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Igualada J, Ferrandis R, Gómez-Luque JA, Cassinello C, Hidalgo F, Llau JV. National survey on perioperative monitoring of direct oral anticoagulants: MonACOD survey. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00082-9. [PMID: 38670489 DOI: 10.1016/j.redare.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 04/28/2024]
Affiliation(s)
- J Igualada
- Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - R Ferrandis
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - C Cassinello
- Hospital Universitario Infanta Sofía, Madrid, Spain
| | - F Hidalgo
- Clínica Universidad de Navarra, Navarra, Spain
| | - J V Llau
- Hospital Universitario Doctor Peset, Valencia, Spain
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Ferrandis R, Sierra P, Gomez-Luque A. COVID-19 thromboprophylaxis. New evidence. Rev Esp Anestesiol Reanim (Engl Ed) 2024; 71:34-47. [PMID: 37678450 DOI: 10.1016/j.redare.2022.11.004] [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] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/17/2022] [Indexed: 09/09/2023]
Abstract
Recent publications have questioned the efficacy of using therapeutic or intermediate doses of low molecular weight heparin (LMWH) in COVID-19 patients, especially in the most severe patients. In order to update these recommendations, a non-systematic review has been carried out in the main medical databases. A total of 14 randomized clinical trials, 14 meta-analyses and the recommendations of 12 scientific societies were selected, stratified according to the type of patient (outpatient, hospitalized, admitted to critical care or post-discharge). The efficacy of LMWH and other therapeutic approaches (rivaroxaban, apixaban, sulodexide, acetylsalicylic acid and P2Y12 inhibitors) has been analyzed. The findings recommend using standard doses of LMWH as thromboprophylaxis in critically hospitalized COVID-19 patients and therapeutic doses in non-critically hospitalized patients if the risk of bleeding is low. In outpatients and those discharged from the hospital, LMWH could be used at a prophylactic dose if there are thrombotic risk factors, and the bleeding risk is low. It is not recommended to associate antiplatelet agents with LMWH unless previously indicated.
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Affiliation(s)
- R Ferrandis
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe, SEDAR, Valencia, Spain; SEDAR Haemostasis, Transfusion Medicine and Fluid Therapy Division, Valencia, Spain
| | - P Sierra
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Virgen de la Victoria, SEDAR, Málaga, Spain; Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Fundació Puigvert, SEDAR, Barcelona, Spain
| | - A Gomez-Luque
- SEDAR Haemostasis, Transfusion Medicine and Fluid Therapy Division, Valencia, Spain; Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Virgen de la Victoria, SEDAR, Málaga, Spain.
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3
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Ferrandis R, Escontrela B, Ferrando C, Hernández M, Herrera J, Hidalgo F, Librero J, Llau JV, Martínez A, Pajares A, Tapia B, Arruti E, Bassas E, Blasi A, Calvo A. Effectiveness of thromboprophylaxis with low molecular weight heparin in critically ill patients with COVID-19. An observational prospective, multicenter study. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:129-139. [PMID: 36842685 PMCID: PMC9957653 DOI: 10.1016/j.redare.2023.02.004] [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] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/09/2022] [Indexed: 04/12/2023]
Abstract
INTRODUCTION COVID-19 induces coagulopathy associated with an increase of thromboembolic events. Due to the lack of agreement on recommendations for thromboprophylactic management, the aim of this study was to study the dosages of LMWH used in critically ill COVID-19 patients assessing the effect on their outcome. METHODS We evaluated data of the Reg-COVID19. According to LMWH dose two groups were analyzed: prophylaxis and treatment. Primary outcome was the relationship of LMWH dosage with mortality. Secondary outcomes included the incidence of thrombotic and bleeding events, length of ICU stay, invasive mechanical ventilation, and thrombotic and inflammatory parameters. RESULTS Data of 720 patients were analyzed, 258 in the prophylaxis group and 462 in the treatment group. C Reactive Protein, invasive mechanical ventilation, tocilizumab and corticosteroid treatments were related with the choice of LMWH dose. Hemorrhagic events (66/720, 9.2%) and thrombotic complications (69/720, 9.6%) were similar in both groups (p = .819 and p = .265), as was the time course of the thrombotic events, earlier than hemorrhagic ones (9 [3-18] and 12 [6-19] days respectively). Mortality was lower in prophylaxis group (25.2% versus 35.1%), but once an inverse probability weighting model was applied, we found no effect of LMWH dose. CONCLUSION We found no benefit or harm with the administration of therapeutic or prophylactic LMWH dose in COVID19 critically ill patients. With a similar rate of hemorrhagic or thrombotic events, the LMWH dose had no influence on mortality. More studies are needed to determine the optimal thromboprophylaxis protocol for critically ill patients.
