1
|
Sylvester KW, Grandoni J, Rhoten M, Coakley L, Matiello-Lyons E, Frankel K, Fortin B, Jolley K, Park HS, Freedman RY, Mehra MR, Givertz MM, Connors JM. Assessment of Temporary Warfarin Reversal in Patients With Left Ventricular Assist Devices: the KVAD Study. J Card Fail 2024:S1071-9164(24)00087-3. [PMID: 38521486 DOI: 10.1016/j.cardfail.2024.02.022] [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] [Received: 01/13/2024] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Patients with left ventricular assist devices (LVADs) require interruption of warfarin for invasive procedures, but parenteral bridging is associated with many complications. Four-factor prothrombin complex concentrate (4F-PCC) can temporarily restore hemostasis in patients undergoing anticoagulation with warfarin. OBJECTIVES This pilot study evaluated the strategy of using variable-dose 4F-PCC to immediately and temporarily reverse warfarin before invasive procedures without holding warfarin in patients with LVADs. The duration of effect of 4F-PCC on factor levels and time to reestablish therapeutic anticoagulation post procedure were assessed. METHODS Adult patients with LVADs and planned invasive procedures were enrolled from a single center. Warfarin was continued uninterrupted. The 4F-PCC dose administered immediately pre-procedure was based on study protocol. International normalized ratio (INR)- and vitamin K-dependent factor levels were collected before and during the 48 hours after 4F-PCC administration. The use of parenteral bridging, International Society for Thrombosis and Haemostasis major and clinically relevant nonmajor bleeding (CRNMB) and thromboembolic events at 7 and 30 days were collected. RESULTS In 21 episodes of 4F-PCC reversal, median baseline INR was 2.7 (IQR 2.2-3.2). The median dosage of 4F-PCC administered was 1794 units (IQR 1536-2130). At 24 and 48 hours post 4F-PCC administration, median INRs were 1.8 (IQR 1.7-2.0) and 2.0 (IQR 1.9-2.4). Two patients required postoperative bridging. One patient experienced major bleeding within 72 hours, and 2 experienced CRNMB within 30 days. There were no thromboembolic events. Baseline and post 4F-PCC vitamin K-dependent factor levels corresponded with changes in INR values. The median time to achieve therapeutic INR post-procedure was 2.5 days (IQR, 1-4). CONCLUSION Administration of 4F-PCC for temporary reversal of warfarin for invasive procedures in patients with LVADs allowed for continued warfarin dosing with minimal use of post-intervention bridging, limited bleeding and no thromboembolic events.
Collapse
Affiliation(s)
- Katelyn W Sylvester
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA. https://twitter.com/KatelynSylvester4
| | - Jessica Grandoni
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA
| | - Megan Rhoten
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA
| | - Lara Coakley
- Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, MA
| | | | - Katie Frankel
- Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, MA
| | - Brooke Fortin
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
| | - Kate Jolley
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
| | - Hae Soo Park
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
| | | | - Mandeep R Mehra
- Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, MA. https://twitter.com/MRMehraMD
| | - Michael M Givertz
- Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, MA. https://twitter.com/GivertzMichael
| | - Jean M Connors
- Division of Hematology, Brigham and Women's Hospital, Boston, MA.
| |
Collapse
|
2
|
Becerra-Bolaños Á, Jiménez-Gil M, Federico M, Domínguez-Díaz Y, Valencia L, Rodríguez-Pérez A. Pain in High-Dose-Rate Brachytherapy for Cervical Cancer: A Retrospective Cohort Study. J Pers Med 2023; 13:1187. [PMID: 37623438 PMCID: PMC10456084 DOI: 10.3390/jpm13081187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
High-dose-rate brachytherapy (HDR) is part of the main treatment for locally advanced uterine cervical cancer. Our aim was to evaluate the incidence and intensity of pain and patients' satisfaction during HDR. Risk factors for suffering pain were also analyzed. A retrospective study was carried out by extracting data from patients who had received HDR treatment for five years. Postoperative analgesia had been administered using pre-established analgesic protocols for 48 h. Pain assessment was collected according to a protocol by the acute pain unit. Analgesic assessment was compared according to analgesic protocol administered, number of needles implanted, and type of anesthesia performed during the procedure. From 172 patients treated, data from 247 treatments were analyzed. Pain was considered moderate in 18.2% of the patients, and 43.3% of the patients required at least one analgesic rescue. Patients receiving major opioids reported worse pain control. No differences were found regarding the analgesic management according to the intraprocedural anesthesia used or the patients' characteristics. The number of inserted needles did not influence the postoperative analgesic assessment. Continuous intravenous infusion of tramadol and metamizole made peri-procedural pain during HDR mild in most cases. Many patients still suffered from moderate pain.
