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1.
Medicine (Baltimore) ; 100(10): e25003, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725878

RESUMO

ABSTRACT: The efficacy and safety of bivalirudin in percutaneous coronary intervention (PCI) has always been a hot topic in perioperative antithrombotic therapy, but there are still some controversies. So studies are needed to provide more evidence, especially the real world study which includes patients excluded from previous RCT studys. Our study aimed to investigate these information and analyze the independent predictors of postoperative adverse events.A retrospective study enrolled 1416 patients underwent PCI in Tianjin Chest Hospital from May 2016 to October 2017. The incidence of stent-thrombosis and net clinical adverse events, including all-cause death, myocardial infarction, stroke, urgent target-vessel revascularization and bleeding, were followed up for 30 days and 1 year. Logistic regression and COX regression were respectively used to analyze independent predictors of bleeding events within 30-days, and independent predictors of Major adverse cardiovascular and cerebrovascular events (MACCE) in patients with stent implantation within 1-year.Seven hundred six patients were treated with bivalirudin while 710 with unfractionated heparin (UFH). The proportions of diabetes, hypertension, anemia, myocardial-infarction history, PCI history, moderate-to-severe renal-impairment, gastrointestinal-bleeding history in the bivalirudin group were significantly higher (P < .05). Women, anemia were independent risk factors for bleeding within 30-days (P < .05). Among 682 patients with stent implantation in bivalirudin group, anemia, Body Mass Index (BMI) >25 kg/m2, KILLIP ≥2, ejection fraction (EF) <45%, eGFR <60 ml/minutes were independent risk factors for MACCE, while Statins, proton pump inhibitor (PPI) were independent protective factors for MACCE with-in 1-year (P < .05).Bivalirudin have good anticoagulant effect and lower bleeding risk during PCI, especially in patients with higher bleeding risk. In patients treated with bivalirudin, female, anemia were independent predictors of bleeding within 30-days, BMI >25 kg/m2, anemia, KILLIP ≥2, EF <45%, eGFR <60 ml/minutes were independent risk factors and Statins, PPI were independent protective factors of MACCE within 1-year.


Assuntos
Antitrombinas/administração & dosagem , Doença das Coronárias/cirurgia , Hirudinas/administração & dosagem , Fragmentos de Peptídeos/administração & dosagem , Intervenção Coronária Percutânea/efeitos adversos , Hemorragia Pós-Operatória/epidemiologia , Trombose/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Antitrombinas/efeitos adversos , Feminino , Hirudinas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Fragmentos de Peptídeos/efeitos adversos , Assistência Perioperatória/efeitos adversos , Assistência Perioperatória/métodos , Hemorragia Pós-Operatória/induzido quimicamente , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Stents , Trombose/etiologia , Trombose/prevenção & controle , Resultado do Tratamento
3.
Int Heart J ; 61(5): 865-871, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921667

RESUMO

Bleeding complication has been considered as a serious problem in current percutaneous coronary interventions (PCI). Fortunately, several groups have already reported the effectiveness of protamine use just after PCI to immediately remove any arterial sheath. However, there is a concern that protamine reversal may increase non-occlusive thrombus and, in turn, lead to mid-term cardiovascular events such as target vessel revascularization (TVR) or stent thrombosis. Thus, the purpose of this study was to evaluate whether protamine use following elective PCI was associated with mid-term clinical outcomes. In total, 472 patients were included in this study; subsequently, they were divided into protamine group (n = 142) and non-protamine group (n = 330). The primary endpoint was the composite of ischemia-driven TVR and stent thrombosis. The median follow-up period was determined to be at 562 days. In total, 32 primary endpoints were observed during the study period, and the incidence of primary endpoints tended to be greater in the protamine group than in the non-protamine group (P = 0.056). However, the lesion length, the degree of calcification, and the prevalence of hemodialysis were significantly determined greater in the protamine group than in the non-protamine group. In the multivariate Cox proportional hazards model, the use of protamine (versus non-protamine: hazard ratio 0.542 and 95% confidence interval 0.217-1.355, P = 0.191) was deemed not to be associated with the primary endpoint after controlling legion length, calcification, and hemodialysis. In conclusion, immediate protamine use following elective PCI did not increase mid-term ischemia-driven TVR or stent thrombosis. However, immediate protamine use after PCI should be discussed further for the safety of the patient.


Assuntos
Estenose Coronária/cirurgia , Antagonistas de Heparina/uso terapêutico , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Operatória/prevenção & controle , Protaminas/uso terapêutico , Trombose/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Estudos de Casos e Controles , Estenose Coronária/epidemiologia , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Heparina/efeitos adversos , Humanos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/estatística & dados numéricos , Complicações Pós-Operatórias/induzido quimicamente , Hemorragia Pós-Operatória/induzido quimicamente , Modelos de Riscos Proporcionais , Diálise Renal , Estudos Retrospectivos , Stents , Trombose/induzido quimicamente , Calcificação Vascular/epidemiologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-32811791

RESUMO

OBJECTIVES: This literature review was performed to assess the risk of bleeding in dental implantation procedures in patients taking antiplatelet drugs (APs), oral anticoagulants (OACs) and direct oral anticoagulants (DOACs). STUDY DESIGN: MEDLINE and SCOPUS databases were searched for English language publications through October 2019, using the keywords "dental implants," "dental implantation," "anticoagulants," "platelet aggregation inhibitors," and "hemorrhage." Reference lists of relevant articles were also hand searched. Collected data regarding dental implantation procedures, type of medications (APs, OACs and DOAC), and postoperative bleeding episodes were analyzed. RESULTS: Nine studies were included in the review. Postoperative bleeding occurred in 10 (2.2%) of 456 of cases involving dental implant placements; in all of those cases, bleeding was controlled with the use of local hemostatic agents. The bleeding incidence in patients on antiplatelet medications was 0.4% (range 1 of 253 to 1 of 261). Among those taking oral anticoagulants, the bleeding incidence was 5.7% (range 6 of 105 to 6 of 113), and among those on direct oral anticoagulants, the bleeding incidence was 3.3% (3 of 90). The numbers of more extensive surgical procedures (i.e., sinus lift and bone augmentation procedures) were small, and additional information regarding the surgery, the specific antithrombotic used, or bleeding was often not provided, so further analysis was not possible. CONCLUSIONS: Evidence supports continuing OACs, DOACs, or APs during dental implant surgery.


