scholarly journals Can we think of a TAT, that is a “tailored antiplatelet therapy”?

2021 ◽  
Author(s):  
luigi tritapepe ◽  
claudio ajmone cat
Keyword(s):  
Case Report ◽  
Platelet Aggregation ◽  
Antiplatelet Therapy ◽  
Point Of Care ◽  
Hemodynamic Instability ◽  
Therapeutic Regimen ◽  
Assessment Tests ◽  
Exact Timing

What can be seen from the case report by Verzelloni et al. has a double value, beyond the case itself. First of all, the use of platelet aggregation assessment tests, such as TEG-PM, allows clinicians to verify the exact timing between the suspension of thienopyridines and the possibility of surgery without further temporal delays and is also able to favor the evolution of ischemic problems or hemodynamic instability not easily treatable. It therefore allows clinicians to optimize the bleeding / thrombosis matching. Secondly, the use of point of care methodologies for the evaluation of platelet aggregation allows us to evaluate the adequacy of the anti-aggregation, facilitating, where resistance or percentages of anti-aggregation are lower than expected, modification of the therapeutic regimen.

scholarly journals Ticagrelor in unstable carotid stenosis - a case report

2021 ◽  
Vol 74 (3-4) ◽  
pp. 123-126
Author(s):  
Aleksandra Ilic ◽  
Vladimir Galic ◽  
Dmitar Vlahovic ◽  
Tamara Rabi-Zikic ◽  
Mirjana Jovicevic ◽  
...  
Keyword(s):  
Case Report ◽  
Platelet Aggregation ◽  
Carotid Stenosis ◽  
Antiplatelet Therapy ◽  
Transient Ischemic Attack ◽  
Dual Antiplatelet Therapy ◽  
Transient Ischemic Attacks ◽  
Suitable Alternative ◽  
Ischemic Attack ◽  
Aggregation Analysis

Introduction. Ticagrelor is an oral, reversible, direct-acting inhibitor of adenosine diphosphate receptor P2Y12, which has a faster onset of action and stronger inhibition of platelet aggregation than clopidogrel. Case Report. This case report describes a 54-year-old male patient with repeated, transient ischemic attacks due to ipsilateral, significant carotid stenosis registered by carotid duplex ultrasound. In addition to aspirin, clopidogrel and rosuvastatin were added to the therapy. Despite optimal treatment, the patient was continuously unstable with frequent but transient neurological symptoms. A magnetic resonance imaging of the brain showed acute, cortical-subcortical ischemic lesions in the left frontal and parietal lobes, while the computed tomography angiography of the endocranium showed progression of findings and occlusion of the left common carotid artery. Subsequently, laboratory platelet aggregation analysis confirmed aspirin resistance and poor response to clopidogrel. Episodes of transient ischemic attacks were stabilized after the exclusion of dual antiplatelet therapy and introduction of ticagrelor. After that, the patient?s symptoms did not recur and he remained stable. Conclusion. The incidence of resistance to antiplatelet therapy in patients with stroke or transient ischemic attack varies greatly and ranges from 3% to 85% for aspirin, and 28% to 44% for clopidogrel. Our case showed that platelet aggregation analysis is reasonable if patients with transient ischemic attack or minor acute ischemic stroke are neurologically unstable, despite optimal medical treatment and when other therapeutic options, such as carotid revascularization, are not indicated. In such situations, ticagrelor may be a suitable alternative to dual antiplatelet therapy.

scholarly journals Whole Blood Platelet Aggregation Test and Prediction of Hemostatic Difficulty After Tooth Extraction in Patients Receiving Antiplatelet Therapy

2017 ◽  
Vol 24 (1) ◽  
pp. 151-156 ◽  
Author(s):  
Yasushi Nagao ◽  
Rikuo Masuda ◽  
Akane Ando ◽  
Mutsumi Nonaka ◽  
Akiko Nishimura ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Antiplatelet Therapy ◽  
Whole Blood ◽  
Tooth Extraction ◽  
Point Of Care ◽  
Adenosine Diphosphate ◽  
Blood Platelet ◽  
Test Results ◽  
Test Sensitivity ◽  
Whole Blood Aggregometry

When patients on antiplatelet therapy (APT) require minor invasive surgery, APT is usually continued to limit the risk of thrombosis. However, the possibility of hemostatic difficulties necessitates the monitoring of platelet aggregation to prevent unexpected bleeding. We examined whether whole blood aggregometry as a point-of-care testing (POCT) could be useful as a tool for predicting hemostatic difficulties. Sixty-five patients receiving APT and 15 patients who were not receiving APT were enrolled in the present study; all patients were scheduled to undergo a tooth extraction. Whole blood samples were obtained and were examined using multiple electrode aggregometry. The aggregometry was performed using arachidonic acid (AA), adenosine diphosphate (ADP), and thrombin receptor activating peptide. Hemostatic difficulty was defined as a need for more than 10 minutes of compression to achieve hemostasis. The AA test results were significantly lower in patients treated with aspirin (control: 97.7 [29.0] U, aspirin: 14.5 [7.2] U, P < .001). The ADP test results were also significantly lower in patients treated with a P2Y12 inhibitor (control: 77.7 [21.7] U, P2Y12 inhibitor: 37.3 [20.4] U, P < .01). Six of the examined cases exhibited hemostatic difficulties. The cutoff values for the prediction of hemostatic difficulty were 16.5 U for the AA test (sensitivity, 0.833; specificity, 0.508) and 21 U for the ADP test (sensitivity, 0.847; specificity, 0.500). Our study showed that whole blood aggregometry was useful as a POCT for the prediction of hemostatic difficulties after tooth extraction in patients receiving APT.

