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Nozumi Y, Yonezawa Y, Yunoki K, Mima H. Cardiopulmonary Bypass Circuit Obstruction and Urgent Replacement After the Administration of Andexanet Alfa. J Cardiothorac Vasc Anesth 2024; 38:780-783. [PMID: 38148268 DOI: 10.1053/j.jvca.2023.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/11/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Yusaku Nozumi
- Department of Anesthesiology and Critical Care, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-Ku, Kobe City, Japan.
| | - Yuta Yonezawa
- Department of Anesthesiology and Critical Care, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-Ku, Kobe City, Japan
| | - Kazuma Yunoki
- Department of Anesthesiology and Critical Care, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-Ku, Kobe City, Japan
| | - Hiroyuki Mima
- Department of Anesthesiology and Critical Care, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-Ku, Kobe City, Japan
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2
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Suzuki Y, Kikura M, Kawashima S, Kimura T, Nakajima Y. Andexanet alpha-induced heparin resistance treated by nafamostat mesylate in a patient undergoing total aortic arch repair for Stanford type A acute aortic dissection: a case report. JA Clin Rep 2024; 10:6. [PMID: 38285208 PMCID: PMC10825097 DOI: 10.1186/s40981-024-00690-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Andexanet alfa, an anti-Xa inhibitor antagonist, induces heparin resistance. Here, we report a case of successful management of cardiopulmonary bypass with andexanet alfa-induced heparin resistance using nafamostat mesylate. CASE PRESENTATION An 84-year-old female, with Stanford type A acute aortic dissection, underwent an emergency surgery for total aortic arch replacement. Andexanet alfa 400 mg was administered preoperatively to antagonize edoxaban, an oral Xa inhibitor. Heparin 300 IU/kg was administered before cardiopulmonary bypass, and the activated clotting time (ACT) was 291 s. The ACT was 361 s after another administration of heparin 200 IU/kg. According to our routine therapy for heparin resistance, an initial dose of nafamostat mesylate 10 mg was administered intravenously, followed by a continuous infusion of 20-30 mg/h. The ACT was prolonged to 500 s, and cardiopulmonary bypass was successfully established thereafter. CONCLUSIONS This case report presents the successful management of cardiopulmonary bypass with andexanet alfa-induced heparin resistance using nafamostat mesilate. This report presents the successful management of cardiopulmonary bypass with andexanet alfa-induced heparin resistance using nafamostat mesilate.
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Affiliation(s)
- Yasuhito Suzuki
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Shizuoka, Japan.
| | - Mutsuhito Kikura
- Department of Anesthesiology, Hamamatsu Rosai Hospital, Japan Organization of Occupational Health and Safety, Shizuoka, Japan
| | - Shingo Kawashima
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Tetsuro Kimura
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Yoshiki Nakajima
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Shizuoka, Japan
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Huang J, Mazer CD, Boisen ML, Tibi P, Baker RA, Chu D, Moffatt-Bruce S, Shore-Lesserson L. Safety of Andexanet Alfa Use in Cardiac Surgery. J Cardiothorac Vasc Anesth 2023; 37:1332-1334. [PMID: 36997371 PMCID: PMC10858990 DOI: 10.1053/j.jvca.2023.02.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/21/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY.