Assuntos
Implantes Dentários , Hemostáticos , Administração Oral , Anticoagulantes/efeitos adversos , Implantes Dentários/efeitos adversos , Fibrinolíticos/efeitos adversos , Humanos , Hemorragia Pós-Operatória/induzido quimicamente , Hemorragia Pós-Operatória/epidemiologia
5.
Transplant Proc ; 52(6): 1778-1783, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32571699

RESUMO

There is no consensus regarding the use of systemic heparin, and long-term outcomes of living donor hepatectomy (LDH) without systemic heparinization have not yet been determined. This study was performed to determine whether systemic heparinization can be omitted during LDH, with a focus on donor safety and long-term outcomes. We retrospectively analyzed the outcomes of 175 cases of LDH performed in our institution between January 2011 and December 2014: group I (n = 79) received systemic heparinization, whereas group II (n = 96) did not, but liver graft was flushed with a heparinized perfusate. Postoperative bleeding requiring blood transfusion or intervention was more frequent in group I than in group II (P = .028). The decreases in donor hemoglobin and hematocrit levels, and platelet count during the early postoperative period, were greater in group I than in group II. In multivariate analysis, systemic heparin was the only independent risk factor for blood transfusion (odds ratio [OR] = 5.114; 95% confidence interval [CI]: 1.201-21.775; P = .027) and significant postoperative bleeding (OR = 7.731; 95% CI: 1.345-44.429; P = .022) after LDH. Most postoperative complications including graft vascular thrombosis were similar between the 2 groups, as was the survival rate, and neither graft loss due to vascular thrombosis nor non-anastomotic biliary stricture was evident. In conclusion, omission of systemic heparinization during LDH is a feasible and safe option without adverse effects.


Assuntos
Heparina/administração & dosagem , Hepatectomia/métodos , Doadores Vivos , Complicações Pós-Operatórias/induzido quimicamente , Coleta de Tecidos e Órgãos/métodos , Adulto , Transfusão de Sangue/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Heparina/efeitos adversos , Hepatectomia/efeitos adversos , Humanos , Fígado/cirurgia , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Hemorragia Pós-Operatória/induzido quimicamente , Período Pós-Operatório , Estudos Retrospectivos , Trombose/induzido quimicamente , Coleta de Tecidos e Órgãos/efeitos adversos , Transplantes/cirurgia , Resultado do Tratamento
6.
Cochrane Database Syst Rev ; 4: CD009894, 2020 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-32302004

