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Boutkourt F, van Haaps T, Brüggemann R, Bhoelan S, ten Cate H, Kruip MJHA, Spaetgens B, van Es N, Roest T, Joling KJ, Meijer K, Hugtenburg J. The effect of current antithrombotic therapy on mortality in nursing home residents with COVID-19: a multicentre retrospective cohort study. Age Ageing 2024; 53:afae094. [PMID: 38748450 PMCID: PMC11095411 DOI: 10.1093/ageing/afae094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 01/31/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The first wave of COVID led to an alarmingly high mortality rate among nursing home residents (NHRs). In hospitalised patients, the use of anticoagulants may be associated with a favourable prognosis. However, it is unknown whether the use of antithrombotic medication also protected NHRs from COVID-19-related mortality. OBJECTIVES To investigate the effect of current antithrombotic therapy in NHRs with COVID-19 on 30-day all-cause mortality during the first COVID-19 wave. METHODS We performed a retrospective cohort study linking electronic health records and pharmacy data in NHRs with COVID-19. A propensity score was used to match NHRs with current use of therapeutic dose anticoagulants to NHRs not using anticoagulant medication. The primary outcome was 30-day all-cause mortality, which was evaluated using a logistic regression model. In a secondary analysis, multivariable logistic regression was performed in the complete study group to compare NHRs with current use of therapeutic dose anticoagulants and those with current use of antiplatelet therapy to those without such medication. RESULTS We included 3521 NHRs with COVID-19 based on a positive RT-PCR for SARS-CoV-2 or with a well-defined clinical suspicion of COVID-19. In the matched propensity score analysis, NHRs with current use of therapeutic dose anticoagulants had a significantly lower all-cause mortality (OR = 0.73; 95% CI: 0.58-0.92) compared to NHRs who did not use therapeutic anticoagulants. In the secondary analysis, current use of therapeutic dose anticoagulants (OR: 0.62; 95% CI: 0.48-0.82) and current use of antiplatelet therapy (OR 0.80; 95% CI: 0.64-0.99) were both associated with decreased mortality. CONCLUSIONS During the first COVID-19 wave, therapeutic anticoagulation and antiplatelet use were associated with a reduced risk of all-cause mortality in NHRs. Whether these potentially protective effects are maintained in vaccinated patients or patients with other COVID-19 variants, remains unknown.
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Affiliation(s)
- Firdaouss Boutkourt
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, location VUmc, De Boelelaan 1117, Amsterdam, The Netherlands
- Farmadam Pharmacy Group, Contactweg 127, Amsterdam, The Netherlands
| | - Thijs van Haaps
- Department of Vascular Medicine, Amsterdam UMC, location AMC Meibergdreef 9, Amsterdam, The Netherlands
- Pulmonary Hypertension & Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Reneé Brüggemann
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Soerajja Bhoelan
- Department of Hematology, UMC Groningen, University of Groningen, The Netherlands
| | - Hugo ten Cate
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marieke J H A Kruip
- Department of Hematology, Erasmus MC Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bart Spaetgens
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Nick van Es
- Department of Vascular Medicine, Amsterdam UMC, location AMC Meibergdreef 9, Amsterdam, The Netherlands
- Pulmonary Hypertension & Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Tineke Roest
- Farmadam Pharmacy Group, Contactweg 127, Amsterdam, The Netherlands
| | - Karlijn J Joling
- Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands, Department of Medicine for Older People, Amsterdam UMC, Location VUmc, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Karina Meijer
- Department of Hematology, UMC Groningen, University of Groningen, The Netherlands
| | - Jacqueline Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, location VUmc, De Boelelaan 1117, Amsterdam, The Netherlands
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Kuteesa J, Nasasira M, Kiguba R. Epidemiology of adverse drug reactions to antihypertensive, antithrombotic and antidiabetic medications among adult inpatients at a National Referral Hospital, Uganda. Expert Opin Drug Saf 2024; 23:129-136. [PMID: 37552628 DOI: 10.1080/14740338.2023.2244421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/22/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Treatment for hypertension, thrombosis and type 2 diabetes mellitus is long term and usually requires a combination of drugs which increases the risk of adverse drug reactions (ADRs). This study aimed to establish the prevalence at admission, incidence during hospitalization and characteristics of ADRs linked to antihypertensive, antithrombotic and antidiabetic drugs among adult inpatients in Uganda. METHODS We conducted a secondary analysis of data from a previously assembled prospective cohort study in Uganda's Mulago National Referral Hospital. We reviewed the files of inpatients who received antihypertensive, antithrombotic and/or antidiabetic medications prior to and/or during hospitalization. The modified Schumock and Thornton Preventability Scale, the Division of AIDS Table for Grading the Severity of Adult and Paediatric Adverse Events and the World Health Organization - Uppsala Monitoring Centre seriousness criteria were used to characterize the ADRs. RESULTS More than a quarter (27%, 42/155) of the inpatients experienced an ADR at admission or during hospitalization. The point prevalence of ADRs at admission was 8% (13/155) and the incidence of ADRs during hospitalization was 23% (36/155). Forty-one percent (35/86) of the ADRs were serious and the majority (59%, 51/86) were preventable. CONCLUSION One in 13 inpatients experienced an ADR on admission and one in four experienced an ADR that developed during hospitalization. Clinicians ought to prescribe medicines with lower ADR risk profile for cardiovascular and/or diabetic patients whenever possible.