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Affiliation(s)
- R Ferrandis
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | - B Escontrela
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - C Ferrando
- Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut d'Investigacions Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, España, CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - M Hernández
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain
| | - J Herrera
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain
| | - F Hidalgo
- Departamento de Anestesiología y Cuidados Críticos, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - J Librero
- Navarrabiomed, Complejo Hospitalario de Navarra-Universidad Pública de Navarra, IDISNA, Pamplona, Navarra, Spain
| | - J V Llau
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario Doctor Peset, Valencia, Spain
| | - A Martínez
- Jefe de Servicio de Anestesiología y Cuidados Críticos, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain
| | - A Pajares
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - B Tapia
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario La Paz, Madrid, Spain
| | - E Arruti
- Innovation and Technology Area, Ubikare SL, Getxo, Vizcaya, Spain
| | - E Bassas
- Departamento de Anestesiología y Cuidados Críticos, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - A Blasi
- Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut d'Investigacions Biomèdica Agust Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - A Calvo
- Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut d'Investigacions Biomèdica Agust Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
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Ferrandis R, Escontrela B, Ferrando C, Hernández M, Herrera J, Hidalgo F, Librero J, Llau J, Martínez A, Pajares A, Tapia B, Arruti E, Bassas E, Blasi A, Calvo A. [Effectiveness of thromboprophylaxis with low molecular weight heparin in critically ill patients with COVID-19. An observational prospective, multicenter study]. Rev Esp Anestesiol Reanim 2023; 70:129-139. [PMID: 35340761 PMCID: PMC8938174 DOI: 10.1016/j.redar.2022.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/09/2022] [Indexed: 11/05/2022]
Abstract
Introduction COVID-19 induces coagulopathy associated with an increase of thromboembolic events. Due to the lack of agreement on recommendations for thromboprophylactic management, the aim of this study was to study the dosages of LMWH used in critically ill COVID-19 patients assessing the effect on their outcome. Metohds We evaluated data of the Reg-COVID19. According to LMWH dose two groups were analyzed: prophylaxis and treatment. Primary outcome was the relationship of LMWH dosage with mortality. Secondary outcomes included the incidence of thrombotic and bleeding events, length of ICU stay, invasive mechanical ventilation, and thrombotic and inflammatory parameters. Results Data of 720 patients were analyzed, 258 in the prophylaxis group and 462 in the treatment group. C Reactive Protein, invasive mechanical ventilation, tocilizumab and corticosteroid treatments were related with the choice of LMWH dose. Hemorrhagic events (66/720, 9.2%) and thrombotic complications (69/720, 9.6%) were similar in both groups (P=.819 and P=.265), as was the time course of the thrombotic events, earlier than hemorrhagic ones (9 [3-18] and 12 [6-19] days respectively). Mortality was lower in prophylaxis group (25.2% versus 35.1%), but once an inverse probability weighting model was applied, we found no effect of LMWH dose. Conclusion We found no benefit or harm with the administration of therapeutic or prophylactic LMWH dose in COVID19 critically ill patients. With a similar rate of hemorrhagic or thrombotic events, the LMWH dose had no influence on mortality. More studies are needed to determine the optimal thromboprophylaxis protocol for critically ill patients.