RESUMO

BACKGROUND: The success of digital replantation is highly dependent on the patency of the repaired vessels after microvascular anastomosis. Antithrombotic agents are frequently used for preventing vascular occlusion. Low molecular weight heparin (LMWH) has been reported to be as effective as unfractionated heparin (UFH) in peripheral vascular surgery, but with fewer adverse effects. Its benefit in microvascular surgery such as digital replantation is unclear. This is an update of the review first published in 2013. OBJECTIVES: To assess if treatment with subcutaneous LMWH improves the salvage rate of the digits in patients with digital replantation after traumatic amputation. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, AMED and CINAHL databases, and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers, to 17 March 2020. The authors searched PubMed, China National Knowledge Infrastructure (CNKI) and Chinese Electronic Periodical Services (CEPS) on 17 March 2020 and sought additional trials from reference lists of relevant publications. SELECTION CRITERIA: We included randomised or quasi-randomised controlled trials comparing treatment with LMWH versus any other treatment in participants who received digital replantation following traumatic digital amputation. DATA COLLECTION AND ANALYSIS: Two review authors (PL, CC) independently extracted data and assessed the risk of bias of the included trials using Cochrane's 'Risk of bias' tool. Disagreements were resolved by discussion. We assessed the certainty of evidence using the GRADE approach. MAIN RESULTS: We included two new randomised trials in this update, bringing the total number of included trials to four. They included a total of 258 participants, with at least 273 digits, from hospitals in China. Three studies compared LMWH versus UFH, and one compared LMWH versus no LMWH. The mean age of participants ranged from 24.5 to 37.6 years. In the studies reporting the sex of participants, there were a total of 145 men and 59 women. The certainty of the evidence was downgraded to low or very low because all studies were at high risk of performance or reporting bias (or both) and there was imprecision in the results due to the small numbers of participants. The three studies comparing LMWH versus UFH reported the success rate of replantation using different units of analysis (participant or digit), so we were unable to combine data from all three studies (one study reported results for both participants and digits). No evidence of a benefit in success of replantation was seen in the LMWH group when compared with UFH, regardless of whether the outcomes were reported by number of participants (risk ratio (RR) 0.98, 95% confidence interval (CI) 0.87 to 1.10; 130 participants, 2 studies; very low-certainty evidence); or by number of digits (RR 0.97, 95% CI 0.90 to 1.04; 200 digits, 2 studies; low-certainty evidence). No studies reported the incidence of compromised microcirculation requiring surgical or non-surgical therapy, or any systemic/other causes of microvascular insufficiency. There was no evidence of a clear difference between the LMWH and UFH groups in occurrence of arterial occlusion (RR 1.08, 95% CI 0.16 to 7.10; 54 participants, 1 study; very low-certainty evidence) or venous occlusion (RR 0.81, 95% CI 0.20 to 3.27; 54 participants, 1 study; very low-certainty evidence). Two studies reported adverse effects. The LMWH and UFH groups showed no evidence of a difference in wound bleeding (RR 0.53, 95% CI 0.23 to 1.23; 130 participants, 2 studies; low-certainty evidence), haematuria (RR 0.43, 95% CI 0.09 to 2.11; 130 participants, 2 studies; very low-certainty evidence), ecchymoses (RR 0.82, 95% CI 0.21 to 3.19; 130 participants, 2 studies; very low-certainty evidence), epistaxis (RR 0.27, 95% CI 0.03 to 2.32; 130 participants, 2 studies; very low-certainty evidence), gingival bleeding (RR 0.18, 95% CI 0.02 to 1.43; 130 participants, 2 studies; very low-certainty evidence), and faecal occult blood (RR 0.27, 95% CI 0.03 to 2.31; 130 participants, 2 studies; very low-certainty evidence). We could not pool data on coagulation abnormalities as varying definitions and tests were used in the three studies. One study compared LMWH versus no LMWH. The success rate of replantation, when analysed by digits, was reported as 91.2% success in the LMWH group and 82.1% in the control group (RR 1.11, 95% CI 0.93 to 1.33; 73 digits, 1 study; very low-certainty evidence). Compromised microcirculation requiring surgical re-exploration, analysed by digits, was 11.8% in the LMWH group and 17.9% in the control group (RR 0.86, 95% CI 0.21 to 3.58; 73 digits, 1 study; very low-certainty evidence). Compromised microcirculation requiring incision occurred in five out of 34 digits (14.7%) in the LMWH group and eight out of 39 digits (20.5%) in the control group (RR 0.72, 95% CI 0.26 to 1.98; 73 digits; very low-certainty evidence). Microvascular insufficiency due to arterial occlusion, analysed by digits, was 11.8% in the LMWH group and 17.9% in the control group (RR 0.66, 95% CI 0.21 to 2.05; 73 digits, 1 study; very low-certainty evidence), and venous occlusion was 14.7% in the LMWH group and 20.5% in the control (RR 0.72, 95% CI 0.26 to 1.98; 73 digits, 1 study; very low-certainty evidence). The study did not report complications or adverse effects. AUTHORS' CONCLUSIONS: There is currently low to very low-certainty evidence, based on four RCTs, suggesting no evidence of a benefit from LMWH when compared to UFH on the success rates of replantation or affect microvascular insufficiency due to vessel occlusion (analysed by digit or participant). LMWH had similar success rates of replantation; and the incidence rate of venous and arterial microvascular insufficiency showed no evidence of a difference between groups when LMWH was compared to no LMWH (analysed by digit). Similar rates of complications and adverse effects were seen between UFH and LMWH. There was insufficient evidence to draw conclusions on any effect on coagulation when comparing LMWH to UFH or no LMWH. The certainty of the evidence was downgraded due to performance and reporting bias, as well as imprecision in the results. Further adequately powered studies are warranted to provide high-certainty evidence.


Assuntos
Anticoagulantes/uso terapêutico , Dedos/transplante , Heparina de Baixo Peso Molecular/uso terapêutico , Microvasos/cirurgia , Reimplante/efeitos adversos , Adulto , Anticoagulantes/efeitos adversos , Transtornos da Coagulação Sanguínea/induzido quimicamente , Feminino , Dedos/irrigação sanguínea , Heparina/uso terapêutico , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Masculino , Doença Arterial Periférica/epidemiologia , Hemorragia Pós-Operatória/induzido quimicamente , Ensaios Clínicos Controlados Aleatórios como Assunto , Insuficiência Venosa/epidemiologia
7.
Int J Pediatr Otorhinolaryngol ; 133: 109965, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32120134

RESUMO

OBJECTIVES: Intravenous (IV) ibuprofen was approved by the FDA for use in pediatric patients in November 2015. The objective of this study was to compare bleeding rates in pediatric tonsillectomy patients who received intraoperative intravenous ibuprofen versus those who did not. Secondary objectives included analyzing factors that correlated with return to the Emergency Department (ED) for pain or dehydration. METHODS: Charts were reviewed for all patients 0-18 years of age who underwent a tonsillectomy with or without adenoidectomy at a tertiary care children's hospital from 1/1/2017 through 5/21/2018. Demographic information and perioperative medications including the use of intraoperative intravenous ibuprofen were recorded. ED visits and operating room (OR) returns for bleeding were tracked for up to 30 days after surgery. RESULTS: 1085 charts were analyzed. Intraoperative IV ibuprofen was used in 132 cases (12.2%). Primary bleeds, defined as bleeding within 24 h of surgery, occurred in 1 (0.76%) of 132 patients who received IV ibuprofen, and 1 (0.10%) of 953 patients who did not receive IV ibuprofen. Secondary bleeds, defined as bleeds after 24 h from surgery occurred in 2 (1.52%) of 132 patients who received IV ibuprofen and 38 (3.99%) of 953 patients who did not receive IV ibuprofen. No statistical difference was found between the two groups in rates of overall (primary plus secondary) bleeding requiring return to ED (p = 0.759) or return to OR (p = 0.710). CONCLUSION: The observed bleeding rate after pediatric tonsillectomy was not statistically different in patients who received intraoperative IV ibuprofen versus those who did not receive this medication. LEVEL OF EVIDENCE: III.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Ibuprofeno/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Hemorragia Pós-Operatória/induzido quimicamente , Tonsilectomia , Adenoidectomia , Administração Intravenosa , Adolescente , Anti-Inflamatórios não Esteroides/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Ibuprofeno/uso terapêutico , Lactente , Recém-Nascido , Masculino , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
8.
Ann Thorac Surg ; 110(4): e269-e270, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32217068