| | - C David Mazer
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Pierre Tibi
- Department of Cardiovascular Surgery, Yavapai Regional Medical Center, Prescott, AZ
| | - Robert A Baker
- Cardiac and Thoracic Surgery Quality and Outcomes Unit, and Perfusion, Flinders Medical Centre and Flinders University Adelaide, South Australia, Australia
| | - Danny Chu
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Susan Moffatt-Bruce
- Division of Thoracic Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Linda Shore-Lesserson
- Department of Anesthesiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY
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Ozawa S, Ozawa-Morriello J, Perelman S, Thorpe E, Rock R, Pearse BL. Improving Patient Blood Management Programs: An Implementation Science Approach. Anesth Analg 2023; 136:397-407. [PMID: 36638516 DOI: 10.1213/ane.0000000000006273] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Organized patient blood management (PBM) programs function in numerous hospitals and health systems around the world contributing to improved patient outcomes as well as increased patient engagement, decreased resource use, and reductions in health care costs. PBM "programming" ranges from the implementation of single strategies/initiatives to comprehensive programs led by dedicated clinicians and PBM committees, employing the use of multiple PBM strategies. Frontline health care professionals play an important role in leading, implementing, operationalizing, measuring, and sustaining successful PBM programs. In this article, we provide practical implementation guidance to support key clinical, administrative, leadership, and structural elements required for the safe and comprehensive delivery of care in PBM programs at the local level.
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Affiliation(s)
- Sherri Ozawa
- From Department of Clinical Optimization, Accumen Incorporated, Phoenix, Arizona.,Department of Bloodless Medicine and Surgery and Patient Blood Management, Englewood Health, Englewood, New Jersey.,Society for the Advancement of Patient Blood Management, Mt Royal, New Jersey
| | - Joshua Ozawa-Morriello
- Department of Bloodless Medicine and Surgery, Hackensack University Medical Center, Hackensack, New Jersey
| | - Seth Perelman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Health, NYU School of Medicine, New York, New York
| | - Elora Thorpe
- From Department of Clinical Optimization, Accumen Incorporated, Phoenix, Arizona
| | - Rebecca Rock
- Department of Patient Blood Management, Alberta Health Services, Calgary, Alberta, Canada
| | - Bronwyn L Pearse
- Department of Surgery and Critical Care, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Department of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
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Milne B, Gilbey T, Kunst G. Perioperative Management of the Patient at High-Risk for Cardiac Surgery-Associated Acute Kidney Injury. J Cardiothorac Vasc Anesth 2022; 36:4460-4482. [PMID: 36241503 DOI: 10.1053/j.jvca.2022.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/27/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022]
Abstract
Acute kidney injury (AKI) is one of the most common major complications of cardiac surgery, and is associated with increased morbidity and mortality. Cardiac surgery-associated AKI has a complex, multifactorial etiology, including numerous factors such as primary cardiac dysfunction, hemodynamic derangements of cardiac surgery and cardiopulmonary bypass, and the possibility of a large volume of blood transfusion. There are no truly effective pharmacologic therapies for the management of AKI, and, therefore, anesthesiologists, intensivists, and cardiac surgeons must remain vigilant and attempt to minimize the risk of developing renal dysfunction. This narrative review describes the current state of the scientific literature concerning the specific aspects of cardiac surgery-associated AKI, and presents it in a chronological fashion to aid the perioperative clinician in their approach to this high-risk patient group. The evidence was considered for risk prediction models, preoperative optimization, and the intraoperative and postoperative management of cardiac surgery patients to improve renal outcomes.
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Affiliation(s)
- Benjamin Milne
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; National Institute of Health Research Academic Clinical Fellow, King's College London, London, United Kingdom
| | - Tom Gilbey
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; National Institute of Health Research Academic Clinical Fellow, King's College London, London, United Kingdom
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular Medicine and Metabolic Medicine and Sciences, King's College London, British Heart Foundation Centre of Excellence, Faculty of Life Sciences and Medicine, London, United Kingdom.
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Pauls LA, Rathor R, Pennington BT. Andexanet Alfa-Induced Heparin Resistance Missing From SCA Blood Management in Cardiac Surgery Guidelines. J Cardiothorac Vasc Anesth 2022; 36:4557-4558. [PMID: 36050215 DOI: 10.1053/j.jvca.2022.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Lynn Adamma Pauls
- Department of Anesthesiology, Washington University in St. Louis Medical Campus, St. Louis, MO.
| | - Rashmi Rathor
- Department of Anesthesiology, Washington University in St. Louis Medical Campus, St. Louis, MO
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