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Affiliation(s)
- R. Ferrandis
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitari i Politècnic La Fe, Valencia, España,Autor para correspondencia
| | - B. Escontrela
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario Infanta Leonor, Madrid, España
| | - C. Ferrando
- Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut d’Investigacions Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, España, CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
| | - M. Hernández
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| | - J. Herrera
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| | - F. Hidalgo
- Departamento de Anestesiología y Cuidados Críticos. Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - J. Librero
- Navarrabiomed, Complejo Hospitalario de Navarra-Universidad Pública de Navarra, IDISNA, Pamplona, Navarra, España
| | - J.V. Llau
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario Doctor Peset, Valencia, España
| | - A. Martínez
- Jefe de Servicio de Anestesiología y Cuidados Críticos, Hospital Universitario Cruces, Barakaldo, Vizcaya, España
| | - A. Pajares
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - B. Tapia
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario La Paz, Madrid, España
| | - E. Arruti
- Innovation and Technology Area, Ubikare SL, Getxo, Vizcaya, España
| | - E. Bassas
- Departamento de Anestesiología y Cuidados Críticos, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España
| | - A. Blasi
- Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut d’Investigacions Biomèdica Agust Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, España
| | - A. Calvo
- Departamento de Anestesiología y Cuidados Críticos, Hospital Clínic, Institut d’Investigacions Biomèdica Agust Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, España
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5
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Ferrandis R, Cassinello C, Sierra P, Llau JV. "Letter to the Editor" response to Vives and Devereaux. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:373-374. [PMID: 35760693 DOI: 10.1016/j.redare.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 11/04/2021] [Indexed: 06/15/2023]
Affiliation(s)
- R Ferrandis
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe, València, Spain.
| | - C Cassinello
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Pilar Sierra
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Fundació Puigvert, Barcelona, Spain
| | - J V Llau
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari Doctor Peset, València, Spain
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Llau JV, Ferrandis R, Sierra P, Hidalgo F, Cassinello C, Gómez-Luque A, Quintana M, Amezaga R, Geroi M, Serrano A, Marcos P. SEDAR-SEMICYUC consensus on the management of haemostasis disorders in severe COVID-19 patients. Med Intensiva 2021; 45:567-568. [PMID: 34776407 PMCID: PMC8542454 DOI: 10.1016/j.medine.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- J V Llau
- Sociedad Española de Anestesiología-Reanimación y Terapéutica del Dolor (SEDAR), Spain; Hospital Universitari Doctor Peset, Valencia, Spain.
| | - R Ferrandis
- Sociedad Española de Anestesiología-Reanimación y Terapéutica del Dolor (SEDAR), Spain; Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - P Sierra
- Sociedad Española de Anestesiología-Reanimación y Terapéutica del Dolor (SEDAR), Spain; Fundació Puigver, Barcelona, Spain
| | - F Hidalgo
- Sociedad Española de Anestesiología-Reanimación y Terapéutica del Dolor (SEDAR), Spain; Clínica Universidad de Navarra, Pamplona, Spain
| | - C Cassinello
- Sociedad Española de Anestesiología-Reanimación y Terapéutica del Dolor (SEDAR), Spain; Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - A Gómez-Luque
- Sociedad Española de Anestesiología-Reanimación y Terapéutica del Dolor (SEDAR), Spain; Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - M Quintana
- Sociedad Española de Medicina Intensiva, Crítica y de Unidades Coronarias (SEMICYUC), Spain; Hospital Universitario La Paz-Carlos III, Madrid, Spain
| | - R Amezaga
- Sociedad Española de Medicina Intensiva, Crítica y de Unidades Coronarias (SEMICYUC), Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - M Geroi
- Sociedad Española de Medicina Intensiva, Crítica y de Unidades Coronarias (SEMICYUC), Spain; Hospital Universitario de Burgos, Burgos, Spain
| | - A Serrano
- Sociedad Española de Medicina Intensiva, Crítica y de Unidades Coronarias (SEMICYUC), Spain; Hospital Clínico Universitario, Valencia, Spain
| | - P Marcos
- Sociedad Española de Medicina Intensiva, Crítica y de Unidades Coronarias (SEMICYUC), Spain; Hospital Germans Trias i Pujol, Badalona, Spain
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Llau JV, Ferrandis R, Sierra P, Hidalgo F, Cassinello C, Gómez-Luque A, Quintana M, Amezaga R, Geroi M, Serrano A, Marcos P. SEDAR-SEMICYUC consensus on the management of haemostasis disorders in severe COVID-19 patients. Med Intensiva 2020; 45:S0210-5691(20)30272-2. [PMID: 33023765 PMCID: PMC7474905 DOI: 10.1016/j.medin.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 11/24/2022]
Affiliation(s)
- J V Llau
- Sociedad Española de Anestesiología-Reanimación y Terapéutica del Dolor (SEDAR), España; Hospital Universitari Doctor Peset, Valencia, España.
