articles, and methodological quality. Data were extracted and pooled using ORs for random effects meta-analysis. Heterogeneity was explored using forest plots, Q-statistic, and I2 statistics. Planned subgroup analysis of use of sequential compression devices, equivalent versus non-equivalent post-operative prophylaxis, cancer diagnosis, and methodological quality were performed.ResultsSome 503 unique studies were found, and 16 studies (28 806 patients) were included in the systematic review. Twelve studies (14 273 patients) were included in the meta-analysis. The OR for incidence of post-operative venous thromboembolism was 0.59 (95% CI 0.39, 0.89), favoring pre-operative pharmacologic thromboembolism prophylaxis compared with no pre-operative pharmacologic prophylaxis (Q=13.80, I2=20.30). In studies where post-operative care was equivalent between groups, the OR for venous thromboembolism was 0.56 (95% CI 0.22, 1.40). Pre-operative pharmacologic prophylaxis demonstrated greatest benefit when utilized with both intra-operative and post-operative sequential compression devices (OR 0.43, 95% CI 0.30, 0.64) compared with when no sequential compression devices were utilized (OR 1.27, 95% CI 0.63, 2.56). When looking at only studies determined to be of high quality, the results no longer reached significance (OR 0.73, 95% CI 0.36, 1.46).ConclusionsPre-operative pharmacologic thromboprophylaxis decreases the odds of venous thromboembolism in the peri-operative period for major gynecologic oncology surgery by approximately 40%. It remains unclear whether this benefit is present in benign and minor procedures. Adequately powered studies are needed.

Pharmacologic Prophylaxis of Contrast-Induced Nephropathy

2020 ◽  
Vol 9 (3) ◽  
pp. 369-383
Author(s):  
Anna Toso ◽  
Mario Leoncini ◽  
Mauro Maioli ◽  
Francesco Bellandi
Keyword(s):  
Contrast Induced Nephropathy ◽  
Pharmacologic Prophylaxis

scholarly journals Does preoperative pharmacologic prophylaxis reduce the rate of venous thromboembolism in pancreatectomy patients?

HPB ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. 1020-1024
Author(s):  
Zhi V. Fong ◽  
Naomi M. Sell ◽  
Carlos Fernandez-del Castillo ◽  
Gabriel del Carmen ◽  
Cristina R. Ferrone ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Pharmacologic Prophylaxis

scholarly journals The syndrome of hepatic veno-occlusive disease after marrow transplantation

Blood ◽  
1995 ◽  
Vol 85 (11) ◽  
pp. 3005-3020 ◽  
Author(s):  
SI Bearman
Keyword(s):  
Serum Bilirubin ◽  
Recombinant Tissue Plasminogen Activator ◽  
Clinical Syndrome ◽  
Therapeutic Drug ◽  
High Dose ◽  
Cellular Mechanisms ◽  
Tissue Plasminogen ◽  
Pharmacologic Prophylaxis ◽  
Supportive Management ◽  
To Receive

The clinical syndrome of VOD is a frequent cause of nonrelapse mortality among patients receiving high-dose cytoreductive regimens. Patients likely to develop VOD have existing liver dysfunction, evidence of infection before conditioning, tend to receive more intensive preparative regimens, and often receive marrow from alternative donors. Therapeutic drug monitoring of busulfan and pharmacokinetic dose adjustments appear to be useful in reducing the incidence of VOD in patients receiving this agent. Data are contradictory as regards whether pharmacologic prophylaxis is effective. Patients who will develop severe VOD are characterized by a rapid increase in serum bilirubin as well as weight. Supportive management of these patients should attempt to preserve respiratory as well as renal function, sometimes a very difficult task. Treatment with recombinant tissue plasminogen activator has promise. However, given its potential for toxicity, a prospective randomized trial should be performed. Hopefully, as more data regarding the molecular and cellular mechanisms of this illness are elucidated, more thoughtful prevention strategies will be developed. This will be necessary, particularly as newer, more intensive preparative regimens are being developed, as access to alternative donors increases, and as more diseases will be treated with this approach.

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