Anticoagulation and antiplatelet therapy in awake transcervical injection laryngoplasty

Dang, Jennifer; Liou, Nelson Eddie; Ongkasuwan, Julina

doi:10.1002/lary.26508

Cited by 17 publications

(16 citation statements)

References 29 publications

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“…As a follow‐up study, we investigated the role of timing of inpatient medialization with awake transcervical injection laryngoplasty in cohorts with postsurgical VFMI. Advantages of this approach includes performability at bedside, short procedure time, good tolerability by most patients, no neck incision, and no requirement to hold anticoagulation . Therefore, we report our clinical experience of early versus late inpatient injection laryngoplasty in VFMI cohorts following thoracic aortic repair.…”

Section: Introductionmentioning

confidence: 99%

Early versus late inpatient awake transcervical injection laryngoplasty after thoracic aortic repair

et al. 2017

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Background: Vocal fold movement impairment (VFMI), a known complication following thoracic aortic surgery, has been associated with poorer surgical outcomes, including higher pulmonary complications and longer length of stay (LOS). Awake transcervical injection laryngoplasty in the inpatient setting serves to augment pulmonary toilet function for affected patients. This study investigates clinical outcomes of patients who underwent early versus late injection laryngoplasty following aortic surgery.Methods: A 5-year review (2011-2016) of 35 patients who underwent inpatient injection laryngoplasty for VFMI following aortic repair was conducted. Data included demographics, surgery parameters, laryngologic evaluation, pulmonary complications, LOS, and mortality. Early injection was defined as within 5 days from extubation. Statistical analyses were performed using SPSS, version 17.0 (IBM Corp., Armonk, NY).Results: All 35 patients (mean age 56, 77% male) underwent left vocal-fold injection laryngoplasty without complication. There were 15 (43%) early procedures and 20 (57%) late procedures. Mean LOS for early and late injection groups (13 vs. 20 days, respectively) significantly differed (P 5 0.04, 95% confidence interval (CI) 0.3 to 14.4). Early laryngoplasty cohorts experienced less pulmonary complications (20%) than those who had late medialization (50%), but this did not reach significance (P 5 0.06, 95% CI 20.3 to 8.1). The most common complication type in both groups was therapeutic bronchoscopy.Conclusion: Early awake injection laryngoplasty within 5 days from extubation is feasible and may improve clinical outcomes for patients with VFMI following aortic repair. Further prospective studies on this approach for VFMI after thoracic surgery are needed.

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Section: Introductionmentioning

confidence: 99%

Early versus late inpatient awake transcervical injection laryngoplasty after thoracic aortic repair

et al. 2017

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“…During the postoperative period, awake transcervical injection laryngoplasty via a transthyrohyoid approach has also been described in a small retrospective study as feasible and safe in patients under antiplatelet or anticoagulation therapy, without increased risk of bleeding. 13 The transthyrohyoid approach utilized in this study may underestimate the risk of hematoma formation since blood can escape via the needle insertion site on the vocal fold. Though there may be increased risk of bleeding into the airway and causing aspiration from this approach.…”

Section: Introductionmentioning

confidence: 96%

Early Injection Laryngoplasty After Surgery: 30 Cases and Proposed Aspiration Assessment Protocol

et al. 2020

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“…4,5 They are well-tolerated, and the avoidance of general anesthesia makes them a potential option for patients with significant comorbidities. [6][7][8] Furthermore, the ability in some cases to titrate the effects of intervention based on real-time patient response may promote better outcomes and patient satisfaction. [9][10][11][12] However, there is some precision lost in the non-operative setting, and there have been reports of hemodynamic instability with topical anesthetic in older patients.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12] However, there is some precision lost in the non-operative setting, and there have been reports of hemodynamic instability with topical anesthetic in older patients. 7,13,14 These considerations must be taken into account before any in-office laryngologic procedure.…”

Section: Introductionmentioning

confidence: 99%

“…19 Similarly, anticoagulants are commonly used in atrial fibrillation, the prevalence of which is expected to rise to 5.6 to 12 million by 2050. 7,20 Use of mechanical heart valves and vessel stents is also increasing, necessitating dual therapy. 21,22 The increased usage of antithrombotics has led to more complicated clinical decision-making in terms of the risk/benefit of officebased laryngologic procedures, as bleeding in the airway may become a potentially emergent situation.…”

Section: Introductionmentioning

confidence: 99%

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The safety of in‐office laryngologic procedures during active antithrombotic therapy

Straub

Calamari

Shin

et al. 2020

Laryngoscope Investig Oto

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Objectives: To determine whether patients undergoing in-office laryngologic procedures on antithrombotic therapy are at increased risk for treatment-related complications. Methods: Patients were those who underwent at least one in-office laryngologic procedure with any of three fellowship-trained laryngologists. Procedures were identified by current procedural terminology (CPT) code and included biopsies, excisions, laser ablations, and injections (therapeutic and augmentative). Patients were divided into two groups based on the use of antithrombotic therapy at the time of their procedure. Retrospective chart review was performed to identify any complications, with an average follow-up of 186 days. Results: Five hundred-sixty-four unique individuals were identified with ages ranging from 18 to 93 years old and with a relatively even distribution between females (45%) and males (55%). They underwent 647 procedures in total, 310 of which were performed while on some form of antithrombotic therapy. Sixteen procedures were associated with complications either during or after the procedure. In comparing overall complication rates, there was no significant difference between nonantithrombotic (2.4%) and antithrombotic (3.3%) cohorts (OR 1.09, 95% CI [0.46-2.60], P = .8454). Conclusions: In spite of known risks in other settings, antithrombotic agents do not appear to confer increased risk of treatment-related complications during in-office laryngologic procedures, obviating the need for cessation of therapy prior to these interventions.

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Anticoagulation and antiplatelet therapy in awake transcervical injection laryngoplasty

Abstract: 4. Laryngoscope, 127:1850-1854, 2017.

Cited by 17 publications

References 29 publications

Early versus late inpatient awake transcervical injection laryngoplasty after thoracic aortic repair

Early versus late inpatient awake transcervical injection laryngoplasty after thoracic aortic repair

Early Injection Laryngoplasty After Surgery: 30 Cases and Proposed Aspiration Assessment Protocol

The safety of in‐office laryngologic procedures during active antithrombotic therapy

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