Dual Antiplatelet Therapy for Coronary and Peripheral Arterial Disease

Dual Antiplatelet Therapy for Coronary and Peripheral Arterial Disease
Author: Sorin Brener
Publsiher: Academic Press
Total Pages: 210
Release: 2020-11-15
ISBN 10: 9780128205365
ISBN 13: 0128205369
Language: EN, FR, DE, ES & NL

Dual Antiplatelet Therapy for Coronary and Peripheral Arterial Disease Book Review:

Dual Antiplatelet Therapy for Coronary and Peripheral Arterial Disease is a complete reference containing updated information on the advantages and disadvantages of dual antiplatelet therapy, its duration, composition and anticipated changes. The basis for DAPT in arterial disease is discussed, allowing readers to understand platelet physiology and its relevance to ischemic events. Data on shorter than usual duration of DAPT, and on extended therapy beyond the recommendation of current guidelines is presented in great detail, summarizing a large body of evidence into concrete, relevant recommendation that is readily adaptable by practicing clinicians. A clinically relevant and updated compendium of data pertaining to this field is also presented, as well as the anticipated trends and innovations likely to occur in the next 3-5 years. Summarizes a large body of evidence into concrete, relevant recommendations that is readily adapted by practicing clinicians Explores the current status of DAPT, controversial topics, and future developments and trends in this field Edited and contributed by renowned cardiologists in the field

Peripheral and Cerebrovascular Intervention

Peripheral and Cerebrovascular Intervention
Author: Deepak L. Bhatt
Publsiher: Springer Science & Business Media
Total Pages: 236
Release: 2011-11-20
ISBN 10: 9781603279659
ISBN 13: 1603279652
Language: EN, FR, DE, ES & NL

Peripheral and Cerebrovascular Intervention Book Review:

Peripheral and Cerebrovascular Intervention draws upon experts from diverse fields to provide readers with a comprehensive foundation for understanding and performing endovascular procedures—from the basic steps to the most current and advanced techniques. Individual chapters focus on primary intervention sites, including lower extremity, renal/mesenteric, subclavian/upper extremity, carotid/vertebral, intracranial and venous interventions. Additionally, chapters covering critical limb ischemia and abdominal and thoracic aortic aneurysms are included. By incorporating valuable clinical information, such as indications, contraindications, complications and discussions of surgical techniques and procedures, this book is a valuable resource for the busy practitioner and will be of interest to all interventional and general cardiologists, radiologists and neurologists; vascular surgeons; internists and residents and fellows.

Clopidogrel and the Newer P2Y12 Antiplatelet Agents

Clopidogrel and the Newer P2Y12 Antiplatelet Agents
Author: Michael P. Savage,David L. Fischman, M.d.
Publsiher: Anonim
Total Pages: 308
Release: 2019-02-22
ISBN 10: 9781536149722
ISBN 13: 1536149721
Language: EN, FR, DE, ES & NL

Clopidogrel and the Newer P2Y12 Antiplatelet Agents Book Review:

Cardiovascular disease remains the leading cause of death in the developed world. By preventing thromboembolic events such as heart attacks and strokes, antiplatelet drugs have become a cornerstone in the treatment of cardiovascular disease. Clopidogrel is a member of the thienopyridine family which inhibit ADP-induced platelet activation by irreversibly binding to the P2Y12 receptor. Clopidogrel is one of the most commonly used medications with over 9 million prescriptions written annually. It is utilized in the treatment of a wide variety of cardiovascular disorders including acute coronary syndromes (ACS), percutaneous coronary intervention (PCI) with stents, cerebrovascular disease, peripheral vascular disease, and structural heart interventions. Most often, clopidogrel is used in combination with low dose aspirin, providing dual antiplatelet therapy (DAPT). Newer, more potent P2Y12 inhibitors, prasugrel and ticagrelor, are now available as alternatives to clopidogrel. These newer agents have been shown to be more effective than clopidogrel in reducing ischemic events in patients with ACS. Recently a novel intravenous P2Y12 inhibitor, cangrelor, has become available for use during PCI in patients who have not been pretreated with an oral P2Y12 inhibitor. This book examines virtually all aspects of P2Y12 inhibitors pharmacology, clinical uses, randomized trial results, guideline recommendations, and adverse drug effects. Important fundamental issues are reviewed including comparative pharmacology of P2Y12 inhibitors, randomized trials of clopidogrel in patients with coronary artery disease, DAPT duration after PCI, and role of platelet function testing. The newer P2Y12 inhibitors (prasugrel, ticagrelor, and cangrelor) receive special focus. Use of antiplatelet therapy in specific patient populations is discussed including patients with coronary bypass graft surgery, peripheral vascular disease, cerebrovascular disease, and structural heart disease. Management of antiplatelet therapy in patients who require anticoagulation is a particularly challenging clinical setting and is the topic of a featured review. Finally, adverse drug effects and reactions are examined in a section highlighting clopidogrel resistance, clopidogrel hypersensitivity, and bleeding complications. This book is designed to provide a comprehensive review of clopidogrel and the newer P2Y12 inhibitors. Towards that end, the authors have enlisted an internationally renowned group of experts as contributors. It is intended to be a resource for clinicians, scientists, pharmacologists, and all healthcare professionals involved in the management of cardiovascular disease.