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Affiliation(s)
- Jonathan Kuteesa
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Marble Nasasira
- Research and Data Centre, Child and Family Foundation, Kampala, Uganda
| | - Ronald Kiguba
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
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Isokuortti H, Iverson GL, Posti JP, Berghem K, Kotilainen AK, Luoto TM. Risk for intracranial hemorrhage in individuals after mild traumatic brain injury who are taking serotonergic antidepressants. Front Neurol 2022; 13:952188. [PMID: 36570453 PMCID: PMC9768034 DOI: 10.3389/fneur.2022.952188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
Abstract
Background Serotonergic antidepressants may predispose to bleeding, but little is known of the risk for traumatic intracranial bleeding. Methods This was a prospective case-control study of 218 patients with mild traumatic brain injuries (TBI) who were treated at a Finnish tertiary trauma hospital. Injury-related information and clinical findings were prospectively collected in the emergency department. Detailed pre-injury health history was collected from electronic medical records. Information on the use of serotonergic antidepressants was attained from the Finnish national prescription registry. All head CT scans were reviewed by a neuroradiologist based on the Common Data Elements. Cases were patients with traumatic intracranial hemorrhage on head CT. Controls were patients from the same cohort, but without traumatic intracranial lesions on CT. The proportion with traumatic intracranial bleeding for patients on serotonergic antidepressant medication was compared to the proportion for patients not on serotonergic medication. Results The study cohort consisted of 24 cases with traumatic intracranial bleeding and 194 injured controls. The median age of the sample was 70 years (interquartile range = 50-83). One fifth (21.6%) of all the patients were taking a serotonergic antidepressant. Of the patients on an antidepressant, 10.6% (5/47) had an acute hemorrhagic lesion compared to 11.1% (19/171) of those who were not on an antidepressant (p = 0.927). In the regression analysis, traumatic intracranial hemorrhage was not associated with antidepressant use. Conclusion Serotonergic antidepressant use was not associated with an increased risk of traumatic intracranial hemorrhage after a mild TBI. The patients in this relatively small cohort were mostly middle-aged and older adults. These factors limit the generalizability of the results in younger patients with mild TBI.
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Affiliation(s)
- Harri Isokuortti
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland,*Correspondence: Harri Isokuortti
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and the Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, United States
| | - Jussi P. Posti
- Neurocenter, Department of Neurosurgery, and Turku Brain Injury Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Ksenia Berghem
- Medical Imaging Centre, Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Anna-Kerttu Kotilainen
- Department of Surgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Teemu M. Luoto
- Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland
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Wang R, Ning N, Wang S, Ye X, Hu X, Xuan J. Real-world treatment patterns and stroke risks among patients with atrial fibrillation in China. Future Cardiol 2022; 18:787-796. [PMID: 36154219 DOI: 10.2217/fca-2022-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Aim: To describe patient characteristics, treatment patterns and stroke risks for patients with newly diagnosed atrial fibrillation (AF) in China. Patients & methods: Patients with AF were identified from an electronic medical record database in China (n = 22,535). Results: Less than half of patients (n = 9971; 44.2%) received antithrombotic medications following AF diagnosis; of these patients, 93.7% received anticoagulants and 71.3% received antiplatelets. Only 27.6% of patients received oral anticoagulants. Multivariate Cox proportional hazard model analysis found that patients treated with antithrombotic medications had a significantly lower risk of stroke compared with patients who were not treated (hazard ratio: 0.4; 95% CI: 0.37-0.43). Conclusion: The results suggest that antithrombotic medications, especially oral anticoagulants, are underused in China.