Collapse
Affiliation(s)
- Ángel Becerra-Bolaños
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain; (Y.D.-D.); (L.V.); (A.R.-P.)
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, 35010 Las Palmas de Gran Canaria, Spain
| | - Miriam Jiménez-Gil
- Department of Anesthesiology, Complejo Hospitalario Universitario Materno Infantil, 35016 Las Palmas de Gran Canaria, Spain;
| | - Mario Federico
- Radiation Oncology Department, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain;
| | - Yurena Domínguez-Díaz
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain; (Y.D.-D.); (L.V.); (A.R.-P.)
| | - Lucía Valencia
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain; (Y.D.-D.); (L.V.); (A.R.-P.)
| | - Aurelio Rodríguez-Pérez
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain; (Y.D.-D.); (L.V.); (A.R.-P.)
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, 35010 Las Palmas de Gran Canaria, Spain
| |
Collapse
|
3
|
Wang JJ, Koulas I, Myrka A, Spyropoulos AC. Implementation of the Management of Anticoagulation in the Periprocedural Period App into an Electronic Health Record: A Cost-Effectiveness Analysis. Clin Appl Thromb Hemost 2023; 29:10760296231154553. [PMID: 36872909 PMCID: PMC9989397 DOI: 10.1177/10760296231154553] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/07/2023] Open
Abstract
The Management of Anticoagulation in the Periprocedural Period (MAPPP) app is a free tool providing up-to-date guidelines on the periprocedural management of patients on long-term anticoagulants. After validating its effectiveness in the post-procedural period, we aimed to study its overall cost-effectiveness. SF-12 surveys were sent to eligible patients, converted into SF-6D forms, and subsequently into quality-adjusted life years (QALYs) to calculate the incremental cost-effectiveness ratio (ICER). The number of 30-day readmissions was used to calculate hospitalization costs, utilizing publicly available data. From 1/1/2018 to 1/31/2019, 642 patients were screened for enrollment, with an overall response rate of 94% (164/175) among the consented and 49% (164/336) among all eligible patients. The average QALY score was 0.7134 (95% CI [0.6836, 0.7431]) for the patients whose treatment plan followed the MAPPP app recommendations (acceptance group) and 0.7104 (95% CI [0.6760, 0.7448]) for those who did not (rejection group), without statistically significant differences. The difference in ICER scores was -$429 866.67, with the negative sign demonstrating that acceptance was the dominant strategy. By utilizing QALYs and ICER scores we have shown that the acceptance of MAPPP app recommendations is the dominant strategy for the periprocedural management of patients on long-term anticoagulation.