RESUMO

Patients with indications for emergent cardiac surgery procedures who have previously received a P2Y12 inhibitor loading dose are at extremely high risk for bleeding. We present a successful example of lateral thinking in solving a controversial clinical scenario.


Assuntos
Ponte de Artéria Coronária , Intubação Gastrointestinal , Hemorragia Pós-Operatória/prevenção & controle , Humanos , Doença Iatrogênica/prevenção & controle , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/induzido quimicamente
9.
Am J Cardiol ; 125(8): 1142-1147, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32087994

RESUMO

Bleeding risk stratification is an unresolved issue in older adults. Anemia may reflect subclinical blood losses that can be exacerbated after percutaneous coronary intervention . We sought to prospectively determine the contribution of anemia to the risk of bleeding in 448 consecutive patients aged 75 or more years, treated by percutaneous coronary interventions without concomitant indication for oral anticoagulation. We evaluated the effect of WHO-defined anemia on the incidence of 1-year nonaccess site-related major bleeding. The prevalence of anemia was 39%, and 13.1% of anemic and 5.2% of nonanemic patients suffered a bleeding event (hazard ratio 2.75, 95% confidence interval 1.37 to 5.54, p = 0.004). Neither PRECISE-DAPT nor CRUSADE scores were superior to hemoglobin for the prediction of bleeding. In conclusion, anemia is a powerful predictor of bleeding with potential utility for simplifying tailoring therapies.


Assuntos
Síndrome Coronariana Aguda/cirurgia , Anemia/epidemiologia , Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea/métodos , Inibidores da Agregação de Plaquetas/uso terapêutico , Hemorragia Pós-Operatória/epidemiologia , Síndrome Coronariana Aguda/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Angina Instável/epidemiologia , Angina Instável/cirurgia , Anticoagulantes/uso terapêutico , Antitrombinas/uso terapêutico , Aspirina/uso terapêutico , Causas de Morte , Clopidogrel/uso terapêutico , Comorbidade , Doença da Artéria Coronariana/epidemiologia , Stents Farmacológicos , Feminino , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/mortalidade , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Hemorragia/mortalidade , Heparina/uso terapêutico , Hirudinas , Humanos , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/mortalidade , Estimativa de Kaplan-Meier , Masculino , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/cirurgia , Fragmentos de Peptídeos/uso terapêutico , Cuidados Pós-Operatórios , Hemorragia Pós-Operatória/induzido quimicamente , Hemorragia Pós-Operatória/mortalidade , Cloridrato de Prasugrel/uso terapêutico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Proteínas Recombinantes/uso terapêutico , Medição de Risco , Stents , Ticagrelor/uso terapêutico , Doenças Urológicas/induzido quimicamente , Doenças Urológicas/epidemiologia , Doenças Urológicas/mortalidade
10.
Am J Med ; 133(8): 969-975.e2, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32007455

RESUMO

BACKGROUND: Hip fracture is common in the elderly, many of whom are on anticoagulation. However, data are limited on outcomes with anticoagulation reversal in patients undergoing hip fracture surgery. METHODS: Adults ≥60 years old on oral anticoagulation who underwent hip fracture surgery at 21 hospitals in Northern California from 2006 to 2016 were identified through electronic databases. Outcomes were compared among patients treated and untreated with anticoagulation reversal preoperatively. RESULTS: Of 1984 patients on oral anticoagulation who underwent hip fracture surgery, 1943 (97.9%) were on warfarin and 41 (2.1%) were on direct oral anticoagulants. Reversal agents were administered to 1635 (82.4%). Compared to a watch-and-wait strategy, patients receiving reversal agents were more likely to be white, male, comorbid, and with higher admission and preoperative international normalized ratios (P <0.001 for all comparisons). No difference for 30-day mortality was detected between reversal vs non-reversal (7.8% vs 6.0%, respectively; hazard ratio [HR], 1.30 [95% confidence interval (CI), 0.82-2.07]). For secondary outcomes, reversal was associated with higher risk of delirium (8.6% vs 4.9%, risk ratio [RR], 1.77 [95% CI, 1.08-2.89]) and increased mean length of stay (6.4 vs 5.8 days, P <0.05). After adjustment, associations were no longer significant for delirium (RR 1.60, 95% CI, 0.97-2.65) or length of stay (mean difference 0.08, 95% CI, -0.55-0.71). No associations were detected between reversal and other secondary outcomes. CONCLUSION: No significant associations were found between reversal agents and 30-day mortality or other outcomes in patients on oral anticoagulation who underwent hip fracture surgery. Further investigation is needed.