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Affiliation(s)
- Rosa Wang
- Daiichi Sankyo Inc, 211 Mt Airy Rd, Basking Ridge, NJ 07920, USA
| | - Ning Ning
- University of Southern California, 635 Downey Way, Verna & Peter Dauterive Hall (VPD), Los Angeles, CA 90089, USA
| | - Shaoping Wang
- Beijing Anzhen Hospital, No. 2 Anzhen Rd, District, Beijing, 100029, China
| | - Xin Ye
- Daiichi Sankyo Inc, 211 Mt Airy Rd, Basking Ridge, NJ 07920, USA
| | - Xiaohan Hu
- Health Economic Research Institute, Sun Yat-Sen University, 135 Xingang W Rd, Binjiang Road, Haizhu District, Guangzhou, Guangdong Province, 510275, China
| | - Jianwei Xuan
- Health Economic Research Institute, Sun Yat-Sen University, 135 Xingang W Rd, Binjiang Road, Haizhu District, Guangzhou, Guangdong Province, 510275, China
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Pallauf M, Herrmann T, Oswald D, Törzsök P, Deininger S, Lusuardi L. Electrosurgery or laser for benign prostatic enlargement: trumpcard or pitfalls. Curr Opin Urol 2021; 31:444-450. [PMID: 34265843 PMCID: PMC8373441 DOI: 10.1097/mou.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To summarize and comment on publications of the last 2 years in the field of endoscopic surgery for benign prostatic enlargement, focusing on similarities and differences of laser and electrosurgery. RECENT FINDINGS Because of good hemostasis and safety, invasive endoscopic surgery has evolved to a choice of treatment for vulnerable patients with ongoing antithrombotic medication and in same-day surgery. Recent publications show a good perioperative course and no deterioration in the postoperative outcome. Furthermore, alterations to the original surgical techniques of resection, enucleation, and vaporization have increased the preservation rate for antegrade ejaculation, advancing them to an appealing choice of treatment for sexually active men. Favorable outcomes can be achieved in both laser and electrosurgery. Only the choice of the surgical technique determines the outcome. SUMMARY Various invasive endoscopic surgical techniques are available, offering different advantages and disadvantages for the patient. All of them can be performed with laser and electrosurgery. Therefore, focusing on the proper choice of surgical technique instead of the energy source will guarantee the patient to benefit most.
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Affiliation(s)
- Maximilian Pallauf
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Austria
| | - Thomas Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
| | - David Oswald
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Austria
| | - Peter Törzsök
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Austria
| | - Susanne Deininger
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Austria
| | - Lukas Lusuardi
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Austria
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Bozkurt H, Sert ÖZ, Ölmez T, Keklikkıran ZZ, Uzun O, Gülmez S, Polat E, Duman M. The risk of post-polypectomy bleeding among patients receiving antithrombotic agents: A prospective observational study. SAO PAULO MED J 2021; 139:218-225. [PMID: 33759909 PMCID: PMC9625013 DOI: 10.1590/1516-3180.2020.0305.r1.10122020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/10/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In July 2012, the Japan Gastroenterological Endoscopy Society updated their guidelines for gastroenterological endoscopy in patients receiving antithrombotic therapy. Colonoscopic polypectomy procedures are associated with a high risk of bleeding. OBJECTIVES The present study evaluated the safety of colonoscopic polypectomy procedures in terms of bleeding, among patients receiving antithrombotic therapy. DESIGN AND SETTING Prospective observational study conducted in a tertiary-level public cardiovascular hospital in Istanbul, Turkey. METHODS Colonoscopic polypectomies carried out in a single endoscopy unit between July 2018 and July 2019 were evaluated prospectively. The patients' data, including age, gender, comorbidities, whether antithrombotic drug use was ceased or whether patients were switched to bridging therapy, polyp size, polyp type, polyp location, histopathology, resection methods (hot snare, cold snare or forceps) and complications relating to the procedures were recorded. RESULTS The study was completed with 94 patients who underwent a total of 167 polypectomy procedures. As per the advice of the physicians who prescribed antithrombotic medications, 108 polypectomy procedures were performed on 60 patients without discontinuing medication and 59 polypectomy procedures were performed on 34 patients after discontinuing medication. The age, gender distribution and rate of bleeding did not differ significantly between the patients whose medication was discontinued and those whose medication was continued (P > 0.05). CONCLUSION This study found that the colonoscopic polypectomy procedure without discontinuation of antithrombotic medication did not increase the risk of bleeding. This procedure can be safely performed by experienced endoscopists in patients with an international normalized ratio (INR) below 2.5.
