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Shacham Abulafia A, Yaniv Y, Steimatzky A, Orbach-Zinger S, Hadar E, Shmueli A, Borovich A, Ziv E, Rozovski U, Wiznitzer A, Eidelman LA, Raanani P, Spectre G. Epidural/spinal anesthesia during delivery in women with factor XI deficiency, a single center experience. Haemophilia 2020; 26:834-839. [PMID: 32666626 DOI: 10.1111/hae.14079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The safety of neuro-axial anaesthesia (epidural/spinal) at labour of women with partial factor XI (FXI) deficiency is uncertain. Although FXI deficiency is frequent in Ashkenazi Jews, it is not routinely measured before labour. Our institute serves a large Ashkenazi population. We assumed that 10% of them have undiagnosed FXI deficiency. AIM Assess the incidence, bleeding tendency and coagulation status among Jewish Ashkenazi women with FXI deficiency that underwent neuro-axial anaesthesia at delivery. METHODS Jewish Ashkenazi women who underwent neuro-axial anaesthesia at labour completed the SSC ISTH bleeding assessment tool (BAT) and had blood drawn for coagulation tests, FXI and thrombin generation after labour. Estimation for 10 years was calculated from the 1-year sample. RESULTS We recruited 261 women during 12 months. Among them, 39 (15%) had FXI deficiency (<70%) with median FXI levels of 63% (range: 33%-70%). Around 50% of them underwent amniocentesis in the current pregnancy and prior neuro-axial anaesthesia with no bleeding complications. BAT score and thrombin generation did not differ between women regardless of FXI status. aPTT was longer in women with partial FXI deficiency (median - 28.6 sec vs 26.3 sec, P < .001, Table 2), although within the normal range in all women. No bleeding complications after neuro-axial anaesthesia at delivery were reported in our centre in the last decade though, and according to our estimation, at least 2150 women had partial FXI deficiency. CONCLUSIONS A significant number of Jewish Ashkenazi women with undiagnosed partial FXI deficiency undergo neuro-axial anaesthesia at labour without bleeding complications.
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Affiliation(s)
- Adi Shacham Abulafia
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Yaniv
- Helen Schneider Hospital for Women, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | - Arza Steimatzky
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | - Sharon Orbach-Zinger
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Anesthesia, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | - Eran Hadar
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Helen Schneider Hospital for Women, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | - Anat Shmueli
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Helen Schneider Hospital for Women, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | - Adi Borovich
- Helen Schneider Hospital for Women, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | - Ester Ziv
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | - Uri Rozovski
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Wiznitzer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Helen Schneider Hospital for Women, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | - Leonid A Eidelman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Anesthesia, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galia Spectre
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Barzilai M, Kirgner I, Steimatzky A, Salzer Gotler D, Belnick Y, Shacham-Abulafia A, Avivi I, Raanani P, Yahalom V, Nakav S, Varon D, Yussim E, Bachar GN, Spectre G. Prothrombin Complex Concentrate before Urgent Surgery in Patients Treated with Rivaroxaban and Apixaban. Acta Haematol 2019; 143:266-271. [PMID: 31610537 DOI: 10.1159/000502173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 07/06/2019] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Merav Barzilai
- Institute of Hematology, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilya Kirgner
- Institute of Hematology, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arza Steimatzky
- Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel
| | | | - Yulia Belnick
- Internal Medicine D, Rabin Medical Center, Hasharon Hospital, Petah Tikva, Israel
| | - Adi Shacham-Abulafia
- Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Avivi
- Institute of Hematology, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pia Raanani
- Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vered Yahalom
- Transfusion and Apheresis Service, Rabin Medical Center, Petah Tikva, Israel
| | - Sigal Nakav
- Hemostasis Laboratory, Rabin Medical Center, Petah Tikva, Israel
| | - David Varon
- Institute of Hematology, Sourasky Medical Center, Tel Aviv, Israel
| | - Ethan Yussim
- Department of Radiology, Sourasky Medical Center, Tel Aviv, Israel
| | - Gil N Bachar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Radiology, Rabin Medical Center, Petah Tikva, Israel
| | - Galia Spectre
- Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel,
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,
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Steimatzky A, Tamir S, Raanani P, Spectre G. [THROMBOCYTOPENIA, LEG EDEMA AND SHORTNESS OF BREATH FOLLOWING CORONARY ARTERY BYPASS SURGERY]. Harefuah 2019; 158:192-195. [PMID: 30916509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Heparin-induced thrombocytopenia (HIT) is the most important non-hemorrhagic complication of heparin treatment. We report a case of a major thromboembolic event accompanied by thrombocytopenia following heparin exposure during coronary artery bypass graft surgery. Thrombocytopenia was documented one month after the surgery, and a major thromboembolic event which led to the patient's death diagnosed 6 weeks after heparin exposure. We discuss the pathophysiology and clinical aspects of heparin-induced thrombocytopenia, focusing on the unique features of this patient, including late persistent thrombocytopenia.
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Affiliation(s)
- Arza Steimatzky
- Thrombosis and Haemostasis Unit, Institute of Hematology, Rabin Medical Center, Beilinson Hospital ,Petah Tikva, Israel
| | - Shlomit Tamir
- Radiology Department, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Pia Raanani
- Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Galia Spectre
- Thrombosis and Haemostasis Unit, Institute of Hematology, Rabin Medical Center, Beilinson Hospital ,Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel
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Dresner-Pollak R, Gabet Y, Steimatzky A, Hamdani G, Bab I, Ackerman Z, Weinreb M. Human parathyroid hormone 1-34 prevents bone loss in experimental biliary cirrhosis in rats. Gastroenterology 2008; 134:259-67. [PMID: 18061175 DOI: 10.1053/j.gastro.2007.10.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Accepted: 09/27/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Reduced bone mass and increased fracture rate are complications of primary biliary cirrhosis (PBC). The effect of intermittent administration of human parathyroid hormone (hPTH) 1-34 on bone mass and architecture in bile duct-ligated (BDL) rats was studied. METHODS Six-month-old male rats were subjected to BDL or sham operation (SO) and were treated from the second postoperative week intermittently with either hPTH 1-34 40 microg/kg per day, 80 microg/kg per day, or a vehicle for 4 weeks. Femoral and tibial bones were evaluated ex vivo by dual x-ray absorptiometry, microcomputed tomography, and histomorphometry. Serum osteocalcin and urinary deoxypyridinoline cross-links (DPD) were determined. RESULTS BDL rats had decreased bone mass compared with SO rats as indicated by a 6% decrease in femoral and tibial bone mineral density (BMD), 18% reduction in femoral trabecular bone volume (bone volume/total volume [BV/TV]), 17% decrease in trabecular thickness, and 10% decrease in tibial cortical thickness. The administration of hPTH 1-34 at 40 microg/kg per day increased femoral and tibial BMD (9% and 9%), femoral trabecular BV/TV (50%), trabecular thickness (50%), tibial cortical thickness (17%), and serum osteocalcin (82%). On the other hand, hPTH 1-34 80 microg/kg per day had no effect on BMD and tibial cortical thickness, was associated with a smaller increase in trabecular BV/TV (24%), and had a higher osteoclast number and DPD compared with untreated BDL rats and the lower hPTH 1-34 dose treatment group. CONCLUSIONS BDL rats exhibit loss of bone mass and structure, which can be prevented by the intermittent administration of hPTH 1-34, a potential therapy for osteoporosis in PBC.
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Affiliation(s)
- Rivka Dresner-Pollak
- Endocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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