Anticoagulation Monitoring for Perioperative Physicians

Maier, Cheryl L.; Sniecinski, Roman

doi:10.1097/aln.0000000000003903

Cited by 8 publications

(3 citation statements)

References 78 publications

(91 reference statements)

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“…Even if DOACs are ceased, they can still influence routine coagulation assay results and point-of-care tests such as activated clotting time. 92 Use of specific anti-factor Xa levels or drug assay concentrations and use of reversal agents such as idarucizumab may not be applicable to the real world. 9 Although viscoelastic testing holds promise in evaluating coagulation in an emergency setting, this practice is only currently being investigated for DOACs and there are uncertainties about timing of assay and interpretation of results.…”

Section: Uncertainties With Bridging Anticoagulation and Anticoagulan...mentioning

confidence: 99%

Obesity and the Risk of Venous Thromboembolism after Major Lower Limb Orthopaedic Surgery: A Literature Review

et al. 2022

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The risk of venous thromboembolism following total joint arthroplasty is significantly greater than those of other types of elective orthopaedic procedures. This risk is increased in obesity due to the associated prothrombotic physiological and hematological changes that predispose to embolic events. The prevalence of obesity is increasing in the aging population, which contributes to a further increase in the risk of postoperative thrombosis in the older patients. There is a lack of clear evidence regarding dosing information for thromboprophylaxis medications in patients with obesity. As a result, the currently available thromboprophylaxis guidelines do not provide specific recommendations for this group. Suboptimal dosing regimens for these medications can place these patients at a risk of bleeding or clotting complications postsurgery. Hence any increase in dosage may require intensive surveillance for the residual anticoagulant effects and careful balancing of risks and benefits on an individual basis. Our review discusses the basis for increased thrombotic risk in obesity, the evidence supporting dosage recommendations, and the implications of the current guidelines for pharmacological thromboprophylaxis in patients with obesity undergoing lower limb arthroplasty.

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Section: Uncertainties With Bridging Anticoagulation and Anticoagulan...mentioning

confidence: 99%

Obesity and the Risk of Venous Thromboembolism after Major Lower Limb Orthopaedic Surgery: A Literature Review

et al. 2022

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“…56 A normal thrombin time can exclude the presence of clinically relevant concentrations of DTIs or unfractionated heparin, but not low-molecular-weight heparin since factor X is not involved in the assay. 57 Mass spectrometry measurements are considered the gold standard for drug-specific assays for DOAC measurement, but due to poor availability and long turnaround times (►Fig. 1) it is unsuitable for emergency situations.…”

Section: Scenario 2: Coagulation Testing In Intracerebral Hemorrhage/...mentioning

confidence: 99%

Section: Scenario 2: Coagulation Testing In Intracerebral Hemorrhage/...mentioning

confidence: 99%

Global Coagulation Testing in Acute Care Medicine: Back to Bedside?

et al. 2022

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Objectives Detailed and decisive information about the patients' coagulation status is important in various emergency situations. Conventional global coagulation testing strategies are often used to provide a quick overview, but several limitations particularly in the trauma setting are well described. With the introduction of direct oral anticoagulations (DOACs), a milestone for several disease entities resulting in overall improved outcomes could be reached, but at the same time providing new diagnostic challenges for the emergency situation. Design As an alternative to conventional coagulation tests, there is increasing clinical and scientific interest in the use of early whole blood strategies to provide goal-directed coagulation therapies (GDCT) and hemostatic control in critically ill patients. Viscoelastic hemostatic assays (VHAs) were therefore introduced to several clinical applications and may provide as a bedside point-of-care method for faster information on the underlying hemostatic deficiency. Conclusion The use of VHA-based algorithms to guide hemostatic control in emergency situations now found its way to several international guidelines for patients at risk of bleeding. With this qualitative review, we would like to focus on VHA-based GDCT and review the current evidence for its use, advantages, and challenges in the two different clinical scenarios of trauma and intracerebral bleeding/stroke management.

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Anticoagulation for cardiopulmonary bypass, Part 2: alternatives and pathological states

Cartwright

Mundell

2023

BJA Education

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Anticoagulation Monitoring for Perioperative Physicians

Abstract: From preoperative medications to intraoperative needs to postoperative thromboprophylaxis, anticoagulants are encountered throughout the perioperative period. This review will focus on coagulation testing clinicians utilize to monitor the effects of these medications.

Cited by 8 publications

References 78 publications

Obesity and the Risk of Venous Thromboembolism after Major Lower Limb Orthopaedic Surgery: A Literature Review

Obesity and the Risk of Venous Thromboembolism after Major Lower Limb Orthopaedic Surgery: A Literature Review

Global Coagulation Testing in Acute Care Medicine: Back to Bedside?

Anticoagulation for cardiopulmonary bypass, Part 2: alternatives and pathological states

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