The Esc Textbook of Cardiovascular Medicine

The Esc Textbook of Cardiovascular Medicine
Author: A. John Camm,Professor of Clinical Cardiology A John Camm,Director of Research Education & Development and Consultant of Cardiology Thomas F Luscher,Thomas F. Luscher,Gerald Maurer,Professor of Cardiology Patrick W Serruys, MD, PhD
Publsiher: European Society of Cardiology
Total Pages: 2384
Release: 2018-11-25
ISBN 10: 9780198784906
ISBN 13: 0198784902
Language: EN, FR, DE, ES & NL

The Esc Textbook of Cardiovascular Medicine Book Review:

This new third edition of The ESC Textbook of Cardiovascular Medicine is a ground breaking initiative from the European Society of Cardiology that is transforming reference publishing in cardiovascular medicine in order to better serve the changing needs of the global cardiology community. Providing the evidence-base behind clinical practice guidelines, with in-depth peer-reviewed articles and broad coverage of this fast-moving field, both the print and digital publication are invaluable resources for cardiologists across the world. Overseen by Professors A. John Camm, Thomas F. Lüscher, Patrick W. Serruys, and Gerald Maurer, supported by an editorial board of subject experts, and more than 900 of the world's leading specialists from research and the clinic contributing, this dynamic encyclopaedic resource covers more than 63 disciplines within cardiology. Split into six key parts; Introduction to the cardiovascular system; Investigations; Heart diseases; Vascular disease; Special populations, and Other aspects of cardiology, providing readers with a trustworthy insight into all aspects of cardiovascular medicine. To respond nimbly to the rapid evolution of the field the digital publication, ESC CardioMed, is continuously updated by the author teams. With expert editors and authors, and stringent peer-review, the publication combines the discoverability of digital with the highest standards of academic publishing. Highly illustrated with embedded multi-media features, along with cross-referenced links to ESC Clinical Practice Guidelines, related content and primary research data in European Heart Journal, as well as all other major journals in the field, ESC CardioMed provides users with the most dynamic and forward thinking digital resource at the heart of cardiology. As a consistently evolving knowledge base, the ESC Textbook of Cardiovascular Medicine 3e together with the online counterpart ESC CardioMed, equips all those, from trainees and consultants, to device specialists and allied healthcare professionals with a powerful, multifaceted resource covering all aspects of cardiovascular medicine.

Platelets

Platelets
Author: Alan D. Michelson,Marco Cattaneo,Andrew Frelinger,Peter Newman
Publsiher: Academic Press
Total Pages: 1268
Release: 2019-03-07
ISBN 10: 0128134690
ISBN 13: 9780128134696
Language: EN, FR, DE, ES & NL

Platelets Book Review:

