Tonsillectomy in the Anticoagulated Patient

2007 ◽  
Vol 116 (8) ◽  
pp. 589-593 ◽  
Author(s):  
Stephanie M. Cole ◽  
Matthew B. Patterson ◽  
Craig L. Cupp
Keyword(s):  
Case Report ◽  
High Risk ◽  
Perioperative Management ◽  
Postoperative Hemorrhage ◽  
Secondary Hemorrhage ◽  
Anticoagulated Patient ◽  
Bridging Strategy ◽  
Risk For Thrombosis ◽  
Anticoagulated Patients

Objectives: The objectives of this study were to review perioperative bridging strategies for anticoagulated patients and to describe a novel bridging strategy for tonsillectomy in an anticoagulated patient that addresses both primary and secondary hemorrhage risks. Methods: A literature review and a case report are presented. PubMed was reviewed for evidence-based recommendations on perioperative management of anticoagulated patients. A case report is detailed of a 28-year-old woman with antiphospholipid syndrome on warfarin for high risk of venous thrombosis who underwent tonsillectomy. A perioperative bridging strategy incorporating outpatient low–molecular weight heparin and inpatient unfractionated heparin was implemented to minimize risks of thrombosis and primary and secondary posttonsillectomy hemorrhage. Results: Limited evidence supports a consensus on the best perioperative management of anticoagulated patients. Tonsillectomy in an anticoagulated patient has not been described previously. The patient in this case underwent successful tonsillectomy with no thrombosis or bleeding after 1 month of follow-up. Conclusions: Tonsillectomy can be done relatively safely in an anticoagulated patient at high risk for thrombosis. The perioperative bridging strategy should account for its unique risk of primary and secondary postoperative hemorrhage. A proposed algorithm for managing these competing risks is presented.

scholarly journals Aggressive angiomyxoma of the perineal region

2019 ◽  
Vol 7 ◽  
pp. 2050313X1984339 ◽  
Author(s):  
Clémence Raptin ◽  
Jean-Philippe Lucot ◽  
Alfred Bassil ◽  
Edouard Poncelet ◽  
Jean-François Prolongeau ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
High Risk ◽  
Genital Prolapse ◽  
Aggressive Angiomyxoma ◽  
Rare Tumour ◽  
Long Term Follow Up ◽  
Perineal Region

Aggressive angiomyxoma is a rare tumour that frequently involves the perineal region with a high risk of local recurrence. This is a case report of a 24-year-old female patient with a genital prolapse. We performed a surgical treatment. Histological examination found an aggressive angiomyxoma. The tumour recurred 1 year after surgery. Long-term follow-up is necessary.

scholarly journals Digital Papillary Adenocarcinoma, a Rare Malignant Tumor

2019 ◽  
Vol 2 (1-3) ◽  
pp. 89-93
Author(s):  
Cláudia Vale ◽  
André Carvalho ◽  
Tiago Roseiro ◽  
João Antunes ◽  
Óscar Tellechea ◽  
...  
Keyword(s):  
Case Report ◽  
High Risk ◽  
Malignant Tumor ◽  
Slow Growth ◽  
Papillary Adenocarcinoma ◽  
Risk Of Recurrence ◽  
Left Thumb ◽  
Delayed Treatment

We present a case report of a digital papillary adenocarcinoma (DPA) on the left thumb with slow growth that was completely excised, without recurrence or metastasis during 24-month follow-up. DPA is a rare malignant tumor often located on the digits of the hand. Due to its slow growth and a non-specific appearance, the diagnosis is often missed or delayed. Treatment should be surgical with clear resection of the margins due to high risk of recurrence and/or metastasis.

scholarly journals Age-adjusted risk factors are independently associated with an increased risk of ischaemic stroke, transient ischaemic stroke and systemic embolism in the ETNA-AF-Europe registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R De Caterina ◽  
J.R De Groot ◽  
T.W Weiss ◽  
P Kelly ◽  
P Monteiro ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Ischaemic Stroke ◽  
Chi Square ◽  
Adjusted Risk ◽  
History Of ◽  
The Mean ◽  
Risk Predictors ◽  
Anticoagulated Patients