| | - R Ferrandis
- Sociedad Española de Anestesiología-Reanimación y Terapéutica del Dolor (SEDAR), España; Hospital Universitari i Politècnic La Fe, Valencia, España
| | - P Sierra
- Sociedad Española de Anestesiología-Reanimación y Terapéutica del Dolor (SEDAR), España; Fundació Puigver, Barcelona, España
| | - F Hidalgo
- Sociedad Española de Anestesiología-Reanimación y Terapéutica del Dolor (SEDAR), España; Clínica Universidad de Navarra, Pamplona, España
| | - C Cassinello
- Sociedad Española de Anestesiología-Reanimación y Terapéutica del Dolor (SEDAR), España; Hospital Universitario Miguel Servet, Zaragoza, España
| | - A Gómez-Luque
- Sociedad Española de Anestesiología-Reanimación y Terapéutica del Dolor (SEDAR), España; Hospital Universitario Virgen de la Victoria, Málaga, España
| | - M Quintana
- Sociedad Española de Medicina Intensiva, Crítica y de Unidades Coronarias (SEMICYUC), España; Hospital Universitario La Paz-Carlos III, Madrid, España
| | - R Amezaga
- Sociedad Española de Medicina Intensiva, Crítica y de Unidades Coronarias (SEMICYUC), España; Hospital Universitario Son Espases, Palma de Mallorca, España
| | - M Geroi
- Sociedad Española de Medicina Intensiva, Crítica y de Unidades Coronarias (SEMICYUC), España; Hospital Universitario de Burgos, Burgos, España
| | - A Serrano
- Sociedad Española de Medicina Intensiva, Crítica y de Unidades Coronarias (SEMICYUC), España; Hospital Clínico Universitario, Valencia, España
| | - P Marcos
- Sociedad Española de Medicina Intensiva, Crítica y de Unidades Coronarias (SEMICYUC), España; Hospital Germans Trias i Pujol, Badalona, España
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Llau J, Ferrandis R, Sierra P, Hidalgo F, Cassinello C, Gómez-Luque A, Quintana M, Amezaga R, Gero M, Serrano A, Marcos P. SEDAR-SEMICYUC consensus recommendations on the management of haemostasis disorders in severely ill patients with COVID-19 infection. Revista Española de Anestesiología y Reanimación (English Edition) 2020. [PMCID: PMC7402104 DOI: 10.1016/j.redare.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The infection by the coronavirus SARS-CoV-2, which causes the disease called COVID-19, mainly causes alterations in the respiratory system. In severely ill patients, the disease often evolves into an acute respiratory distress syndrome that can predispose patients to a state of hypercoagulability, with thrombosis at both venous and arterial levels. This predisposition presents a multifactorial physiopathology, related to hypoxia as well as to the severe inflammatory process linked to this pathology, including the additional thrombotic factors present in many of the patients. In view of the need to optimise the management of hypercoagulability, the working groups of the Scientific Societies of Anaesthesiology-Resuscitation and Pain Therapy (SEDAR) and of Intensive, Critical Care Medicine and Coronary Units (SEMICYUC) have developed a consensus to establish guidelines for actions to be taken against alterations in haemostasis observed in severely ill patients with COVID-19. These recommendations include prophylaxis of venous thromboembolic disease in these patients, and in the peripartum, management of patients on long-term antiplatelet or anticoagulant treatment, bleeding complications in the course of the disease, and the interpretation of general alterations in haemostasis.
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9
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Llau JV, Ferrandis R, Sierra P, Hidalgo F, Cassinello C, Gómez-Luque A, Quintana M, Amezaga R, Gero M, Serrano A, Marcos P. SEDAR-SEMICYUC consensus recommendations on the management of haemostasis disorders in severely ill patients with COVID-19 infection. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:391-399. [PMID: 32591185 PMCID: PMC7245242 DOI: 10.1016/j.redar.2020.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/06/2020] [Accepted: 05/10/2020] [Indexed: 01/08/2023]
Abstract
The infection by the coronavirus SARS-CoV-2, which causes the disease called COVID-19, mainly causes alterations in the respiratory system. In severely ill patients, the disease often evolves into an acute respiratory distress syndrome that can predispose patients to a state of hypercoagulability, with thrombosis at both venous and arterial levels. This predisposition presents a multifactorial physiopathology, related to hypoxia as well as to the severe inflammatory process linked to this pathology, including the additional thrombotic factors present in many of the patients. In view of the need to optimise the management of hypercoagulability, the working groups of the Scientific Societies of Anaesthesiology-Resuscitation and Pain Therapy (SEDAR) and of Intensive, Critical Care Medicine and Coronary Units (SEMICYUC) have developed a consensus to establish guidelines for actions to be taken against alterations in haemostasis observed in severely ill patients with COVID-19. These recommendations include prophylaxis of venous thromboembolic disease in these patients, and in the peripartum, management of patients on long-term antiplatelet or anticoagulant treatment, bleeding complications in the course of the disease, and the interpretation of general alterations in haemostasis.