Platelets, Fourth Edition, integrates the entire field of platelet biology, pathophysiology, and clinical medicine with contributions from 142 world experts from 18 countries. This award-winning reference provides clear presentations by basic scientists on the cellular, molecular, and genetic mechanisms of platelets and the role of platelets in thrombosis, hemorrhage, inflammation, antimicrobial host defense, wound healing, angiogenesis and cancer. It also provides start-of-the-art presentations by hematologists, cardiologists, stroke physicians, blood bankers, pathologists and other clinicians on platelet function testing, disorders of platelet numbers and function, antiplatelet therapy and therapy to increase platelet numbers and/or function. Since the publication of the Third Edition of Platelets, there has been a rapid expansion of knowledge in both basic biology of platelets and the clinical approach to platelet-related diseases. This Fourth Edition of Platelets draws all this information into a single, comprehensive and authoritative resource. Comprehensive and definitive source of state-of-the-art knowledge about platelets Integrates the entire field of platelet biology, pathophysiology, and clinical medicine Written for clinicians, pathologists and scientists by 142 world-renowned experts from 18 countries Completely revised and updated, with 11 new chapters on topics such as platelet glycobiology, the platelet transcriptome, platelet inhibitory receptors, platelet function testing in clinical research trials, therapeutic platelet-rich plasma in wound healing, and new antiplatelet drugs Full color textbook with over 250 illustrations and 15,000 references

Platelets in Thrombotic and Non-Thrombotic Disorders

Platelets in Thrombotic and Non-Thrombotic Disorders
Author: Paolo Gresele,Neal S. Kleiman,José A. Lopez,Clive P. Page
Publsiher: Springer
Total Pages: 1445
Release: 2017-03-08
ISBN 10: 3319474626
ISBN 13: 9783319474625
Language: EN, FR, DE, ES & NL

Platelets in Thrombotic and Non-Thrombotic Disorders Book Review:

This book reviews current science and applications in fields including thrombosis and hemostasis, signal transduction, and non-thrombotic conditions such as inflammation, allergy and tumor metastasis. It is a detailed, up-to-date, highly referenced text for clinical scientists and physicians, including recent developments in this rapidly expanding field. More than a scientific resource, this is also an authoritative reference and guide to the diagnosis.

Antiplatelet Therapy in Cardiovascular Disease

Antiplatelet Therapy in Cardiovascular Disease
Author: Ron Waksman,Paul A. Gurbel,Michael A. Gaglia, Jr.
Publsiher: John Wiley & Sons
Total Pages: 352
Release: 2014-03-24
ISBN 10: 1118494024
ISBN 13: 9781118494028
Language: EN, FR, DE, ES & NL

Antiplatelet Therapy in Cardiovascular Disease Book Review:

Edited by one of the world's leading interventional cardiologistsand educators, this new book is created with an eye on giving thereader a solid, practical and clinically-focused understanding ofthis important class of drugs, from basic science to a clear-headeddiscussion of complex topics such as combination therapies,drug-drug interactions, and platelet resistance. This important new book: Begins with a concise but thorough discussion of plateletbiology and pathophysiology so that readers understand how thesetherapies work and why they can also produce such a varied range ofcomplications, from minor gastrointestinal upset, to potentiallylife-threatening conditions such as neutropenia, a criticalshortage of white blood cells. Thoroughly covers platelet function testing, including new,novel techniques. Clarifies current best-practices regarding the use ofantiplatelet agents in both chronic and acute cardiovasculardisease Reviews of all types of antiplatelet agents – fromaspirin to recently approved drugs – including indications,clinical outcomes, and side effects/complications Written by an international who's-who of experts in the field,Antiplatelet Therapy also includes an entire section covering theuse of antiplatelet drugs in PCIs, including percutaneous valverepair, which makes this text particularly essential toInterventional Cardiologists.

Peripheral Vascular Disease: A Clinical Approach

Peripheral Vascular Disease: A Clinical Approach
Author: Carlos Mena,Sasanka Jayasuriya
Publsiher: Lippincott Williams & Wilkins
Total Pages: 400
Release: 2019-05-21
ISBN 10: 1496349423
ISBN 13: 9781496349422
Language: EN, FR, DE, ES & NL

Peripheral Vascular Disease: A Clinical Approach Book Review:

Part of the new Clinical Approach series—which focuses on key topics in cardiology—this pragmatic, comprehensive guide is intended for residents, practitioners, advanced practice nurses, and physician assistants, and covers arterial, venous, and lymphatic diseases. Easy-to-read chapters are written by clinical experts in interventional cardiology, interventional radiology, vascular surgery, and podiatry, and begin with helpful quick-reference summaries.