Assuntos
Anticoagulantes/efeitos adversos , Antifibrinolíticos/uso terapêutico , Fatores de Coagulação Sanguínea/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Fraturas do Quadril/cirurgia , Hemorragia Pós-Operatória/prevenção & controle , Cuidados Pré-Operatórios/métodos , Afro-Americanos , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados/uso terapêutico , Artroplastia de Quadril , Americanos Asiáticos , Transfusão de Sangue , Estudos de Coortes , Delírio/epidemiologia , Grupo com Ancestrais do Continente Europeu , Inibidores do Fator Xa/efeitos adversos , Feminino , Fixação Interna de Fraturas , Hispano-Americanos , Humanos , Coeficiente Internacional Normatizado , Tempo de Internação , Masculino , Mortalidade , Procedimentos Ortopédicos , Plasma , Complicações Pós-Operatórias , Hemorragia Pós-Operatória/induzido quimicamente , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores Sexuais , Vitamina K/uso terapêutico , Varfarina/efeitos adversos
11.
World Neurosurg ; 137: 408-414, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32105874

RESUMO

OBJECTIVE: Cerebral venous thrombosis (CVT) is a rare type of stroke whose pathophysiology differs from arterial stroke. CVT is treated with systemic anticoagulant therapy even in the setting of intracerebral hemorrhage. Patients who do not respond adequately may require decompressive surgery. The study objective was to examine the timing of anticoagulation in patients with CVT who require decompressive surgery through systematic literature review and consecutive case series. METHODS: A review of the literature was performed through PubMed using key word search to identify case series and cohort studies examining timing of anticoagulation following decompressive surgery. Our case series included 4 patients who had decompressive surgery for hemorrhagic CVT between 1 January, 2015 and 31 December, 2016 at our comprehensive stroke center. RESULTS: The literature review summarizes 243 patients from 15 studies whose timing of anticoagulation varied. The review suggests anticoagulation can be safely resumed at 48 hours postoperatively based on larger series and as early as 12 hours in smaller series, especially when delivered as a half or prophylactic dose. In our case series, timing of anticoagulation varied slightly but was started or resumed within 38-44 hours postoperatively in 3 patients and was started at the time of decompressive surgery without interruption in 1 patient. No patient had worsening hemorrhage or new hemorrhage while 2 patients rethrombosed. CONCLUSIONS: Despite the lack of high-quality studies, this systematic review of patients with CVT requiring decompressive surgery indicates that anticoagulation can be safely initiated or resumed around 24-48 hours postoperatively; our series supports the existing literature.


Assuntos
Anticoagulantes/administração & dosagem , Craniectomia Descompressiva/métodos , Heparina/administração & dosagem , Trombose dos Seios Intracranianos/terapia , Adulto , Anticoagulantes/efeitos adversos , Angiografia Cerebral , Hemorragia Cerebral/induzido quimicamente , Procedimentos Endovasculares , Feminino , Heparina/efeitos adversos , Antagonistas de Heparina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/induzido quimicamente , Período Pós-Operatório , Protaminas/uso terapêutico , Trombectomia , Terapia Trombolítica , Fatores de Tempo
12.
Plast Reconstr Surg ; 145(2): 360e-367e, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985640

RESUMO

BACKGROUND: Carpal tunnel release is one of the most common procedures in hand surgery. There is only scarce evidence regarding whether platelet inhibitors increase the risk of developing postoperative hemorrhage in carpal tunnel release. METHODS: This is a multicenter, propensity score-matched study including 635 carpal tunnel releases in 497 patients. Multivariate regression models were adjusted with the propensity score, which was developed to mitigate differences in patients with and without platelet inhibition with acetylsalicylic acid. Propensity score matching provides results close to the statistical quality of randomized controlled trials. The primary study endpoint was postoperative bleeding complication, defined as acute bleeding leading to reoperation or hematoma leading to physician visit. Patient satisfaction, functional outcome measured with the Boston Carpal Tunnel Questionnaire, and onset of surgical-site infection were also analyzed. RESULTS: Bleeding complications were observed in 56 procedures (8.8 percent). After propensity score matching, there was no significant difference between the patients with and without acetylsalicylic acid treatment (p = 0.997). History of thyroid disease (p = 0.035) and of rheumatoid arthritis (p = 0.026) were independent risk factors, whereas higher body mass index might have a beneficial effect (p = 0.006). Patients with postoperative bleeding had significantly impaired functional outcome as measured with the Boston Carpal Tunnel Questionnaire (p = 0.026). Median satisfaction in the investigated study population was 10 of 10 points and did not differ significantly between the antiplatelet and the non-antiplatelet cohorts (p = 0.072) CONCLUSION:: Carpal tunnel release under platelet inhibition with acetylsalicylic acid is safe and can be performed without interruption of such medication. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Aspirina/efeitos adversos , Síndrome do Túnel Carpal/cirurgia , Inibidores da Agregação de Plaquetas/efeitos adversos , Hemorragia Pós-Operatória/induzido quimicamente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Hemorragia Pós-Operatória/prevenção & controle , Pontuação de Propensão , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco
13.
Ann Vasc Surg ; 66: 272-281.e1, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31931126

