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Ludwig, D.; Schädel, S; Brüning, A; Schiefer, Bernhard; Stange, Eduard F.

doi:10.1023/a:1005553914878

Cited by 30 publications

(4 citation statements)

References 40 publications

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“…AVR performed in the context of advanced liver disease added an additional layer of complexity in preventing further decline of hepatic and renal function. The patient's history of significant portal hypertension justified the use of both terlipressin and octreotide to prevent variceal beeding [11][12][13] . Terlipressin has also been shown to improve hepatorenal syndrome, thought to be due to arteriolar vasoconstriction in the splanchnic area, which was an important consideration for the patient's underlying IgA nephropathy.…”

Section: Discussionmentioning

confidence: 99%

Haemostatic management for aortic valve replacement in a patient with advanced liver disease

Weinberg

Kearsey

Tjoakarfa

et al. 2014

WJCC

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Redo-sternotomy and aortic valve replacement in patients with advanced liver disease is rare and associated with a prohibitive morbidity and mortality. Refractory coagulopathy is common and a consequence of intense activation of the coagulation system that can be triggered by contact of blood with the cardiopulmonary bypass circuitry, bypass-induced fibrinolysis, platelet activation and dysfunction, haemodilution, surgical trauma, hepatic decompensation and hypothermia. Management can be further complicated by right heart dysfunction, porto-pulmonary hypertension, poor myocardial protection, and hepato-renal syndrome. Complex interactions between coagulation/fibrinolysis and systemic inflammatory response syndrome reactions like "post-perfusion-syndrome" also compound haemostatic failure. Given the limited information available for the specific management and prevention of cardiopulmonary bypass-induced haemostatic failure, this report serves to guide the anaesthesia and medical management of future cases of a similar kind. We discuss our multimodal management of haemostatic failure using pharmacological strategies, thromboelastography, continuous cerebral and liver oximetry, and continuous cardiac output monitoring.

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Section: Discussionmentioning

confidence: 99%

Haemostatic management for aortic valve replacement in a patient with advanced liver disease

Weinberg

Kearsey

Tjoakarfa

et al. 2014

WJCC

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“…Compared to somatostatin, octreotide has a longer half-life, but causes a similar prompt reduction of variceal pressure; however, despite adding continuous infusion, these effects only last some minutes, probably due to a pharmacodynamic desensitization (40). Nevertheless, a longer term effect mediated by other pathways may not be excluded (41).…”

Section: Vasoactive Drugsmentioning

confidence: 99%

Acute upper and lower gastrointestinal bleeding management in older people taking or not taking anticoagulants: a literature review

Menichelli,

Gazzaniga,

Del Sole

et al. 2024

Front. Med.

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Acute upper and lower gastrointestinal (GI) bleeding may be a potentially life-threatening event that requires prompt recognition and an early effective management, being responsible for a considerable number of hospital admissions. Methods. We perform a clinical review to summarize the recent international guidelines, helping the physician in clinical practice. Older people are a vulnerable subgroup of patients more prone to developing GI bleeding because of several comorbidities and polypharmacy, especially related to an increased use of antiplatelet and anticoagulant drugs. In addition, older patients may have higher peri-procedural risk that should be evaluated. The recent introduction of reversal strategies may help the management of GI bleeding in this subgroup of patients. In this review, we aimed to (1) summarize the epidemiology and risk factors for upper and lower GI bleeding, (2) describe treatment options with a focus on pharmacodynamics and pharmacokinetics of different proton pump inhibitors, and (3) provide an overview of the clinical management with flowcharts for risk stratification and treatment. In conclusion, GI is common in older patients and an early effective management may be helpful in the reduction of several complications.

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“…It might be blunted by octreotide and isosorbide-5-mononitrate (ISMN), whereas propranolol decreases only baseline HVPG [37][38][39][40].…”

Section: Recommendationsmentioning

confidence: 99%

Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver

et al. 2008

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The Asian Pacific Association for the Study of the Liver (APASL) set up a Working Party on Portal Hypertension in 2002, with a mandate to develop consensus guidelines on various clinical aspects of portal hypertension relevant to disease patterns and clinical practice in the Asia-Pacific region. Variceal bleeding is a consequence of portal hypertension, which, in turn, is the major complication of liver cirrhosis. Primary prophylaxis to prevent the first bleed from varices is one of the most important strategies for reducing the mortality in cirrhotic patients. Experts predominantly from the Asia-Pacific region were requested to identify the different aspects of primary prophylaxis and develop the consensus guidelines. The APASL Working Party on Portal Hypertension evaluated the various therapies that have been used for the prevention of first variceal bleeding. A 2-day meeting was held on January 12 and 13, 2007, at New Delhi, India, to discuss and finalize the consensus statements. Only those statements that were unanimously approved by the experts were accepted. These statements were circulated to all the experts and were subsequently presented at the annual conference of the APASL at Kyoto, Japan, in March 2007.

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Untitled

Cited by 30 publications

References 40 publications

Haemostatic management for aortic valve replacement in a patient with advanced liver disease

Haemostatic management for aortic valve replacement in a patient with advanced liver disease

Acute upper and lower gastrointestinal bleeding management in older people taking or not taking anticoagulants: a literature review

Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver

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