Peripheral Artery Disease: New Insights for the Healthcare Professional: 2011 Edition

Peripheral Artery Disease: New Insights for the Healthcare Professional: 2011 Edition
Author: Anonim
Publsiher: ScholarlyEditions
Total Pages: 24
Release: 2012-01-09
ISBN 10: 1464912297
ISBN 13: 9781464912290
Language: EN, FR, DE, ES & NL

Peripheral Artery Disease: New Insights for the Healthcare Professional: 2011 Edition Book Review:

Peripheral Artery Disease: New Insights for the Healthcare Professional: 2011 Edition is a ScholarlyPaper™ that delivers timely, authoritative, and intensively focused information about Peripheral Artery Disease in a compact format. The editors have built Peripheral Artery Disease: New Insights for the Healthcare Professional: 2011 Edition on the vast information databases of ScholarlyNews.™ You can expect the information about Peripheral Artery Disease in this eBook to be deeper than what you can access anywhere else, as well as consistently reliable, authoritative, informed, and relevant. The content of Peripheral Artery Disease: New Insights for the Healthcare Professional: 2011 Edition has been produced by the world’s leading scientists, engineers, analysts, research institutions, and companies. All of the content is from peer-reviewed sources, and all of it is written, assembled, and edited by the editors at ScholarlyEditions™ and available exclusively from us. You now have a source you can cite with authority, confidence, and credibility. More information is available at http://www.ScholarlyEditions.com/.

Ferri's Clinical Advisor 2013

Ferri's Clinical Advisor 2013
Author: Fred F. Ferri
Publsiher: Elsevier Health Sciences
Total Pages: 1600
Release: 2012-06-01
ISBN 10: 032308432X
ISBN 13: 9780323084321
Language: EN, FR, DE, ES & NL

Ferri's Clinical Advisor 2013 Book Review:

With the 2013 edition of Ferri’s Clinical Advisor, you can access current diagnostic and therapeutic information on more than 700 common medical conditions faster and more effectively than ever before. Dr. Ferri’s popular "5 books in 1" format provides quick guidance on vitamin-D deficiency, statin-induced muscle syndrome, postural tachycardia syndrome (POTS), and much more. Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets, tables, boxes, and algorithms to expedite reference. Review normal values and interpret results for more than 200 lab tests. Get the insurance billing codes you require, including ICD-9-CM codes, to expedite insurance reimbursements. Improve your practice’s efficiency with cost-effective referral and consultation guidelines. Identify and treat a broader range of disorders with 25 new topics in the Diseases & Disorders section, including vitamin-D deficiency, oral cancer, hypovitaminosis, sarcoma, hyperemesis in pregnancy, androgen deficiency in the elderly male, statin-induced muscle syndrome, and more. Improve your interpretation of presenting symptoms with 41 new topics and 7 new references in the Differential Diagnosis section.

Complex Cases in Peripheral Vascular Interventions

Complex Cases in Peripheral Vascular Interventions
Author: Martin Schillinger,Erich Minar
Publsiher: CRC Press
Total Pages: 304
Release: 2010-06-15
ISBN 10: 1841847321
ISBN 13: 9781841847320
Language: EN, FR, DE, ES & NL

Complex Cases in Peripheral Vascular Interventions Book Review:

This new title provides a systematic review of complex cases in peripheral vascular interventions (PVI), a minimal invasive endovascular approach to treating peripheral arteries. This increasingly evolving area in interventional therapies offers reduced risk for complications compared to conventional surgery and takes advantage of advanced techniqu

Guidelines for Antithrombotic Therapy

Guidelines for Antithrombotic Therapy
Author: Jack Hirsh
Publsiher: Pmph USA Limited
Total Pages: 184
Release: 2008-01-01
ISBN 10: 9781607950097
ISBN 13: 160795009X
Language: EN, FR, DE, ES & NL

Guidelines for Antithrombotic Therapy Book Review:

Includes a new chapter addressing the management of patients who are treated with anti-coagulants or anti-platelet drugs Provides a detail summary to each chapter, documenting the therapeutic recommendations Updates on important clinical trials since last edition

Drug-Coated Balloons

Drug-Coated Balloons
Author: Bernardo Cortese
Publsiher: Springer
Total Pages: 234
Release: 2019-06-19
ISBN 10: 3319926004
ISBN 13: 9783319926001
Language: EN, FR, DE, ES & NL

Drug-Coated Balloons Book Review:

This book provides a comprehensive, up-to-date summary of drug-coated balloon (DCB) technology and the role of DCBs in the treatment of coronary and peripheral arterial disease. In addition to clear explanation of how DCBs works, readers will find an enlightening analysis of the mistakes and successes of the past decade and the emergence of the latest delivery systems, which combine a more deliverable device with much improved drug delivery to the vessel wall. The full range of current applications of DCBs are reviewed in detail, drawing on the latest scientific evidence. Due attention is paid to newer devices, with provision of technical insights and documentation of the available clinical data. Ongoing research projects, remaining technical challenges, likely future directions, and reimbursement issues are also carefully considered. This book will be a useful tool for any interventional cardiologist, interventional radiologist, or vascular surgeon who wishes to acquire a deep knowledge of this technology and its application in both coronary and peripheral interventions.

