Major bleeding complicating deep sternal infection after cardiac surgery

Yellin, Alon; Refaely, Yael; Paley, Michael; Simansky, David

doi:10.1067/mtc.2003.31

Cited by 42 publications

(28 citation statements)

References 14 publications

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“…These included revisions for bleeding, transfusions, IABP usage and prolonged ventilator therapy (2,6,8). This increase in morbidity is mainly explained by relatively increased hemodilution due to priming volume, which induces development of coagulopathy due to cardiopulmonary bypass, increasing the need of transfusion, RF and prolonged ventilation (26). The results in underweight patients in our study were similar.…”

Section: Discussionsupporting

confidence: 78%

Body mass index as a determinant of postoperative morbidity

Gürkan¹,

Gür²

2014

Curr Res Cardiol

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Section: Discussionsupporting

confidence: 78%

Body mass index as a determinant of postoperative morbidity

Gürkan¹,

Gür²

2014

Curr Res Cardiol

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“…133 In fi ve studies, major bleeding was defi ned as bleeding requiring reexploration [90][91][92]134 ; across these studies, the risk of major bleeding was remarkably consistent, with a median risk of 4.7% (range, 3.1%-5.9%). Thus, we classify most cardiac surgery patients as being at high risk for anticoagulant prophylaxis-related bleeding.…”

Section: Baseline Risk Risk Factors and Risk Stratifi Cation For Mamentioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,821

744

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(Grade 2C) prophylaxis be used other than early ambulation. For patients at low risk for VTE ( ‫ف‬ 1.5%), we suggest mechanical prophylaxis, preferably with intermittent pneumatic compression (IPC), over no prophylaxis (Grade 2C). For patients at moderate risk for VTE ( ‫ف‬ 3%) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B), low-dose unfractionated heparin (Grade 2B), or mechanical prophylaxis with IPC (Grade 2C) over no prophylaxis. For patients at high risk for VTE ( ‫ف‬ 6%) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or low-dose unfractionated heparin (Grade 1B) over no prophylaxis. In these patients, we suggest adding mechanical prophylaxis with elastic stockings or IPC to pharmacologic prophylaxis (Grade 2C). For patients at high risk for VTE undergoing abdominal or pelvic surgery for cancer, we recommend extended-duration, postoperative, pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis (Grade 1B). For patients at moderate to high risk for VTE who are at high risk for major bleeding complications or those in whom the consequences of bleeding are believed to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated (Grade 2C). For patients in all risk groups, we suggest that an inferior vena cava fi lter not be used for primary VTE prevention (Grade 2C) and that surveillance with venous compression ultrasonography should not be performed (Grade 2C). We developed similar recommendations for other nonorthopedic surgical populations. Conclusions: Optimal thromboprophylaxis in nonorthopedic surgical patients will consider the risks of VTE and bleeding complications as well as the values and preferences of individual patients. CHEST 2012; 141(2)(Suppl):e227S-e277SAbbreviations: CABG 5 coronary artery bypass graft; ES 5 elastic stockings; ICH 5 intracranial hemorrhage; IPC 5 intermittent pneumatic compression; IVC 5 inferior vena cava; LDUH 5 low-dose unfractionated heparin; LMWH 5 low-molecular-weight heparin; PE 5 pulmonary embolism; QALY 5 quality-adjusted life year; RR 5 risk ratio; VCU 5 venous compression ultrasonography

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“…[2][3][4][5] However, no case similar to ours was found in the English literature in a PubMed search (available at http://www.ncbi.nlm.nih.gov/pubmed/), using "rupture" and "hemorrhage" connected with "mediastinitis" as index words. This is the first report of an ascending aorta hemorrhage due to recurrent mediastinal infection after irradiation for sternal bone metastasis from breast cancer.…”

Section: Discussionmentioning

confidence: 99%

Profuse Mediastinal Hemorrhage due to Mediastinitis after a Sternal Infection

Kamiyoshihara

Igarashi

Igai

et al. 2014

ATCS

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A 79-year-old female patient was admitted because of profuse bleeding from a skin defect in the anterior chest due to a deep sternal wound infection. Eighteen years earlier, she had undergone irradiation to treat a sternal metastasis from breast cancer. Computed tomography (CT) showed the extravasation of iodinated contrast material from the ascending aorta. The patient underwent an immediate thoracotomy and recovered. This report presents a very rare case of massive bleeding from the thoracic aorta due to a mediastinal infection after irradiation for sternal metastasis from breast cancer.

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Major bleeding complicating deep sternal infection after cardiac surgery

Cited by 42 publications

References 14 publications

Body mass index as a determinant of postoperative morbidity

Body mass index as a determinant of postoperative morbidity

Prevention of VTE in Nonorthopedic Surgical Patients

Profuse Mediastinal Hemorrhage due to Mediastinitis after a Sternal Infection

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