Abstract Background Oral anticoagulation is highly effective in preventing ischaemic stroke in patients with atrial fibrillation, but 1–2% of the patients suffer an ischaemic stroke upon anticoagulation. Outcomes are further influenced by various factors, and recent research has focussed on identifying risk factors that could be helpful in predicting stroke outcomes in anticoagulated patients. This could further assist clinicians in timely identification and management of high-risk patients. Purpose The present analysis aims to assess the age-adjusted risk predictors of ischaemic stroke and systemic embolic events (SEE) (including transient ischaemic attack [TIA]) during two-year follow-up of unselected European patients with AF in the ETNA-AF-Europe registry. Methods ETNA-AF-Europe is a prospective, multi-centre, post-authorisation, observational study conducted in 825 centres enrolling patients treated with edoxaban once daily in 10 European countries. Wald Chi square tested the association between risk predictors and stroke and SEE after adjusting for age, given that age is a well-known, strong predictor of stroke. Results A total of 13,417 patients with AF (edoxaban 60 mg: n=10,248; edoxaban 30 mg: n=3169) completed the two-year follow-up. The mean age was 73.6±9.5 years, with ∼84% of the patients aged over 65 years. The mean weight was 81.0±17.3 kg, estimated glomerular filtration rate was 74.4±30.5 ml/min/1.73m2 and males were 56.6%. The mean CHA2DS2-VASc and HAS-BLED scores were 3.2 and 2.5, respectively. Univariate analysis demonstrated that history of TIA at baseline was the strongest age-adjusted predictor of stroke and SEE (Wald Chi-square: 77.69; p<0.0001) (Figure 1), followed by CHA2DS2-VASc score (41.09; p<0.0001) (Figure 2), history of ischaemic stroke (29.47; p<0.0001), history of any stroke (all strokes combined including stroke of unknown/unspecified type) (29.18; p<0.0001), subjective frailty as assessed by physician (20.60; p<0.0001), and HAS-BLED score (17.22; p<0.0001). Conclusion History of TIA, CHA2DS2-VASc score, history of stroke, frailty and HAS-BLED score are independently associated with an increased age-adjusted risk of ischaemic stroke, TIA and SEE in anticoagulated patients with AF. These findings highlight the importance of optimising anticoagulation therapy in secondary prevention of TIA and in patients with high CHA2DS2-VASc scores, ensuring the correct use of NOACs - adherence and correct dosing - in this high-risk population. These findings also suggest that additional therapies could be needed to prevent stroke in this population. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Europe GmbH Figure 1. History of TIA as a predictor Figure 2. CHA2DS2-VASc score as a predictor

Management of Patients Taking Oral Anticoagulants Who Need Urgent Surgery for Hip Fracture

2019 ◽  
Vol 45 (02) ◽  
pp. 164-170 ◽  
Author(s):  
Angelo Ostuni ◽  
Giovanni Tiscia ◽  
Francesco Marongiu ◽  
Doris Barcellona ◽  
Elvira Grandone
Keyword(s):  
Hip Fracture ◽  
High Risk ◽  
Elderly Patients ◽  
Perioperative Management ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Urgent Surgery ◽  
Anticoagulated Patients

AbstractThe number of hip fractures in anticoagulated patients is predicted to increase, due to people living longer. However, evidence regarding urgent perioperative management of elderly patients with hip fracture who take oral anticoagulants (vitamin K antagonists or direct oral anticoagulants) is scarce. In this article, the authors present a narrative review of the evidence to date supporting the urgent management of hip fracture in anticoagulated elderly patients. They discuss the complexity of managing the high risk of procedure-related bleeding and, at the same time, the high risk of thromboembolism. The role of a bridging procedure and the best strategy of anticoagulation reversal are also reviewed. Further studies are required to improve the evidence in urgent surgery, especially in frail elderly patients.

scholarly journals Is psychodynamic psychotherapy an effective intervention for individuals at ultra-high risk (UHR) of psychosis?: a case report

2012 ◽  
Vol 61 (4) ◽  
pp. 266-270
Author(s):  
Paula A. Martins ◽  
Priscila Dib Gonçalves ◽  
Silvia Maria Arcuri ◽  
Oswaldo F. Leite Netto ◽  
Gamaliel Macedo ◽  
...  
Keyword(s):  
Case Report ◽  
High Risk ◽  
Psychodynamic Psychotherapy ◽  
Structured Interview ◽  
Psychiatric Interview ◽  
Prodromal Symptoms ◽  
Ultra High Risk ◽  
Baseline Evaluation ◽  
Neuropsychological Evaluations

OBJECTIVE: To report a case and to discuss the use of psychodynamic psychotherapy (PD-P) to treat individuals at ultra-high risk (UHR) of psychosis. METHODS: An individual at UHR was followed up for 24 months. The baseline evaluation included a psychiatric interview, the Structured Interview for Prodromal Symptoms (SIPS), the Scale of Prodromal Symptoms (SOPS), and neuropsychological assessment. He underwent weekly sessions of PD-P for 12 months and was followed up for 12 months after the end of PD-P. The evaluations were at baseline, after 6-, 12-, and 24-month follow-up. No medication was prescribed during the 24-month follow-up. RESULTS: The prodromal symptoms remitted. The initial total score on the SIPS/SOPS was 37 points. After the first 12 months of PD-P, there was a reduction to 12 points on the SIPS/SOPS score, which stabilized in the 24-month follow-up. There was also a slight improvement in his performance on the neuropsychological evaluations. CONCLUSION: This case report suggests that PD-P can reduce prodromal symptoms; nevertheless, a better understanding of the specificity and efficacy of PD-P as an option of treatment for UHR individuals is needed.

Intensive Stuttering Therapy With Telepractice Follow-up: A Case Study

2011 ◽  
Vol 21 (1) ◽  
pp. 11-21 ◽  
Author(s):  
Farzan Irani ◽  
Rodney Gabel
Keyword(s):  
Case Report ◽  
Therapeutic Intervention ◽  
Intensive Therapy ◽  
Positive Outcome ◽  
Eclectic Approach

This case report describes the positive outcome of a therapeutic intervention that integrated an intensive, residential component with follow-up telepractice for a 21 year old male who stutters. This therapy utilized an eclectic approach to intensive therapy in conjunction with a 12-month follow-up via video telepractice. The results indicated that the client benefited from the program as demonstrated by a reduction in percent stuttered syllables, a reduction in stuttering severity, and a change in attitudes and feelings related to stuttering and speaking.

Sign in / Sign up

Export Citation Format

Share Document