Surgeon's guide to anticoagulant and antiplatelet medications part two: antiplatelet agents and perioperative management of long-term anticoagulation

Yeung, Louise; Sarani, Babak; Weinberg, Jordan A.; McBeth, Paul B.; May, Addison K.

doi:10.1136/tsaco-2016-000022

Cited by 23 publications

(9 citation statements)

References 45 publications

(52 reference statements)

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“…This was perhaps due to the increased risk of bleeding such therapy poses. The use of anti-platelets alone has been associated with increasing the risk of post-traumatic bleeding and morbidity [ 29 , 30 ] and therefore, the risk is largely dependent on platelet function that is perhaps best assessed by determining overall clot strength through a whole blood assay [ 31 ]. In a time-restricted situation such as in traumatic vascular surgery, this can be a challenging feat.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis on anticoagulation after vascular trauma

Khan

Elghazaly

Mian

et al. 2020

Eur J Trauma Emerg Surg

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Purpose There is much debate regarding the use of anticoagulation following vascular trauma. The aim of this meta-analysis was to compare the outcome of trauma following administration of anticoagulation medication. Methods The literature search was carried out using Ovid MEDLINE and PubMed databases to search for keywords and MeSH terms including "Anticoagulation", "Vascular Surgery", "Vascular Trauma", "Vascular Repair", "Repair" and "Wounds and Injuries". Results Use of anticoagulation was associated with a better prognosis for overall vascular trauma outcomes (weighted OR 0.46; 95% CI 0.34-0.64; P < 0.00001), as well as reduced risk of amputation for both lower and upper limb vascular trauma (weighted OR 0.42; 95% CI 0.22-0.78; P = 0.007), and reduced occurrence of reoperation events and amputations in isolated lower limb vascular trauma (weighted OR 0.27; 95% CI 0.14-0.52; P < 0.0001). Conclusion There was a statistically significant correlation between the use of anticoagulation and vascular trauma outcome. A major limitation with many of the studies includes a lack of prospective analysis and therefore we recommend prospective studies to properly elucidate prognostic outcomes following use of these anticoagulants. Further studies need to be conducted to assess the effects of timing of anticoagulant delivery, dosages and severity of traumatic injury. Thus, this would prove to be very useful in the formation of guidelines.

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Section: Discussionmentioning

confidence: 99%

A meta-analysis on anticoagulation after vascular trauma

Khan

Elghazaly

Mian

et al. 2020

Eur J Trauma Emerg Surg

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“…In cases where the patient is at high risk for a thromboembolic episode, a "bridge"-a balance between surgical bleed and risk of thrombosis may be achieved either with intravenous unfractionated heparin or with subcutaneous lowmolecular-weight heparin [16].…”

Section: Bridging With Heparinmentioning

confidence: 99%

Management of Medical Comorbidities in Maxillofacial Surgery

Moorthy

Krishna²

2021

Oral and Maxillofacial Surgery for the Clinician

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Oral and Maxillofacial surgery, like any surgical specialty, has two vital requirements. First, having the right armamentarium, and, second, acquiring appropriate skills and knowledge of the patients’ disease process, including comorbidities. With the changing demographic in India, the profile of Indian patient has undergone a sea change in the last few decades. From acute conditions that had little impact on subsequent health of the patient, we have arrived at a scenario where a large proportion of patients present with chronic disorders like diabetes, ischemic heart diseases, etc. that affect many elective procedures we undertake and require optimization of the overall physical status of the patient before proceeding with any surgery.Trainee surgeons need to be aware and updated and should be able to recognize, treat, or appropriately refer patients to the requisite specialty in case of complex conditions beyond their remit or ability. In this chapter, readers will get a very brief overview of the different organ systems that play crucial role in homeostasis and how to modify the treatment when there’s an imbalance in either of these systems.

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“…Antithrombotic therapy involves both antiplatelet and anticoagulation therapies. Although both antiplatelet and anticoagulation therapies have different mechanisms of action, they are vital to prevent further cardiovascular thrombotic events in high-risk patients; however, they also poses the risk of hemorrhage [1]. In these patients, surgeons should decide whether to continue these medications perioperatively, while considering the increased risk of bleeding and thrombotic events.…”

Section: Antithrombotic Therapymentioning

confidence: 99%