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Affiliation(s)
- J V Llau
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitari Doctor Peset, SEDAR, Valencia, España.
| | - R Ferrandis
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe, SEDAR, Valencia, España
| | - P Sierra
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Fundació Puigvert, SEDAR , Barcelona, España
| | - F Hidalgo
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Clínica Universidad de Navarra, SEDAR, Pamplona, Navarra, España
| | - C Cassinello
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Miguel Servet, SEDAR, Zaragoza, España
| | - A Gómez-Luque
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Virgen de la Victoria, SEDAR, Málaga, España
| | - M Quintana
- Servicio de Medicina Intensiva, Hospital Universitario La Paz-Carlos III, SEMICYUC, Madrid, España
| | - R Amezaga
- Servicio de Medicina Intensiva, Hospital Universitario Son Espases, SEMICYUC, Palma de Mallorca, Baleares, España
| | - M Gero
- Servicio de Medicina Intensiva, Hospital Universitario, SEMICYUC, Burgos, España
| | - A Serrano
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, SEMICYUC, Valencia, España
| | - P Marcos
- Servicio de Medicina Intensiva, Hospital Germans Trias i Pujol, SEMICYUC, Badalona, Barcelona, España
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Colomina MJ, Guilabert P, Ripollés-Melchor J, Jover JL, Basora M, Llau JV, Casinello C, Ferrandis R. Fluid therapy in the surgical patient in our environment. Reporting on the Fluid Day Study. ACTA ACUST UNITED AC 2019; 66:119-121. [PMID: 30665797 DOI: 10.1016/j.redar.2018.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- M J Colomina
- Servicio de Anestesiología y Reanimación, Hospital Universitari Bellvitge, Barcelona, España.
| | - P Guilabert
- Servicio de Anestesiología y Reanimación, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J Ripollés-Melchor
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España
| | - J L Jover
- Servicio de Anestesiología y Reanimación, Hospital Verge dels Lliris, Alcoy (Alicante), España
| | - M Basora
- Servicio de Anestesiología y Reanimación, Hospital Clínic, Barcelona, España
| | - J V Llau
- Servicio de Anestesiología y Reanimación, Hospital Universitari Dr. Peset, Valencia, España
| | - C Casinello
- Servicio de Anestesiología y Reanimación, Hospital Miguel Servet, Zaragoza, España
| | - R Ferrandis
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, España
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Ferrandis R, Colomina MJ, Durán L, Gómez-Luque A, Hidalgo F, Llau JV. Reversion algorithm for patients anticoagulated with dabigatran in urgent surgery. ACTA ACUST UNITED AC 2018; 66:149-156. [PMID: 30447895 DOI: 10.1016/j.redar.2018.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 10/27/2022]
Affiliation(s)
- R Ferrandis
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, València, España.
| | - M J Colomina
- Servicio de Anestesiología y Reanimación, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - L Durán
- Servicio de Anestesiología y Reanimación, Hospital Clínico San Carlos, Madrid, España
| | - A Gómez-Luque
- Servicio de Anestesiología y Reanimación, Hospital Univesitario Virgen de la Victoria, Málaga, España
| | - F Hidalgo
- Servicio de Anestesiología y Reanimación, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - J V Llau
- Servicio de Anestesiología y Reanimación, Hospital Universitari Doctor Peset, València, España
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Sierra P, Gómez-Luque A, Llau JV, Ferrandis R, Cassinello C, Hidalgo F. Recommendations for perioperative antiplatelet treatment in non-cardiac surgery. Working Group of the Spanish Society of Anaesthesiology-Resuscitation and Pain Therapy, Division of Haemostasis, Transfusion Medicine, and Perioperative Fluid Therapy. Update of the Clinical practice guide 2018. ACTA ACUST UNITED AC 2018; 66:18-36. [PMID: 30166124 DOI: 10.1016/j.redar.2018.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/13/2018] [Indexed: 12/24/2022]
Affiliation(s)
- P Sierra
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Fundación Puigvert (IUNA), Barcelona, España.