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Affiliation(s)
- Hilmi Bozkurt
- MD, MSc. General Surgeon, Gastrointestinal Surgeon and Molecular Oncology Doctoral Student, University of Health Sciences, Haseki Research and Education Hospital, Istanbul, Turkey.
| | - Özlem Zeliha Sert
- MD, MSc. General Surgeon, Gastrointestinal Surgeon and Molecular Oncology Doctoral Student, University of Health Sciences, Haydarpaşa Research and Education Hospital, Istanbul, Turkey.
| | - Tolga Ölmez
- MD. General Surgeon and Gastrointestinal Surgeon, University of Health Sciences, Koşuyolu Research and Education Hospital, Istanbul, Turkey.
| | - Zeynep Zehra Keklikkıran
- MD. General Surgeon and Gastrointestinal Surgeon, University of Health Sciences, Koşuyolu Research and Education Hospital, Istanbul, Turkey.
| | - Orhan Uzun
- MD. General Surgeon and Gastrointestinal Surgeon, University of Health Sciences, Koşuyolu Research and Education Hospital, Istanbul, Turkey.
| | - Selçuk Gülmez
- MD. General Surgeon and Gastrointestinal Surgeon, University of Health Sciences, Koşuyolu Research and Education Hospital, Istanbul, Turkey.
| | - Erdal Polat
- MD. Associate Professor, General Surgeon and Gastrointestinal Surgeon, University of Health Sciences, Koşuyolu Research and Education Hospital, Istanbul, Turkey.
| | - Mustafa Duman
- MD. Professor, General Surgeon and Gastrointestinal Surgeon, University of Health Sciences, Koşuyolu Research and Education Hospital, Istanbul, Turkey.
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Okuyama K, Naruse T, Yutori H, Yanamoto S, Umeda M. Oral surgery in patients with antiphospholipid syndrome. J Oral Sci 2019; 61:386-390. [PMID: 31217370 DOI: 10.2334/josnusd.18-0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by recurrent thrombosis, other associated autoimmune disease, and/or obstetrical morbidity along with persistent production of antiphospholipid antibodies. Because of the nature of this systemic disease, most patients are medicated with antithrombotic agents and abundant glucocorticoids. This study reports a cohort of 16 patients with APS, who underwent oral surgery between 2010 and 2017 at the Nagasaki University Hospital. Because oral antithrombotic therapy was continued in the perioperative period, all wounds were strictly closed by suturing to prevent postoperative bleeding. Perioperative laboratory dates and medications were assessed. All patients achieved local postoperative hemostasis and did not exhibit systemic complications. Moreover, there were no postoperative systemic and/or local infections. Oral surgeons should suture oral wounds and ensure local hemostasis to prevent postoperative bleeding. Because patients with APS are likely to develop thrombosis despite continued administration of antithrombotic medications, strict perioperative examination of blood coagulation is needed. Furthermore, it is important to consider the damage and stress caused due to oral surgery. Moreover, when necessary, glucocorticoid therapy should be carefully administered, in accordance with the degree of invasion and judgment of the attending physician.
