Hemostatic management of patients undergoing ear-nose-throat surgery

Thiele, Thomas; Kaftan, Holger; Hosemann, Werner; Greinacher, Andreas

doi:10.3205/cto000122

Cited by 6 publications

(2 citation statements)

References 64 publications

(69 reference statements)

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“…While not always validated for the postoperative setting, these schemas may serve as valuable adjuncts for stratifying and balancing risks and establishing guidelines in the future. 16,19,20,23 -30…”

Section: Discussionmentioning

confidence: 99%

Restarting Antithrombotic Therapies After Endoscopic Sinus Surgery: A Systematic Review

Boyi,

Richmond,

Kayastha

et al. 2024

Ann Otol Rhinol Laryngol

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Objectives: Antithrombotic therapies, comprised of both anticoagulant and antiplatelet agents, are routinely paused prior to endoscopic sinus surgery (ESS) to reduce the risk of perioperative hemorrhage. At present, no clear guidelines exist to guide otolaryngologists on when to resume these agents after ESS. Our goal was to systematically review the existing literature related to this topic. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically queried the PubMed, Embase, Ovid, Web of Science, Cochrane, and CINAHL databases to identify publications reporting on antithrombotic and antiplatelet therapy in the context of ESS. The primary outcomes we sought were recommendations on the timing of antithrombotic therapy resumption after ESS. Results: Of the 104 unique articles identified, all were screened for relevance by 2 independent reviewers based on title and abstract, 20 underwent full-text review, and 6 met inclusion criteria for analysis. Of these, 3 were literature reviews, 2 were case-control studies, and 1 was a cohort study. All publications discussed when to pause antithrombotic therapy prior to surgery while only 3 articles discussed resumption of these agents. Recommendations were mixed. Conclusion: A paucity of literature exists on the resumption of antithrombotic therapies after ESS. As a major determining factor in patient morbidity, guideline-based resumption of these therapies is needed.

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Section: Discussionmentioning

confidence: 99%

Restarting Antithrombotic Therapies After Endoscopic Sinus Surgery: A Systematic Review

Boyi,

Richmond,

Kayastha

et al. 2024

Ann Otol Rhinol Laryngol

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“…Postoperative bleeding risk is based on wound condition after surgery, tissue damage, and tissue perfusion. 28 …”

Section: Available Data On Specific Antithrombotics and Oculoplastic ...mentioning

confidence: 99%

Perioperative Considerations for Antithrombotic Therapy in Oculofacial Surgery: A Review of Current Evidence and Practice Guidelines

Kim

Pfeiffer

Chang

et al. 2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Recent survey studies have demonstrated wide variability in practice patterns regarding the management of antithrombotic medications in oculofacial plastic surgery. Current evidence and consensus guidelines are reviewed to guide perioperative management of antithrombotic medications.Methods: Comprehensive literature review of PubMed database on perioperative use of antithrombotic medication.Results/Conclusions: Perioperative antithrombotic management is largely guided by retrospective studies, consensus recommendations, and trials in other surgical fields due to the limited number of studies in oculoplastic surgery. This review summarizes evidence-based recommendations from related medical specialties and provides context for surgeons to tailor antithrombotic medication management based on patient's individual risk. The decision to continue or cease antithrombotic medications prior to surgery requires a careful understanding of risk: risk of intraoperative or postoperative bleeding versus risk of a perioperative thromboembolic event. Cessation and resumption of antithrombotic medications after surgery should always be individualized based on the patient's thrombotic risk, surgical and postoperative risk of bleeding, and the particular drugs involved, in conjunction with the prescribing doctors. In general, we recommend that high thromboembolic risk patients undergoing high bleeding risk procedures (orbital or lacrimal surgery) may stop antiplatelet agents, direct oral anticoagulants, and warfarin including bridging warfarin with low-molecular weight heparin. Low-risk patients, regardless of type of procedure performed, may stop all agents. Decision on perioperative management of antithrombotic medications should be made in conjunction with patient's internist, cardiologist, hematologist, or other involved physicians which may limit the role of guidelines depending on patient risk and should be used on a case-by-case basis. Further studies are needed to provide oculofacial-specific evidence-based guidelines.

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Perioperative Management of Oral Antithrombotics in Dentistry and Oral Surgery: Part 2

Statman¹

2023

Anesthesia Progress

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Part 1 of “Perioperative Management of Oral Antithrombotics in Dentistry and Oral Surgery” covered the physiological process of hemostasis and the pharmacology of both traditional and novel oral antiplatelets and anticoagulants. Part 2 of this review discusses various factors that are considered when developing a perioperative management plan for patients on oral antithrombotic therapy in consultation with dental professionals and managing physicians. Additionally included are how thrombotic and thromboembolic risks are assessed as well as how patient- and procedure-specific bleeding risks are evaluated. Special attention is given to the bleeding risks associated with procedures encountered when providing sedation and general anesthesia within the office-based dental environment.

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Hemostatic management of patients undergoing ear-nose-throat surgery

Cited by 6 publications

References 64 publications

Restarting Antithrombotic Therapies After Endoscopic Sinus Surgery: A Systematic Review

Restarting Antithrombotic Therapies After Endoscopic Sinus Surgery: A Systematic Review

Perioperative Considerations for Antithrombotic Therapy in Oculofacial Surgery: A Review of Current Evidence and Practice Guidelines

Perioperative Management of Oral Antithrombotics in Dentistry and Oral Surgery: Part 2

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