Peri-procedure management of antithrombotic agents and thrombocytopenia for common procedures in oncology: Guidance from the SSC of the ISTH.

Patients with cancer have an increased risk of thrombosis requiring anticoagulants and/or antiplatelet agents, and they can also encounter thrombocytopenia due to cancer itself or cancer therapies. They often undergo many procedures such as tissue or bone marrow biopsies, placement of central access lines, diagnostic or therapeutic draining procedures, lumbar puncture, and more. Management of antithrombotic agents or thrombocytopenia around the time of these procedures is highly variable. In this document, the Hemostasis and Malignancy Subcommittee of the International Society on Thrombosis and Haemostasis aims to provide useful practice guidance in the management of antithrombotic agents and thrombocytopenia around the time of common procedures in patients with cancer.

Management algorithm of acute cholecystitis after percutaneous cholecystostomy catheter placement based on outcomes from 377 patients.

PURPOSE: To report outcomes of percutaneous cholecystostomy (PC) catheter placement in patients with acute cholecystitis (AC) and propose management algorithm of AC after PC catheter placement based on the outcomes. METHOD AND MATERIALS: Retrospective study was performed. 419 patients who underwent PC between July 2010 and September 2016 were included. Patients who underwent PC for indication other than AC were excluded. The primary outcome was definitive treatment of AC following PC, including cholecystectomy or percutaneous cholecystolithotomy. Secondary outcomes include removal of drainage catheter without further management or death with catheter in place. Based on outcomes, we proposed management algorithm of AC after PC catheter placement. RESULTS: 377 of 419 patients underwent PC for treatment of AC (median age, 66 years; range 18-100 years). Technical success rate was 100% with 2.4% major complications rate and 1.6% minor complications rate. Following PC, 118 patients (31%) underwent definitive treatment with cholecystectomy. Sixty-one patients (16%) underwent definitive treatment with percutaneous cholecystolithotomy with removal of catheters. Seventy-four patients (20%) had their catheters removed upon resolution of cholecystitis without undergoing surgery or stone removal. Fifty patients (13%) died with catheters in place due to other comorbidities. Five patients (1%) still had their catheters in place at the end of the study. CONCLUSION: PC remains a viable option for treatment of AC with low complication rate and can be used as bridge to definitive therapy. Our proposed management algorithm can be a guideline for the management of AC after PC catheter placement.