Cardiovascular Thrombus

Cardiovascular Thrombus
Author: On Topaz
Publsiher: Academic Press
Total Pages: 670
Release: 2018-08-18
ISBN 10: 0128126167
ISBN 13: 9780128126165
Language: EN, FR, DE, ES & NL

Cardiovascular Thrombus Book Review:

Cardiovascular Thrombus: From Pathology and Clinical Presentations to Imaging, Pharmacotherapy and Interventions provides a comprehensive, up-to-date presentation of the research and clinical practices as related to the contemporary aspects of the diagnosis and management of cardiovascular thrombosis. The formation, identification and management of cardiovascular thrombus is of paramount importance for researchers and practicing physicians, yet it remains one of the most challenging diagnostic and clinical scenarios. This important reference connects between research, up-to-date clinical knowledge, and the technological tools available for diagnosis and management of thrombus in cardiovascular medicine. The book includes comprehensive descriptions and review of pathology, clinical presentations, diagnosis, pharmacotherapy, interventions and future trends. It is the perfect reference for basic science students and researchers in general and interventional cardiology, general and interventional radiology, vascular medicine specialists, and vascular, general and cardiac surgeons. Provides comprehensive presentation of the pathophysiology, clinical presentations and diagnosis of cardiovascular thrombosis Includes the most up-to-date information on the practical management of patients with thrombus related conditions Written by the leading experts in the field Describes the current and upcoming pharmacotherapy and technology available for thrombus research and treatment

Issues in Circulatory and Lymphatic Research: 2011 Edition

Issues in Circulatory and Lymphatic Research: 2011 Edition
Author: Anonim
Publsiher: ScholarlyEditions
Total Pages: 797
Release: 2012-01-09
ISBN 10: 1464965714
ISBN 13: 9781464965715
Language: EN, FR, DE, ES & NL

Issues in Circulatory and Lymphatic Research: 2011 Edition Book Review:

Issues in Circulatory and Lymphatic Research: 2011 Edition is a ScholarlyEditions™ eBook that delivers timely, authoritative, and comprehensive information about Circulatory and Lymphatic Research. The editors have built Issues in Circulatory and Lymphatic Research: 2011 Edition on the vast information databases of ScholarlyNews.™ You can expect the information about Circulatory and Lymphatic Research in this eBook to be deeper than what you can access anywhere else, as well as consistently reliable, authoritative, informed, and relevant. The content of Issues in Circulatory and Lymphatic Research: 2011 Edition has been produced by the world’s leading scientists, engineers, analysts, research institutions, and companies. All of the content is from peer-reviewed sources, and all of it is written, assembled, and edited by the editors at ScholarlyEditions™ and available exclusively from us. You now have a source you can cite with authority, confidence, and credibility. More information is available at http://www.ScholarlyEditions.com/.

Antiplatelet Agents

Antiplatelet Agents
Author: Paolo Gresele,Gustav V. R Born,Carlo Patrono,Clive P. Page
Publsiher: Springer Science & Business Media
Total Pages: 616
Release: 2012-08-23
ISBN 10: 3642294235
ISBN 13: 9783642294235
Language: EN, FR, DE, ES & NL

Antiplatelet Agents Book Review:

Antiplatelet therapy is the cornerstone of treatment of ischemic cardiovascular disease and over the last few years spectacular advancements in this field have been recorded. This is the first comprehensive handbook entirely dedicated to all the aspects of antiplatelet therapy. The book is divided into three main sections, pathophysiology, pharmacology and therapy, for a total of 23 chapters. A large group of leading experts from different European countries and from the USA, both from academia and industry, have contributed to the book. Besides a detailed overview on the pharmacology and clinical applications of all the currently used or of the novel antiplatelet agents, innovative approaches (e.g. intracellular signalling as an antiplatelet target, small RNAs as platelet therapeutics, etc.) or unconventional aspects (e.g. pharmacologic modulation of the inflammatory action of platelets are also treated. The book is oriented to both basic investigators and to clinicians involved with research on platelet inhibition or with the clinical use of antiplatelet therapies.