| | - A Gómez-Luque
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, España
| | - J V Llau
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Dr. Peset, Universitat de València, Valencia, España
| | - R Ferrandis
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hopital Clínic i Universitari La Fe, Universitat de València, Valencia, España
| | - C Cassinello
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Miguel Servet, Zaragoza, España
| | - F Hidalgo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Clínica Universidad de Navarra, Pamplona, España
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Hidalgo F, Gómez-Luque A, Ferrandis R, Llau JV, de Andrés J, Gomar C, Sierra P, Castillo J, Torres LM. [Perioperative management of direct oral anticoagulant in emergency surgery and bleeding. Haemostasis monitoring and treatment]. ACTA ACUST UNITED AC 2015; 62:450-60. [PMID: 25702199 DOI: 10.1016/j.redar.2015.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 08/23/2014] [Revised: 01/02/2015] [Accepted: 01/09/2015] [Indexed: 10/24/2022]
Abstract
There is an almost unanimous consensus on the management of the direct new oral anticoagulants, dabigatran, rivaroxaban, and apixaban in elective surgery. However, this general consensus does not exist in relation with the direct new oral anticoagulants use in emergency surgery, especially in the bleeding patient. For this reason, a literature review was performed using the MEDLINE-PubMed. An analysis was made of the journal articles, reviews, systematic reviews, and practices guidelines published between 2000 and 2014 using the terms "monitoring" and "reversal". From this review, it was shown that the routine tests of blood coagulation, such as the prothrombin time and activated partial thromboplastin time, have a limited efficacy in the perioperative control of blood coagulation in these patients. There is currently no antidote to reverse the effects of these drugs, although the possibility of using concentrated prothrombin complex and recombinant activated factor vii has been suggested for the urgent reversal of the anticoagulant effect.
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Affiliation(s)
- F Hidalgo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - A Gómez-Luque
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, España.
| | - R Ferrandis
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España
| | - J V Llau
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España
| | - J de Andrés
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Universidad de Valencia, Valencia, España
| | - C Gomar
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - P Sierra
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Fundación Puigvert (IUNA), Barcelona, España
| | - J Castillo
- Servicio de Anestesiología, Hospital del Mar, Barcelona, España
| | - L M Torres
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Puerta del Mar, Cádiz, España
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Llau JV, Ferrandis R, Castillo J, de Andrés J, Gomar C, Gómez-Luque A, Hidalgo F, Torres LM. [Management of direct action oral anticoagulants in the peri-operative period and invasive techniques]. Rev Esp Anestesiol Reanim 2012; 59:321-330. [PMID: 22633209 DOI: 10.1016/j.redar.2012.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 01/23/2012] [Indexed: 06/01/2023]
Abstract
The new direct-acting oral anticoagulants (ACOD) in patients on prolonged treatment require the need to balance the risk of haemorrhage by administering them against the risk of thrombosis on withdrawing them. Recommendations for their management are proposed in the present article: A) Thromboprophylaxis and general anaesthesia: the performing of regional anaesthesia if administered with an ACOD as thromboprophylaxis requires some safety intervals based on their pharmacokinetic parameters; B) Management of ACOD in elective surgery: in patients with normal renal function and a low haemorrhage/thrombosis risk, stop the ACOD two days before the surgery; it the haemorrhage/thrombosis risk is high and/or renal function is impaired, therapy with a low molecular weight heparin is proposed from 5 days prior to the surgery, and C) Management of ACOD in urgent surgery and associated haemorrhage: the systematic prophylactic administration of haemostatics is recommended. In the event of acute bleeding that may place the life of the patient at risk (due to volume or location), the administration of concentrated prothrombin complex, fresh plasma, or factor VIIa, must be assessed, together with general control measures of acute haemorrhage. These recommendations should be considered in the context of the use drugs that do have a specific antidote, where their monitoring by the usual coagulation tests is not routine, and with those in which there is limited experience. We believe they need to be reviewed in the future, depending on further studies and clinical experience obtained.