Collapse
Affiliation(s)
- Jason J Wang
- Department of Radiology, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA.,Institute of Health System Science, 88982Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Ioannis Koulas
- Institute of Health System Science, 88982Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | | | - Alex C Spyropoulos
- Institute of Health System Science, 88982Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| |
Collapse
|
4
|
Colonna P, von Heymann C, Santamaria A, Saxena M, Vanassche T, Wolpert D, Laeis P, Wilkins R, Chen C, Unverdorben M. Routine clinical practice in the periprocedural management of edoxaban therapy is associated with low risk of bleeding and thromboembolic complications: The prospective, observational, and multinational EMIT-AF/VTE study. Clin Cardiol 2020; 43:769-780. [PMID: 32406557 PMCID: PMC7368298 DOI: 10.1002/clc.23379] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Guidance for periprocedural anticoagulant management is mainly based on limited data from Phase III or observational studies and expert opinion. HYPOTHESIS EMIT-AF/VTE was designed to document the risks of bleeding and thromboembolic events in more than 1000 patients on edoxaban undergoing diagnostic and therapeutic procedures in clinical practice. METHODS Routine care in a multinational multicenter, prospective observational study. Participants were adult patients with atrial fibrillation and/or venous thromboembolism treated with edoxaban for stroke prevention or for secondary prevention in venous thromboembolic disease, undergoing a wide range of diagnostic and therapeutic procedures. Edoxaban therapy was interrupted periprocedurally at the treating physician's discretion. Patients were evaluated from 5 days pre- until 30 days postprocedure. Primary outcome was the incidence of International Society on Thrombosis and Haemostasis defined major bleeding; secondary outcomes included incidence of clinically relevant non-major bleeding, acute coronary syndrome, and acute thromboembolic events. RESULTS Outcomes and management are reported for the first procedures in 1155 unselected patients. Five cases of major bleeding (0.4%) and eight of clinically relevant non-major bleeding (0.7%) were documented, five (38%) of which occurred outside the period of likely edoxaban effect (last edoxaban dose ≥3 days prior to bleeding). Five (0.4%) deaths from any cause, seven acute thromboembolic events (0.6%) including two cardiac deaths (0.2%) in six patients, and one acute coronary event (0.1%) occurred. CONCLUSIONS The periprocedural bleeding and acute thromboembolic event risks for patients treated with edoxaban were low. This can help inform both clinical routine and guidelines for the periprocedural management of edoxaban.
Collapse
Affiliation(s)
- Paolo Colonna
- Polyclinic of Bari-Hospital, Department of Cardiology, Bari, Italy
| | - Christian von Heymann
- Vivantes Klinikum im Friedrichshain, Department of Anaesthesia & Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Berlin, Germany
| | - Amparo Santamaria
- Hematology Department, Alicante University, Hospitals University Vinalopó Salut and Torrevieja Salut, Alicante, Spain
| | - Manish Saxena
- William Harvey Research Institute, Barts Health NHS Trust, Charterhouse Square, London, UK
| | - Thomas Vanassche
- Department of Cardiovascular Sciences, University Hospitals (UZ) Leuven, Leuven, Belgium
| | - Diana Wolpert
- Daiichi Sankyo, Medical Affairs Europe, Munich, Germany
| | - Petra Laeis
- Daiichi Sankyo, Medical Affairs Europe, Munich, Germany
| | | | - Cathy Chen
- Daiichi Sankyo Inc., Global Medical Affairs Specialty and Value Products, Basking Ridge, New Jersey, USA
| | - Martin Unverdorben
- Daiichi Sankyo Inc., Global Medical Affairs Specialty and Value Products, Basking Ridge, New Jersey, USA
| |
Collapse
|
5
|
Kaplovitch E, Dounaevskaia V. Treatment in the dental practice of the patient receiving anticoagulation therapy. J Am Dent Assoc 2019; 150:602-8. [PMID: 31109636 DOI: 10.1016/j.adaj.2019.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 01/26/2019] [Accepted: 02/07/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The use of anticoagulants is ubiquitous in outpatient medical practice, with anticoagulants now among the most common classes of medications prescribed in the United States. Despite its safety, anticoagulation around minimally invasive dental procedures remains a source of discomfort for dental practitioners and a common reason for referral to specialist anticoagulation clinics. The introduction of new anticoagulant options, as well as the changing practice pattern in anticoagulant prescription, somewhat contributes to this situation. Reviewing the commonly used anticoagulants in outpatient medical practice, as well as their implications in dental practice, is integral to providing safe oral health care. CONCLUSIONS Direct oral anticoagulants are now the preferred agents for most patients receiving anticoagulation therapy. With patients receiving any type of therapeutic anticoagulation, clinicians usually can perform dental procedures such as restorations, limited dental extractions, endodontic procedures, soft-tissue biopsies, and scalings safely without anticoagulation therapy interruption. Although local hemostatic maneuvers are often sufficient during dental procedures, antifibrinolytic medications, as well as local sponges and glues, can be used to ensure adequate hemostasis. Different classes of anticoagulants interact with commonly prescribed medications in unique ways and may require differing management and monitoring. PRACTICAL IMPLICATIONS Clinicians can perform most dental procedures safely despite patients' receiving therapeutic anticoagulation. Recognizing common classes of anticoagulants, incorporating strategies to minimize bleeding, and understanding how commonly prescribed medications in dentistry interact with anticoagulants are essential to practicing safe, comprehensive care.
