Effect of Intraoperative Arterial Hypotension on the Risk of Perioperative Stroke After Noncardiac Surgery: A Retrospective Multicenter Cohort Study

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Karuna Wongtangman ◽  
Luca J. Wachtendorf ◽  
Michael Blank ◽  
Stephanie D. Grabitz ◽  
Felix C. Linhardt ◽  
...  
2020 ◽  
Author(s):  
Bei Mao ◽  
Yang Liu ◽  
Yan-hua Chai ◽  
Xiao-yan Jin ◽  
Hai Wen Luo ◽  
...  

Author(s):  
Walusa Assad Gonçalves-Ferri ◽  
Francisco Eulógio Martinez ◽  
Fábia Pereira Martins-Celini ◽  
João Henrique Carvalho Leme de Almeida ◽  
Renato Procianoy ◽  
...  

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Richard Descamps ◽  
Mouhamed D. Moussa ◽  
Emmanuel Besnier ◽  
Marc-Olivier Fischer ◽  
Sébastien Preau ◽  
...  

Abstract Background Hemorrhagic events remain a major concern in patients under extracorporeal membrane oxygenation (ECMO) support. We tested the association between anticoagulation levels and hemorrhagic events under ECMO using anti-Xa activity monitoring. Methods We performed a retrospective multicenter cohort study in three ECMO centers. All adult patients treated with veno-venous (VV)- or veno-arterial (VA)-ECMO in 6 intensive care units between September 2017 and August 2019 were included. Anti-Xa activities were collected until a hemorrhagic event in the bleeding group and for the duration of ECMO in the non-bleeding group. All dosages were averaged to obtain means of anti-Xa activity for each patient, and patients were compared according to the occurrence or not of bleeding. Results Among 367 patients assessed for eligibility, 121 were included. Thirty-five (29%) presented a hemorrhagic complication. In univariate analysis, anti-Xa activities were significantly higher in the bleeding group than in the non-bleeding group, both for the mean anti-Xa activity (0.38 [0.29–0.67] vs 0.33 [0.22–0.42] IU/mL; p = 0.01) and the maximal anti-Xa activity (0.83 [0.47–1.46] vs 0.66 [0.36–0.91] IU/mL; p = 0.05). In the Cox proportional hazard model, mean anti-Xa activity was associated with bleeding (p = 0.0001). By Kaplan–Meier analysis with the cutoff value at 0.46 IU/mL obtained by ROC curve analysis, the probability of survival under ECMO without bleeding was significantly lower when mean anti-Xa was > 0.46 IU/mL (p = 0.0006). Conclusion In critically ill patients under ECMO, mean anti-Xa activity was an independent risk factor for hemorrhagic complications. Anticoagulation targets could be revised downward in both VV- and VA-ECMO.


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