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Affiliation(s)
- J V Llau
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario de Valencia, Universidad Católica «San Vicente Mártir», Valencia, España
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Ferrandis R, Belda FJ, Garcia-Raimundo M, Soro M, Martí F, Montoya FJ, Cortés V, Bahamonde JA. Airway pressure curve: a good tool to measure neural inspiratory time? Minerva Anestesiol 2012; 78:54-62. [PMID: 21971435] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Considerable asynchrony during pressure-support ventilation has been reported. While the beginning of active inspiration is usually identifiable in the airway pressure (Paw) curve (the inspiratory trigger), there is still a need for accurate, non-invasive methods to identify the end of inspiration. To test the hypothesis that inspiration, particularly the end of inspiration, can be estimated from the Paw curve, we compared indirect measurements based on Paw with simultaneous direct electromyography of the diaphragm (EMGdi). METHODS We prospectively studied 10 patients during the weaning period after cardiac surgery. Inspiratory pressure support was set at 20, 15, 10, and 5 cm H(2)O; 25 respiratory cycles were analyzed at each pressure level. Recording of the electromyogram was obtained with electrodes inserted into the diaphragm during surgery. RESULTS The start and end of inspiration were identified in the Paw curve in 99% and 98% of the 1000 cycles analyzed, respectively, and were coincident with the electromyogram in 62% and 53% of the cycles, respectively. The inspiratory time estimated from the Paw curve was well correlated (r=0.94, P<0.0001) with the electromyogram. CONCLUSION The end of neural inspiration (EMGdi) can be easily and with little error recognized from the Paw curve alone in patients with normal ventilatory mechanics who receive pressure-support ventilation.
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Affiliation(s)
- R Ferrandis
- Department of Anesthesiology and Critical Care, Hospital Clínic Universitari, Valencia, Spain.
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Soro M, García-Pérez ML, Belda FJ, Ferrandis R, Aguilar G, Tusman G, Gramuntell F. Effects of prone position on alveolar dead space and gas exchange during general anaesthesia in surgery of long duration. Eur J Anaesthesiol 2007; 24:431-7. [PMID: 17156508 DOI: 10.1017/s0265021506001888] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE We investigated the effects of prone position on respiratory dead space and gas exchange in 14 anaesthetized healthy patients undergoing elective posterior spinal surgery of more than 3 h of duration. METHODS The patients received a total intravenous anaesthetic with propofol/remifentanil/cisatracurium. They were ventilated at a tidal volume of 8-10 mL kg(-1), zero positive end-expiratory pressure and an inspired oxygen fraction of 0.4. Physiological, airway and alveolar dead spaces were calculated by analysis of the volumetric capnography waveform. Measurements were made in supine position (20 min after the beginning of mechanical ventilation) and 30, 120 and 180 min after turning to prone position. RESULTS We found that the alveolar dead space/tidal volume ratio did not change. PaO(2)/F(i)O(2) increased, although not statistically significantly. Dynamic compliance was reduced due to a reduction in tidal volume and an increase in plateau pressure. CONCLUSIONS Patients undergoing surgery in prone position for a duration of 3 h under general anaesthesia including muscle relaxation and mechanical ventilation without positive end-expiratory pressure have stable haemodynamics and no significant changes in the alveolar dead space to tidal volume ratio. Oxygenation tended to improve.
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Affiliation(s)
- M Soro
- Hospital Clínico Universitario, Department of Anaesthesia and Critical Care, Valencia, Spain
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Jover JL, Soro M, Belda FJ, Aguilar G, Caro P, Ferrandis R. [Measurement of cardiac output after cardiac surgery: validation of a partial carbon dioxide rebreathing (NICO) system in comparison with continuous thermodilution with a pulmonary artery catheter]. Rev Esp Anestesiol Reanim 2005; 52:256-62. [PMID: 15968903] [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: 05/03/2023]
Abstract
UNLABELLED Cardiac output is usually monitored with a pulmonary artery catheter. However, because that method is not free of risk, devices have been designed in recent years to measure cardiac output in a way that is minimally invasive or fully noninvasive. Among such devices is the NICO monitor, which is based on a modified Fick equation (partial CO2 rebreathing). OBJECTIVE To compare the accuracy of cardiac output measurements from the NICO monitor to measurements obtained by continuous thermodilution with a pulmonary artery catheter. MATERIAL AND METHODS A nonprobabilistic, consecutive sample of 20 patients was enrolled in the early postoperative period after elective cardiac surgery (coronary or valve procedures) in the recovery ward. Seven measurements of cardiac output were taken simultaneously with each method in each patient. RESULTS AND CONCLUSIONS Cardiac output estimated by the partial CO2 rebreathing method was lower than the measurement obtained by the pulmonary artery catheter. The percentage error between the 2 methods was 37%, indicating that the NICO monitor can not substitute for the traditional method. The better correlation found between normal-to-low cardiac output values and the absence of side effects of using the NICO method suggest that it might be indicated for detecting low cardiac output after cardiac surgery, especially when the risk-benefit ratio does not favor using a pulmonary artery catheter.