Collapse
|
6
|
Colonna P, von Heymann C, Santamaria A, Matsushita Y, Unverdorben M. Edoxaban Management in Diagnostic and Therapeutic Procedures (EMIT-AF/VTE)-Trial design. Clin Cardiol 2018; 41:1123-1129. [PMID: 30069910 PMCID: PMC6221054 DOI: 10.1002/clc.23037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 11/09/2022] Open
Abstract
Non‐vitamin K dependent oral anticoagulants (NOAC) are now widely used in patients with nonvalvular atrial fibrillation (NVAF) for stroke prevention and in patients with venous thromboembolism (VTE) for the treatment and secondary prevention of the disease. Among NOAC, edoxaban demonstrated noninferiority to warfarin for stroke prevention in NVAF and for VTE treatment, with superior safety. EMIT‐AF/VTE (Edoxaban Management in Diagnostic and Therapeutic Procedures) (NCT02950168) is a multicenter, prospective, and noninterventional registry study designed to collect detailed information on the periprocedural management of patients with NVAF and VTE receiving edoxaban. The primary objective of EMIT‐AF/VTE is to document the periprocedural management of patients receiving edoxaban and to collect data on safety and other outcomes in these patients. The primary safety outcome is the rate of major bleeding. Other assessments include the evaluation of efficacy outcomes, periprocedural dosing, and timing of edoxaban. The observation period will start 5 days prior to the procedure and end 30 days post‐procedure. EMIT‐AF/VTE will aim to prospectively enroll up to approximately 1400 procedures from Europe. Enrollment commenced in December 2016 and will be completed in July 2018. As of July 2018, before database lock and with several procedure forms still temporarily inserted, a preliminary number of 1204 patients have been enrolled, who underwent a total of 1453 procedures. The prospective EMIT‐AF/VTE registry program will expand the knowledge of periprocedural management of patients with NVAF and VTE receiving edoxaban in clinical practice.
Collapse
Affiliation(s)
- Paolo Colonna
- Department of Cardiology, University Hospital Policlinico, Bari, Italy
| | - Christian von Heymann
- Department of Anesthesia, Intensive Care Medicine, Emergency Medicine, and Pain Therapy; Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Amparo Santamaria
- Service of Hematology, Haemostasis and Thrombosis Unit, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Yasuyuki Matsushita
- Biostatistics & Data Management, Daiichi Sankyo Europe GmbH, Munich, Germany
| | - Martin Unverdorben
- Global Medical Affairs, Daiichi Sankyo, Inc, Basking Ridge, New Jersey, USA
| |
Collapse
|
7
|
Dézsi CA, Dézsi BB, Dézsi AD. Management of dental patients receiving antiplatelet therapy or chronic oral anticoagulation: A review of the latest evidence. Eur J Gen Pract 2018; 23:196-201. [PMID: 28743214 PMCID: PMC5774272 DOI: 10.1080/13814788.2017.1350645] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The perioperative management of patients treated with antithrombotic medications who undergo surgical procedures represents a common clinical problem. Dental interventions are usually associated with a low risk of bleeding; however, the dental implications of new antithrombotic agents are not yet fully understood. The present review is based on the latest evidence and recommendations published on the periprocedural management of dental patients treated with single or dual antiplatelet therapy, vitamin K antagonists, or direct oral anticoagulants for a variety of indications.