RESUMO

BACKGROUND: The benefit of long-term anticoagulation or dual antiplatelet therapy (DAPT) for patients with extra-anatomic bypasses to the lower extremity remains poorly defined. Our study analyzed the real-world use of antithrombotic therapy in patients with extra-anatomic bypass grafts to the lower extremity and compared graft and patient outcomes by antithrombotic regimen. METHODS: We studied patients who underwent axillofemoral or femoral-femoral bypass within the Vascular Quality Initiative with one-year follow-up data. Primary exposures were anticoagulation and DAPT, at the time of index procedure and one-year follow-up. Primary outcomes were major adverse limb events (MALE) defined as reintervention or above-ankle amputation, and primary patency. Secondary outcomes included perioperative blood transfusion requirements and the need for reoperation specifically for bleeding. We analyzed outcomes using the Kaplan-Meier estimation and examined factors associated with choice of antithrombotic therapy via logistic regression. RESULTS: Our cohort included 2,760 patients (axillofemoral bypass, n = 857; femoral-femoral bypass, n = 1,903) across 168 centers from 2009 to 2018. Mean age was 66.5 ± 10.5 years and 59% were male. Patients were infrequently prescribed long-term anticoagulation (19%) or DAPT (22%). One-year primary patency was 86% and was similar by anticoagulation (log-rank P = 0.12) and DAPT status (log-rank P = 0.26). Freedom from MALE was 87% at 1 year and was slightly inferior for patients on anticoagulation (88 vs. 83%, log-rank P = 0.001) but was similar by DAPT (log-rank P = 0.19). Transfusion was more common in patients who were anticoagulated than those who were not (30 vs. 25%, P < 0.01), but there was no increase in reoperation because of bleeding (anticoagulation 0.8 vs. 0.8, P = 0.98). Anticoagulation was more commonly prescribed according to disease severity, such as rest pain (adjusted odds ratio (OR): 1.6 (95% confidence interval (CI): 1.20-2.20), tissue loss (OR: 1.9, CI: 1.28-2.73), or acute limb ischemia (OR: 1.9, CI: 1.35-2.71) or prior bypass graft (OR: 2.6, CI: 2.07-3.35). Patients were more commonly prescribed DAPT according to comorbidities, including hypertension (OR: 1.4, CI: 1.04-1.94) and coronary artery disease (OR: 1.6, CI 1.26-1.95). CONCLUSIONS: Antithrombotics are selectively used in patients with extra-anatomic bypass to the lower extremity, the selection of which appears associated with disease severity for anticoagulants and patient comorbidities for DAPT. Primary patency and MALE rates are similar with focused utilization of anticoagulants or DAPT. Blood transfusions are more common among patients on antithrombotics without a difference in the need for reoperation for bleeding.


Assuntos
Anticoagulantes/administração & dosagem , Implante de Prótese Vascular , Terapia Antiplaquetária Dupla , Fibrinolíticos/administração & dosagem , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Inibidores da Agregação de Plaquetas/administração & dosagem , Idoso , Amputação , Anticoagulantes/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Tomada de Decisão Clínica , Terapia Antiplaquetária Dupla/efeitos adversos , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Inibidores da Agregação de Plaquetas/efeitos adversos , Hemorragia Pós-Operatória/induzido quimicamente , Hemorragia Pós-Operatória/cirurgia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
14.
J Card Surg ; 35(2): 413-421, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31803992

RESUMO

BACKGROUND: Clopidogrel and other P2Y12 inhibitors have become the standard of care among patients presenting with acute coronary syndromes. A substantial proportion of these patients require surgical revascularization during index hospitalization. HYPOTHESIS: Guidelines recommend a 5-day waiting period off clopidogrel before coronary artery bypass grafting (CABG) to reduce hemorrhagic complications. These recommendations are not routinely followed in clinical practice, while recent studies also propose shorter waiting periods off clopidogrel for patients awaiting in-hospital CABG. METHODS: A preliminary PubMed search was conducted using the following MeSH terms under the publication type "Hemorrhage:" "Clopidogrel," AND "Coronary Artery Bypass." Relevant studies and guidelines were then reviewed and selected based on a predetermined criteria. Studies that formulated the current recommendations for stopping clopidogrel preoperative to CABG are discussed in detail this review. RESULTS: A comprehensive review of recent evidence illustrates mixed bleeding and transfusion outcomes among CABG patients with preoperative exposure to clopidogrel in less than 5 days. CONCLUSIONS: The optimal discontinuation time of clopidogrel before CABG is still poorly defined. The recommendation of a 5-day washout period for clopidogrel should be reconsidered to be on par with current clinical practice.


Assuntos
Clopidogrel/administração & dosagem , Clopidogrel/efeitos adversos , Ponte de Artéria Coronária , Hemorragia Pós-Operatória/prevenção & controle , Antagonistas do Receptor Purinérgico P2Y/administração & dosagem , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Humanos , Hemorragia Pós-Operatória/induzido quimicamente , Fatores de Tempo
15.
Dermatol Surg ; 46(2): 192-201, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31743247

RESUMO

BACKGROUND: Bleeding is an unavoidable risk of dermatologic surgery. The risk may be higher in patients taking agents that affect hemostasis. OBJECTIVE: The aim of this study was to provide an updated review of current anticoagulant and antiplatelet therapy available in the market and their associated risk of bleeding complications in cutaneous surgery. MATERIALS AND METHODS: A review of PubMed and MEDLINE was performed to review the English-language medical literature. RESULTS: Many anticoagulant and antiplatelet therapies exist. Several studies recommend the continued use of antiplatelet and anticoagulant medications in the perioperative period. Combination regimens and novel oral anticoagulants may be associated with an increased risk of bleeding. CONCLUSION: An updated understanding of antiplatelet and anticoagulant agents is critical for the surgeon. Current evidence does not support the discontinuation of antiplatelet and anticoagulant agents in the perioperative period under most circumstances. However, relevant data on novel oral anticoagulant agents are still sparse, suggesting that a precautionary approach is warranted.