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Affiliation(s)
- J L Jover
- Servicio de Anestesiología y Reanimación, Hospital Virgen de los Lirios, Alcoy, Alicante.
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Soro M, García-Pérez ML, Ferrandis R, Aguilar G, Belda EJ. Closed-system anaesthesia for laparoscopic surgery: is there a risk for carbon monoxide intoxication? Eur J Anaesthesiol 2004; 21:483-8. [PMID: 15248629 DOI: 10.1017/s0265021504006118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE One of the complications of laparoscopic surgery is carbon monoxide production during electrocautery. The aim of our study was to ascertain the relationship between intraperitoneal and alveolar concentrations of carbon monoxide and systemic carboxyhaemoglobin in patients undergoing laparoscopic cholecystectomy and anaesthetized with a closed system, where the carbon monoxide excreted through the lungs is accumulated in the circuit and thus re-inhaled. METHODS Nine consecutive patients undergoing laparoscopic cholecystectomy were studied. Patients' lungs were ventilated with a closed anaesthesia breathing system (Physioflex). Measurements were taken after establishing pneumoperitoneum (baseline) and at 5, 15 and 30 min after starting electrocautery. RESULTS Mean duration of pneumoperitoneum was 42 +/- 13 min with cumulative electrocautery time of 2.4 +/- 1.8 min. Intraperitoneal carbon monoxide concentrations increased significantly at 5, 15 and 30 min reaching peak values of 481 +/- 151 ppm at 15 min. No significant differences were found in alveolar carbon monoxide and carboxyhaemoglobin concentrations with respect to baseline. CONCLUSIONS No significant increase in carboxyhaemoglobin is produced during laparoscopic surgery, even under closed-system anaesthesia without pulmonary carbon monoxide elimination. This is most likely due to a low peritoneal absorption of carbon monoxide. We conclude that in adult patients, no carbon monoxide intoxication is caused if reasonable periods of electrocautery are used and the intraperitoneal gas is regularly renewed.
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Affiliation(s)
- M Soro
- Hospital Clínico Universitario, Department of Anesthesiology and Postsurgical Intensive Care, Valencia, Spain
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Brizuela G, Llana S, Ferrandis R, García-Belenguer AC. The influence of basketball shoes with increased ankle support on shock attenuation and performance in running and jumping. J Sports Sci 1997; 15:505-15. [PMID: 9386208 DOI: 10.1080/026404197367146] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of this study was to assess the influence of footwear with increased ankle support on ankle kinematics and on impact loads during landing from a vertical jump using high-speed cinematography, dynamometry and accelerometry in a series of tests in which a rebound action was simulated. To analyse the effect of this increased support on motor performance, two performance tests were designed: a vertical jump test and an obstacle course running test. Two prototype shoes with identical soles but different uppers were used. The first was designed to provide greater ankle support, with such features as a high top, heel counters and a rearfoot lacing system. The second prototype was a less supporting shoe, with low top and no heel counter or any other feature for support. In the shock attenuation test, the use of high-support shoes resulted in higher forefoot impact forces and higher shock transmission to the head, but showed lower shock transmission to the tibia. The use of high support shoes resulted in lower ranges of eversion and higher ranges of inversion of the ankle on landing. In the motor performance tests, the high-support shoes reduced the height jumped and increased the time to complete the running course relative to the low-support shoes. We conclude that increased ankle support reduces ankle eversion range but increases shock transmission, and reduces both jumping and running performance.
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Affiliation(s)
- G Brizuela
- Institute of Biomechanics of Valencia, Paterna, Spain
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Peiró A, Ferrandis R, Garcia L, Alcazar E. Simultaneous and spontaneous bilateral rupture of the patellar tendon in rheumatoid arthritis. A case report. Acta Orthop Scand 1975; 46:700-3. [PMID: 1180031 DOI: 10.3109/17453677508989253] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A case of rupture of the patellar tendon in a patient with rheumatoid arthritis is presented. The age of this patient (27 years) makes this case quite uncommon. The rupture was bilateral, simultaneous and spontaneous. The absence of previous cortisone administration rules out this drug as a cause of the tendon rupture.
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