Methodist DeBakey cardiovascular journal
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Methodist Debakey Cardiovasc J · Oct 2011
Review Case ReportsPerioperative management of antithrombotic therapy in cardiovascular patients.
Many patients with underlying cardiovascular disease require long-term anticoagulation. The perioperative or periprocedural management of patients who require temporary interruption of anticoagulant or antiplatelet medications is a common and often challenging clinical problem. It requires a fine balance between the risk of thromboembolic events during anticoagulant interruption and the risk of bleeding in the setting of antithrombotic therapy administered around the time of surgery. ⋯ Bridging anticoagulation, generally with low-molecular-weight heparin (LMWH), is often an integral part of perioperative thrombosis risk reduction. Perioperative anticoagulation management varies depending on the indication for anticoagulation and the anticoagulant or antiplatelet agent being used by the patient. In this article, we review some of the general principles involved with perioperative anticoagulation and discuss the perioperative management of patients taking vitamin K antagonists (VKAs), bridging regimens for anticoagulants and antiplatelet agents, and strategies for managing patients on the newer oral anticoagulants.
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Methodist Debakey Cardiovasc J · Oct 2011
ReviewEnhanced strategies for prevention and management of blood loss in special, unusual, and unexpected surgical situations.
Typically, surgical and anesthesia teams work together in the operating room to control blood loss by thoroughly evaluating bleeding risk preoperatively and by using their training in the treatment of intraoperative blood loss. As a result, most bleeding is usually well controlled. ⋯ In the end, however, it is usually the surgeons and anesthesiologists making decisions about how best to control bleeding. What follows is an update on currently available options in the management of surgical bleeding (Table 1).
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Methodist Debakey Cardiovasc J · Oct 2011
Review Case ReportsBalancing hemostasis and thrombosis in interventional vascular medicine and surgery.
Antithrombotic therapy and revascularization are critical factors in managing patients presenting with acute coronary syndromes and are described in multiple guidelines documents. In addition to preventing intravascular thrombosis, they increase the risk of bleeding, which has been implicated as a risk factor in short- and long-term mortality. Randomized controlled trials provide useful aggregate information comparing the risks and benefits of various therapies. In this paper, we will use a case-based format to discuss optimal individualized antithrombotic treatments.
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Methodist Debakey Cardiovasc J · Oct 2011
Facts and frictions: conflicts of interest in medical research.
I'm going to give you a bird's eye view, as an editor-in-chief, of why conflict of interest in medical research is such a vital problem today in medicine. By the time I am finished, I hope that I will convince you that we physicians and medical scientists need to make sure we take control of our profession to protect our patients in a way that only we can do. The first definition of "conflict of interest" that I could find goes back to 1850 in Webster's Dictionary: "To conflict between the private interests and the official responsibility of a person in a position of trust." That sounds familiar to all of us in medicine, because that's who we are. ⋯ It is the most manipulative thing in the world because journal editors have to live by it, and departments use the impact factor as a mechanism for promotion. Editors also want to increase subscriptions and increase the financial profitability of their journals; sometimes, they have a conflict of interest because they're trying to eliminate or decrease stress, hostility, or harassment. In fact, I invite anyone who doesn't think a journal editor deals with stress, hostility, or harassment to spend a day with me.