Assuntos
Anticoagulantes/efeitos adversos , Perda Sanguínea Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Inibidores da Agregação de Plaquetas/efeitos adversos , Hemorragia Pós-Operatória/prevenção & controle , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/prevenção & controle , Humanos , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/prevenção & controle , Período Perioperatório , Hemorragia Pós-Operatória/induzido quimicamente , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/prevenção & controle , Acidente Vascular Cerebral/tratamento farmacológico , Trombose Venosa/tratamento farmacológico , Trombose Venosa/prevenção & controle
16.
Acta Haematol ; 143(3): 266-271, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31610537

RESUMO

INTRODUCTION: Patients treated with direct Xa inhibitors may require urgent surgery. Administration of prothrombin complex concentrate (PCC) in this setting is common; however, it is based on limited experience in healthy volunteers. OBJECTIVE: To characterize the population receiving PCC for apixaban/rivaroxaban reversal prior to an urgent surgery and evaluate its efficacy and safety. METHODS: This was a retrospective study in 2 tertiary hospitals. Bleeding was evaluated based on surgical reports, hemoglobin drop, and the use of blood products or additional PCC during 48 h. Safety measures were thrombotic complications and 30-day mortality. RESULTS: Sixty-two patients aged 80.7 ± 9 years, treated with apixaban (39.63%) or rivaroxaban (23.37%), received PCC before an urgent surgery/procedure. Most underwent abdominal operation (61%), orthopedic surgery (13%), or transhepatic cholecystostomy insertion (10%). Bleeding during surgery was reported in 3 patients (5%), no patient required additional PCC, and 16 patients (26%) received packed cells (median: 1 unit, range: 1-5). The 30-day mortality and thrombosis rates were 21% (n = 13) and 3% (n = 2), respectively. The cause of death was related to the primary disease, most commonly sepsis. No patient died due to bleeding/thrombosis. CONCLUSIONS: Our results support the use of PCC to achieve hemostasis in patients treated with Xa inhibitors prior to an urgent surgery.


Assuntos
Fatores de Coagulação Sanguínea/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Emergências , Inibidores do Fator Xa/efeitos adversos , Hemorragia Pós-Operatória/prevenção & controle , Cuidados Pré-Operatórios/métodos , Pirazóis/efeitos adversos , Piridonas/efeitos adversos , Rivaroxabana/efeitos adversos , Centros Médicos Acadêmicos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Fatores de Coagulação Sanguínea/efeitos adversos , Transfusão de Componentes Sanguíneos , Inibidores do Fator Xa/uso terapêutico , Feminino , Hemostáticos/uso terapêutico , Humanos , Masculino , Hemorragia Pós-Operatória/induzido quimicamente , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Estudos Retrospectivos , Rivaroxabana/uso terapêutico , Procedimentos Cirúrgicos Operatórios , Centros de Atenção Terciária/estatística & dados numéricos , Trombofilia/tratamento farmacológico , Trombofilia/etiologia , Trombose/etiologia , Ácido Tranexâmico/uso terapêutico
17.
Eur J Surg Oncol ; 46(4 Pt A): 577-581, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31677939

RESUMO

INTRODUCTION: Morbidity associated with cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is due to the synergistic effect of cytoreduction, effect hyperthermia and the cytotoxic agents used for HIPEC. This study was done to analyse the postoperative morbidity in relation to the chemotherapy agent used in patients undergoing CRS-HIPEC for peritoneal surface malignancy (PSM) in Indian set up. MATERIALS AND METHODS: Patient with PSM, underwent CRS-HIPEC as per the institutional protocol. Patients were stratified as per the chemotherapy drug used during HIPEC & perioperative outcome were documented. RESULTS: 163 patients underwent CRS-HIPEC for PSM: 67.4% were of ovarian primary. Others were colorectal, appendicular, gastric primary and rare tumors.Cisplatin was the most common drug used: as alone (57.05%) or in combination with Adriamycin (12.88%). Mitomycin-C (MMC) was used in 20% and oxaliplatin in 10%.Grade 3-5 morbidity in the whole cohort was 44.8% and grade 1-2 was 74%.Grade 1-2 electrolyte abnormality was the most common morbidity overall and grade 3-4 hematological toxicity was the most common severe morbidity. Frequency of grade 3-5 morbidity were 38.7%, 48.5%,50% and 61.9% for Cisplatin alone, MMC, oxaliplatin and Adriamycin + cisplatin respectively. None of the patients had grade 3-4 nephrotoxicity as sole complication. All major complications were highest in the group who received Adriamycin. Cisplatin was associated with higher rate of electrolyte imbalance, oxaliplatin with post-operative bleeding. Rates of other complications did not differ significantly. CONCLUSION: Cisplatin followed by MMC were the well tolerated drugs during HIPEC and tolerance to Adriamycin combination regimen in Indian patients was poor.


Assuntos
Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carcinoma/terapia , Procedimentos Cirúrgicos de Citorredução , Hipertermia Induzida , Neoplasias Peritoneais/terapia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Neoplasias do Apêndice/patologia , Carcinoma/secundário , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Neoplasias Colorretais/patologia , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Mitomicina/efeitos adversos , Neoplasias Ovarianas/patologia , Oxaliplatina/efeitos adversos , Neoplasias Peritoneais/secundário , Complicações Pós-Operatórias/induzido quimicamente , Hemorragia Pós-Operatória/induzido quimicamente , Hemorragia Pós-Operatória/epidemiologia , Neoplasias Gástricas/patologia , Desequilíbrio Hidroeletrolítico/induzido quimicamente , Desequilíbrio Hidroeletrolítico/epidemiologia
18.
Urologe A ; 59(1): 40-51, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31541268