The Durability of Vascular and Endovascular Surgery

The Durability of Vascular and Endovascular Surgery
Author: Roger Malcolm Greenhalgh
Publsiher: W B Saunders Company
Total Pages: 524
Release: 1999
ISBN 10:
ISBN 13: UOM:39015042797913
Language: EN, FR, DE, ES & NL

The Durability of Vascular and Endovascular Surgery Book Review:

With an international range of contributors, this work discusses the new techniques of endovascular surgery in relation to established open surgical procedures.

The Coagulation Consult

The Coagulation Consult
Author: Alan Lichtin,John Bartholomew
Publsiher: Springer Science & Business Media
Total Pages: 279
Release: 2014-02-06
ISBN 10: 1461495601
ISBN 13: 9781461495604
Language: EN, FR, DE, ES & NL

The Coagulation Consult Book Review:

There have been many changes in the field of coagulation during the past decade. New concepts of epidemiology of risk factors for thrombosis now help clinicians predict who is more likely to form clots after surgery, or after being placed on oral contraceptives. New anticoagulants have the potential to redefine how patients with atrial fibrillation and venous thrombosis are managed. There are new forms of recombinant clotting factors which have changed our approach to hypofibrinogenemia and von Willebrand’s disease. Newer antiplatelet agents are available and their use in patients receiving cardiac stents has mushroomed. The management of thrombosis in the setting of pregnancy has changed over the past decade, as well as the way clinicians approach women with multiple miscarriages. An entire new class of compounds, the thrombopoietins, are available to treat individuals with immune thrombocytopenic purpura (ITP). The Coagulation Consult covers major topics of interest to hematologists who are asked to consult on individuals with coagulation related diseases, and encompasses the field’s most recent developments. This “case-directed” book describes state-of-the-art approaches to patients with bleeding and clotting disorders, as well as laboratory tests for coagulation. Chapters include different vignettes, focus on typical clinical consult questions, and lay out specific types of treatment. Practicing clinicians being confronted with coagulation consult students, residents, fellows and attending physicians will find this unique text an invaluable resource for some of the newer areas of coagulation science, therapy and pharmacology.

EPIDURAL ANESTHESIA FOR MANAGEMENT OF PSEUDO ANEURYSM OF FEMORAL ARTERY IN ASA- IV PATIENT ON DUAL ANTIPLATELET THERAPY: CASE REPORT PARADIGM SHIFT IN ANAESTHESIA PRACTICE

EPIDURAL ANESTHESIA FOR MANAGEMENT OF PSEUDO ANEURYSM OF FEMORAL ARTERY IN ASA- IV PATIENT ON DUAL ANTIPLATELET THERAPY: CASE REPORT PARADIGM SHIFT IN ANAESTHESIA PRACTICE
Author: Sherif Abeer
Publsiher: Anonim
Total Pages: 329
Release: 2017
ISBN 10:
ISBN 13: OCLC:1163822074
Language: EN, FR, DE, ES & NL

EPIDURAL ANESTHESIA FOR MANAGEMENT OF PSEUDO ANEURYSM OF FEMORAL ARTERY IN ASA- IV PATIENT ON DUAL ANTIPLATELET THERAPY: CASE REPORT PARADIGM SHIFT IN ANAESTHESIA PRACTICE Book Review:

Epidural anesthesia for management of pseudo aneurysm of femoral artery in ASA- IV patient on dual antiplatelet therapy: Case report and a paradigm shift in anaesthesia practiceAbeer A. Sherif, MD(1), Abdulatif Araji, MD(2) (1) Professor of anaesthesia & Pain medicine, Faculty of Medicine, El-menufia university, Consultant & Chief anaesthesiologist NMC royal hospital UAE (2) Vascular surgeon, NMC Royal hospital, UAEIntroduction: Anticoagulation achieved with dual antiplatelet therapy is becoming increasingly common after coronary angioplasty and represents an everyday challenge to the anaesthesiologists when neuraxial anaesthesia is to be considered specially in high risk patients with multiple comorbidities. Epidural hematoma is a rare but potentially devastating complication of neuraxial anesthesia. To date, no clear data addressing the safety of epidural anesthesia in patients on dual antiplatelet therapy. Despite being extremely rare, the development of epidural hematoma is a known risk after epidural analgesia. The third National Audit Project of the Royal College of Anesthetists found an incidence of two in 100 000 cases. The incidence of spontaneous epidural hematoma is rarer, estimated at 1 per 1 000 000 patients per year, most going undetected. Antiplatelet agents are known to be protective in most patients at increased risk of occlusive vascular events, including those with an acute myocardial infarction, ischemic stroke, angina, peripheral arterial disease, or atrial fibrillation. Brilianta (ticagrelor) is a platelet adenosine diphosphate (ADP) P2Y12 receptor inhibitor, a new oral anticoagulants are approved for a variety of clinical syndromes like coronary artery disease, peripheral vascular disease, or ischaemic strokes. Current ASRA recommendations to stop Brilianta (Ticagrelor) therapy 5 - 7 days before the surgery are based on level III evidence such as clinical judgement and sporadic case reports of epidural hematoma after regional analgesia, in patients with a history of taking Tecagrelor in combination with other anticoagulants ( level C evidence). To date, no prospective studies have investigated the safety of epidural analgesia in patients actively taking Ticagrelor.Methods: A 80-year-old man presented with a history of swelling and redness in his left groin. Patients was on aspirin and brilianta after angioplasty 3 month ago, ischemic nephropathy, COPD, sever chest infection, heart failure and pacemaker in place. Epidural anesthesia was planned because of the poor general condition of the patient. Epidural was conducted in the sitting position using L 3- 4 interspaces, 10 ml of bupivacaine 0.5% was injected in the epidural catheter. Primary repair of the femoral vein performed, along with the patching of the left common femoral artery. The surgical procedure lasted for 6 hours and the patient was shifted to ICU for monitoring. The intraoperative as well as the postoperative period remained uneventful.Discussion:The risk of central neuraxial blockade in patients treated with newer antiplatelet drugs is unclear. However, a disturbing lack of data exists concerning the safety of neuroaxial blockade in such patients, with a wide difference in opinion not only among anesthetists but also between published guidelines. The American Society of Regional Anesthesia agreed on an interval of 5 - 7 days between discontinuation of Brilianta (Ticagrelor) therapy and neuraxial blockade. In the current case the patient had recently undergone a coronary artery stent implantation and was treated with both Brilianta, and aspirin. Despite this dual antiplatelet therapy, uneventful epidural anesthesia at two levels was carried out. Our case report demonstrate that, for certain high-risk patients, the benefit of placing an epidural catheter while actively taking antiplatelet therapy may be considered. Conclusion:Epidural anesthesia was conducted safely for emergency vascular surgery, in high risk patient with multiple comorbidities. Decision to perform regional anesthesia in the patients receiving antithrombotic drugs should be made on an individual basis weighing risk of epidural hematoma with the benefits of regional anesthesia. This report is not meant to recommend the liberal placement of epidural catheters in patients actively taking dual antiplatelet therapy. prospective studies with a large number of patients are needed in order to give more accurate recommendation regarding performing epidural block in such population.References: 1-tHorlocker TT, Wedel DJ, Benzon H, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Reg Anesth Pain Med 2003; 28: 172u201397.2-tCook T, Counsell D, Wildsmith J. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth 2009; 102: 179u201390.3-tHorlocker TT, Wedel DJ, Benzon H, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Regional Anesthesia and Pain Medicine 2003; 28: 172u201397.

Vascular Disease, An Issue of Cardiology Clinics,

Vascular Disease, An Issue of Cardiology Clinics,
Author: Leonardo C. Clavijo
Publsiher: Elsevier Health Sciences
Total Pages: 185
Release: 2014-12-27
ISBN 10: 0323354548
ISBN 13: 9780323354547
Language: EN, FR, DE, ES & NL

Vascular Disease, An Issue of Cardiology Clinics, Book Review:

The entire spectrum of vascular disease is examined in this issue of Cardiology Clinics. Topics include carotid artery disease, endovascular interventions for thoracic and abdominal aortic aneurismal disease, critical limb ischemia, contemporary treatment of venous thromboembolic disease, renal artery stenosis, resistant hypertension, advances in peripheral arterial disease revascularization, stroke interventions, medical management of PAD, pre-operatory evaluation of vascular patients.