Case Report: When all claims that it is necrotizing fasciitis but Point of care ultrasound (POCUS) proves the opposite!

POCUS Journal ◽  
2018 ◽  
Vol 3 (1) ◽  
pp. 13-14
Author(s):  
Hadiel Kaiyasah, MD, MRCS (Glasgow), ABHS-GS ◽  
Maryam Al Ali, MBBS
Keyword(s):  
Emergency Department ◽  
Critical Care ◽  
Case Report ◽  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Soft Tissue Infection ◽  
Critical Care Unit ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Soft Tissue Infections

Soft tissue ultrasound (ST-USS) has been shown to be of utmost importance in assessing patients with soft tissue infections in the emergency department or critical care unit. It aids in guiding the management of soft tissue infection based on the sonographic findings.

Case Report: Hemoptysis localization – hearing with your eyes

POCUS Journal ◽  
2016 ◽  
Vol 1 (2) ◽  
pp. 7
Author(s):  
Barry Chan, MD
Keyword(s):  
Case Report ◽  
Respiratory Failure ◽  
Hemodynamic Instability ◽  
Clinical Vignette ◽  
Massive Hemoptysis ◽  
Airway Patency ◽  
Peripheral Site ◽  
Adventitious Sound

Clinical Vignette: 45 year old was transferred from a peripheral facility for acute massive hemoptysis though maintained sufficient airway patency with no evidence of hemodynamic instability or respiratory failure. Thoracic auscultation revealed vesicular breathing with no adventitious sound. CXR from the peripheral site was normal.

scholarly journals Erector spinae plane block in laparoscopic nephrectomy as a cause of involuntary hemodynamic instability: A case report

2021 ◽  
Author(s):  
Antonio Coviello ◽  
Ludovica Golino ◽  
Alfredo Maresca ◽  
Maria Vargas ◽  
Giuseppe Servillo
Keyword(s):  
Case Report ◽  
Hemodynamic Instability ◽  
Erector Spinae ◽  
Laparoscopic Nephrectomy ◽  
Erector Spinae Plane Block

scholarly journals Point-of-Care Ultrasound Diagnosis of Acute High Altitude Illness: A Case Report

2021 ◽  
Author(s):  
Flavia Wipplinger ◽  
Niels Holthof ◽  
Jasmin Lienert ◽  
Anastasia Budowski ◽  
Monika Brodmann Maeder ◽  
...  
Keyword(s):  
Case Report ◽  
High Altitude ◽  
Point Of Care ◽  
Ultrasound Diagnosis ◽  
Point Of Care Ultrasound ◽  
High Altitude Illness

scholarly journals Point-of-Care Gastric Ultrasound in a Pediatric Patient After Bowel Preparation: A Case Report

2020 ◽  
Vol Volume 13 ◽  
pp. 245-248
Author(s):  
Yoshikazu Yamaguchi ◽  
Steven P Zadora ◽  
Colleen Flahive ◽  
John M Russo ◽  
Gregory S Maves ◽  
...  
Keyword(s):  
Case Report ◽  
Pediatric Patient ◽  
Bowel Preparation ◽  
Point Of Care

scholarly journals A case report of anaesthesia for craniotomy in sitting position

2021 ◽  
Vol 8 (4) ◽  
pp. 611-614
Author(s):  
Dinesh Suryanarayana Rao ◽  
Veena Velmurugan
Keyword(s):  
Case Report ◽  
High Risk ◽  
Air Embolism ◽  
Hemodynamic Instability ◽  
Anaesthetic Management ◽  
Sitting Position ◽  
Venous Air Embolism ◽  
Long Duration ◽  
Exact Position ◽  
Space Occupying Lesion

Tumors in the posterior fossa can be done in lateral, supine, prone, sitting and in park bench positions. Depending on the exact position of the lesion and the technical preference of the surgeon, sitting position may be preferred. Sitting position grants best possible access to deeper structures with minimal retraction. However, maintenance of anaesthesia in this position for long duration pose some serious challenges to the anaesthesiologist including high risk of venous air embolism (VAE), hemodynamic instability and respiratory disturbances. Here, we present a case report of a 36year old male diagnosed with pineal gland space occupying lesion (SOL), operated in the sitting position under general anaesthesia. We discuss about anaesthetic management and possible complications that can be encountered.

scholarly journals A Case Report of a DES-Implanted Patient : Continuation of Antiplatelet Therapy Would Prevent Stent Thrombosis after Surgery

2011 ◽  
Vol 31 (7) ◽  
pp. 986-989 ◽  
Author(s):  
Karin KATO ◽  
Yasutaka SHINJO ◽  
Keizou YOSHIKAWA ◽  
Akitomo YONEI
Keyword(s):  
Case Report ◽  
Antiplatelet Therapy ◽  
Stent Thrombosis
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