RESUMO

BACKGROUND: According to the current definition of the German guideline for prevention of venous thromboembolism, urological surgery includes a high number of high-risk patients. All patients undergoing urological surgery between 2012 and 2016 were analyzed with regard to complications (bleeding or thrombosis). MATERIALS AND METHODS: This study is a retrospective and monocentric cohort study. Included were all patients who underwent surgery between 2012 and 2016 at the Urological Department at the University Hospital of Luebeck. Information was collected relating to anticoagulation, patient-specific and surgery-specific risk factors, and complications. RESULTS: In all, 3609 surgeries were analyzed: 77.8% of patients received no medical prophylaxis, 10.2% received an aggregation inhibitor, and 8.5% synthetic, unfractionated or low molecular weight heparin. Heparin was administered to 80.4% of patients after surgery. During an average hospital stay of 4.5 days, 93.3% of the patients received no change in anticoagulation. Merely 0.8% of all patients suffered from clinical thomboembolic events within 28 days. In contrast the number of bleedings was higher with 20.3% (minor: 4.8%, major: 15.5%). CONCLUSION: We found a slight risk for postoperative thromboembolism (0.8%). The risk for postoperative bleeding in contrast was 20.3%, including 15.5% major bleedings. The results are discussed in relation to the current guidelines.


Assuntos
Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Hemorragia Pós-Operatória/induzido quimicamente , Tromboembolia/prevenção & controle , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Anticoagulantes/efeitos adversos , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Tromboembolia/etiologia
19.
Asian J Endosc Surg ; 13(1): 33-38, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30784217

RESUMO

INTRODUCTION: The perioperative antiplatelet management of patients receiving antiplatelet therapy (APT) for elective laparoscopic cholecystectomy (LC) is still controversial. METHODS: A total of 808 patients who underwent elective LC were reviewed. We classified patients in this cohort into three groups according to thromboembolic risks: patients with no thromboembolic risk (non-APT group, n = 653), patients with low thromboembolic risk (APT-LR group, n = 106), patients with high thromboembolic risk (APT-HR group, n = 49). Our perioperative management of patients with high thrombotic risks included preoperative continuation of single aspirin therapy and early postoperative reinstitution. We assessed intraoperative and postoperative bleeding/thrombotic events among three groups. Primary outcome measures were intraoperative bleeding complications (IBCs, blood loss 200 mL or more) and postoperative bleeding complications (PBCs), and the independent risk factors for increased IBC were determined by multivariate analysis. This study was approved by our institutional review board (#17011804). RESULTS: In the current cohort, IBC occurred in 17 (2.1%) patients. Postoperatively, there were three PBCs (0.4%) and two thromboembolic complications (TCs, 0.2%), respectively. The occurrences of IBC and TC did not show any significant difference between the three groups, but PBC was more common in the APT-LR group (P = 0.022). Multivariate analysis showed that only chronic cholecystitis was the independent risk factor for IBC (P < 0.001, odds ratio = 12.355), but preoperative continuation of APT or multiple APT use did not affect IBC. CONCLUSION: We performed elective LC safely in patients receiving APT under rigorous perioperative management of APT. Continuation of aspirin monotherapy is considered in patients with APT during elective LC.


Assuntos
Aspirina/efeitos adversos , Perda Sanguínea Cirúrgica , Colecistectomia Laparoscópica , Inibidores da Agregação de Plaquetas/efeitos adversos , Hemorragia Pós-Operatória/induzido quimicamente , Tromboembolia/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Aspirina/administração & dosagem , Colecistectomia Laparoscópica/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Masculino , Inibidores da Agregação de Plaquetas/administração & dosagem , Hemorragia Pós-Operatória/etiologia , Medição de Risco , Centros de Atenção Terciária , Resultado do Tratamento
20.
Asian J Endosc Surg ; 13(1): 71-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30931549

RESUMO

INTRODUCTION: In patients receiving chronic anticoagulation agents, antiplatelet agents, or both, perioperative antithrombotic therapy for inguinal hernia repair requires an understanding of potential side-effects-specifically, the postoperative bleeding risks. In the present study, we evaluated postoperative bleeding complications after transabdominal preperitoneal patch plasty (TAPP) in patients undergoing antithrombotic therapy. METHODS: We retrospectively reviewed 413 patients who had undergone TAPP between February 2013 and June 2017. Individuals in the antithrombotic group received one of three regimens of perioperative antithrombotic therapy. The clinical indications for chronic anticoagulation agents (ie bridging therapy with unfractionated heparin), antiplatelet agents (ie continuation of aspirin), or both were followed. The antithrombotic group was compared to the control group in terms of surgical outcomes. We primarily focused on the incidence of postoperative bleeding complications. RESULTS: A total of 83 patients received antithrombotic therapy. We observed significant differences between the groups in terms of mean age, ASA physical status, and length of postoperative stay. In contrast, postoperative complications were not significantly different between the antithrombotic and control groups (4.8% vs 5.5%, P = 0.818). In addition, a significantly greater postoperative bleeding rate was not observed in the antithrombotic group than in the control group (1.2% vs 0.6%, P = 0.566). Likewise, other complications were similar in both groups. CONCLUSIONS: Antithrombotic therapy is not a risk factor for postoperative bleeding complications in patients who have undergone TAPP, suggesting its safety and efficacy in this patient population. Indeed, this group has the same incidence rates of morbidity and postoperative bleeding complications as patients who have not undergone antithrombotic therapy.


Assuntos
Anticoagulantes/efeitos adversos , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Inibidores da Agregação de Plaquetas/efeitos adversos , Hemorragia Pós-Operatória/etiologia , Trombose/prevenção & controle , Idoso , Anticoagulantes/administração & dosagem , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/administração & dosagem , Hemorragia Pós-Operatória/induzido quimicamente , Estudos Retrospectivos , Telas Cirúrgicas
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