Collapse
Affiliation(s)
- Csaba András Dézsi
- a Department of Cardiology , Petz Aladár County Teaching Hospital , Győr , Hungary
| | | | - András Döme Dézsi
- c Department of Cardiology , State Hospital for Cardiology , Balatonfüred , Hungary
| |
Collapse
|
8
|
Vorobyeva NM. [Basic Principles of Periprocedural Management of Patients With Nonvalvular Atrial Fibrillation Receiving Anticoagulant Therapy: the Consensus Document of Experts of the American College of Cardiology]. Kardiologiia 2018:91-104. [PMID: 29466205 DOI: 10.18087/cardio.2018.2.10091] [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] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The article contains an outline of the 2017 ACC Expert Consensus Decision Pathway for Periprocedural Management of Anticoagulation in Patients With Nonvalvular Atrial Fibrillation. This document considers in detail problems of necessity and safety of temporary interrupting of anticoagulation for the period of procedure, main principles of interruption and restarting anticoagulant therapy after procedure, indications to the transitional (bridging) therapy in the periprocedural period, as well as possible strategies of periprocedural management of patients in dependence of risk of bleeding and thromboembolic complications. This Expert Consensus Decision Pathway refer to the periprocedural use of both oral (vitamin K antagonists, new oral anticoagulants) and parenteral (unfractionated and low-molecular-weight heparins) anticoagulants.
Collapse
Affiliation(s)
- N M Vorobyeva
- Federal State Budgetary Educational Institution of Higher Education, "Pirogov Russian National Research Medical University " of the Ministry of Health of the Russian Federation, "Russian Gerontology Clinical Research Center"
| |
Collapse
|
9
|
Martínez-Rubio A, Alcazar MD, Cadena AS, Martínez-Torrecilla R. Using Direct Oral Anticoagulants in Patients with Atrial Fibrillation: Assessment, Monitoring and Treatment Reversal. Eur Cardiol 2016; 11:118-122. [PMID: 30310459 DOI: 10.15420/ecr.2016:30:1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 12/13/2022] Open
Abstract
It is essential to prevent thromboembolic events in atrial fibrillation. The risks of thromboembolic and haemorrhagic events must be carefully assessed and weighed against one another, both in routine situations and in relation to invasive procedures. Vitamin K antagonists, until recently the first-line treatment for prophylaxis against thromboembolic events in patients with atrial fibrillation, have various drawbacks. Direct-acting oral anticoagulants overcome these limitations and are efficacious and safe. The recent developments of tests to monitor anticoagulant levels, and of target-specific reversal agents for these newer drugs, has facilitated their use in several situations, including emergencies. For these reasons, the European Society of Cardiology and other scientific societies now recommend direct-acting oral anticoagulants as first-line treatment for preventing thromboembolic events in atrial fibrillation.
Collapse
Affiliation(s)
- Antoni Martínez-Rubio
- Department of Cardiology, University Hospital Sabadell, Autonomous University of Barcelona, Barcelona, Spain and the International Society of Cardiovascular Pharmacotherapy
| | - Mario DiazNuila Alcazar
- Department of Cardiology, University Hospital Sabadell, Autonomous University of Barcelona, Barcelona, Spain and the International Society of Cardiovascular Pharmacotherapy
| | - Anna Soria Cadena
- Department of Cardiology, University Hospital Sabadell, Autonomous University of Barcelona, Barcelona, Spain and the International Society of Cardiovascular Pharmacotherapy
| | - Roger Martínez-Torrecilla
- Department of Cardiology, University Hospital Sabadell, Autonomous University of Barcelona, Barcelona, Spain and the International Society of Cardiovascular Pharmacotherapy
| |
Collapse
|
10
|
Kennedy SA, Milovanovic L, Midia M. Major bleeding after percutaneous image-guided biopsies: frequency, predictors, and periprocedural management. Semin Intervent Radiol 2015; 32:26-33. [PMID: 25762845 DOI: 10.1055/s-0034-1396961] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 01/21/2023]
Abstract
Major bleeding remains an uncommon yet potentially devastating complication following percutaneous image-guided biopsy. This article reviews two cases of major bleeding after percutaneous biopsy and discusses the frequency, predictors, and periprocedural management of major postprocedural bleeding.
Collapse
Affiliation(s)
- Sean A Kennedy
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lazar Milovanovic
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mehran Midia
- Department of Diagnostic Imaging, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|