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Affiliation(s)
- Kohei Okuyama
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences.,Division of Oral and Maxillofacial Surgery, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Tomofumi Naruse
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences
| | - Hirokazu Yutori
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences
| | - Souichi Yanamoto
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences
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Bogunovic L, Haas AK, Brophy RH, Matava MJ, Smith MV, Wright RW. The Perioperative Continuation of Aspirin in Patients Undergoing Arthroscopic Surgery of the Knee. Am J Sports Med 2019; 47:2138-2142. [PMID: 31226002 DOI: 10.1177/0363546519855643] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The perioperative withdrawal of aspirin increases the risk of cardiac, neurologic, and vascular thromboembolic events. The safety of continuing aspirin in patients undergoing knee arthroscopy is unknown. HYPOTHESIS Perioperative continuation of aspirin does not increase surgical complications or worsen outcomes in patients 50 years of age and older undergoing knee arthroscopy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This is a single-center, institutional review board-approved, prospective matched dual-cohort study comparing the surgical complication rates and postoperative outcomes of patients taking daily aspirin with those of unmedicated controls. Ninety patients who were 50 years of age or older and taking 81 mg or 325 mg daily aspirin were matched to 90 controls. Patients were matched on age, surgery type, and the use of a tourniquet. A complication was defined as bleeding, wound dehiscence, or wound infection requiring reoperation. Postoperative outcome measures including hematoma formation, extent of ecchymosis (mm), visual analog scale (VAS) scores for pain and swelling, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were collected preoperatively and postoperatively (10-14 days and 4-6 weeks). RESULTS There were no complications (0%) in either cohort. There was no difference in hematoma formation (aspirin, 1.8%; controls, 2.4%; P = .79), incidence of ecchymosis (aspirin, 17%; controls, 21%; P = .70), or the average extent of ecchymosis (aspirin, 124.6 mm; controls, 80.3 mm; P = .36) between patients taking aspirin and controls. There was no significant difference in pre- or postoperative knee range of motion between controls and patients taking aspirin. The KOOS subscores and VAS pain scores were similar between patients taking aspirin and controls at baseline and at follow-up. CONCLUSION The perioperative continuation of daily aspirin in patients 50 years of age and older undergoing arthroscopic procedures of the knee is safe and does not result in an increased rate of bleeding or wound complications requiring reoperation. Continued aspirin use in patients 50 years of age and older had no significant effect on postoperative physical examination measures or patient-rated outcome scores.
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Affiliation(s)
- Ljiljana Bogunovic
- Department of Orthopaedics, Washington University, Chesterfield, Missouri, USA
| | - Amanda K Haas
- Department of Orthopaedics, Washington University, Chesterfield, Missouri, USA
| | - Robert H Brophy
- Department of Orthopaedics, Washington University, Chesterfield, Missouri, USA
| | - Matthew J Matava
- Department of Orthopaedics, Washington University, Chesterfield, Missouri, USA
| | - Matthew V Smith
- Department of Orthopaedics, Washington University, Chesterfield, Missouri, USA
| | - Rick W Wright
- Department of Orthopaedics, Washington University, Chesterfield, Missouri, USA
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Bervini D, Jaeggi C, Mordasini P, Schucht P, Raabe A. Antithrombotic medication and bleeding risk in patients with cerebral cavernous malformations: a cohort study. J Neurosurg 2018; 130:1-9. [PMID: 29882707 DOI: 10.3171/2018.1.jns172547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/10/2017] [Accepted: 01/10/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVECerebral cavernous malformations (CCMs) are frequently diagnosed vascular abnormalities. The hemorrhagic risk associated with the use of long-term antithrombotic medication (ATM) in patients with CCMs is a matter of controversy. The aim of this study was to determine the hemorrhagic risk associated with ATM use in patients diagnosed with one or more CCMs.METHODSDemographic, clinical, treatment, and ATM-related information on patients diagnosed with one or more CCMs at a single institution over more than 34 years was retrospectively recorded. Univariate and multivariate descriptive and survival analyses were used to assess potential risk factors associated with CCM-related hemorrhage at presentation and during follow-up (first or subsequent hemorrhage).RESULTSA total of 408 patients were included in the analysis and 492 CCMs were followed up after diagnosis, for a total of 1616 lesion-years. Thirty-seven (7.5%) CCMs bled during follow-up, leading to an overall annual rate of CCM-related symptomatic hemorrhage of 2.3% (95% CI 1.7%-3.2%). Eighty-two patients harboring 91 CCMs (16.8%) were on ATM. When stratified for ATM, the annual rates of hemorrhage were 0.7% (95% CI < 0.01% to 4.2%) for the lesions in patients on ATM versus 2.5% (95% CI 1.8%-3.4%) for those not on ATM. ATM was not found to be associated with either an increased risk of CCM-related hemorrhage at presentation (p = 0.355) or an increased risk of CCM-related hemorrhage (first or subsequent hemorrhage) in multivariate descriptive (p = 0.912) and survival (p = 0.145) analyses.CONCLUSIONSThe use of ATM does not seem to be associated with an increased risk of hemorrhage in patients diagnosed with CCMs.
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Affiliation(s)
- David Bervini
- 1Department of Neurosurgery, Inselspital, Bern University Hospital
| | | | - Pasquale Mordasini
- 3Department of Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Philippe Schucht
- 1Department of Neurosurgery, Inselspital, Bern University Hospital
| | - Andreas Raabe
- 1Department of Neurosurgery, Inselspital, Bern University Hospital
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