Sandbox spb2013: Difference between revisions
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' We recommend that early treatment involves immediate use of [[vasopressor]]s ([[somatostatin]] or [[terlipressin]]) to reduce [[bleeding]] and early interventional [[endoscopy]]. [[Antibiotic]]s must be started on admission. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' We recommend that early treatment involves immediate use of [[vasopressor]]s ([[somatostatin]] or [[terlipressin]]) to reduce [[bleeding]] and early interventional [[endoscopy]]. [[Antibiotic]]s must be started on admission. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' rFVIIa should be used only as rescue therapy; we recommend against its routine use. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Factor VII|rFVIIa]] should be used only as rescue therapy; we recommend against its routine use. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ESA guidelines classification scheme#Classification of Recommendations|Class 1]] | | colspan="1" style="text-align:center; background:LightGreen"|[[ESA guidelines classification scheme#Classification of Recommendations|Class 1]] | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' We recommend against the use of rFVIIa in children. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' We recommend against the use of [[Factor VII|rFVIIa]] in children. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
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| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.''' [[Platelet]] [[transfusion]] may be ineffective for treating [[bleeding]] clearly related to [[ticagrelor]] when given 12 h before. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | | bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.''' [[Platelet]] [[transfusion]] may be ineffective for treating [[bleeding]] clearly related to [[ticagrelor]] when given 12 h before. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
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===Heparin=== | |||
{|class="wikitable" style="width: 80%;" | |||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ESA guidelines classification scheme#Classification of Recommendations|Class 1]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' We recommend that severe [[bleeding]] associated with [[intravenous]] [[UFH|unfractionated heparin (UFH)]] should be treated with [[intravenous]] [[protamine]] at a dose of 1 mg per 100 IU [[UFH]] given in the preceding 2–3 h. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki> | |||
|} | |||
{|class="wikitable" style="width: 80%;" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESA guidelines classification scheme#Classification of Recommendations|Class 2]] | |||
|- | |||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' We suggest that severe [[bleeding]] associated with subcutaneous [[UFH]] unresponsive to [[intravenous]] [[protamine]] at a dose of 1 mg per 100 IU [[UFH]] could be treated by continuous administration of [[intravenous]] [[protamine]], with dose guided by [[aPTT]]. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' We suggest that severe [[bleeding]] related to subcutaneous [[LMWH|low molecular weight heparin (LMWH)]] should be treated with [[intravenous]] [[protamine]] at a dose of 1 mg per 100 anti-[[Factor X|Xa]] units of [[LMWH]] administered. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' We suggest that severe [[bleeding]] associated with subcutaneous [[LMWH]] and unresponsive to initial administration of [[protamine]] could be treated with a second dose of [[protamine]] (0.5 mg per 100 anti-[[Factor X|FXa]] units of [[LMWH]] administered). ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
|- | |||
|} | |} | ||
Revision as of 15:35, 21 April 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
2013 ESA Guidelines for the Management of Severe Perioperative Bleeding (DO NOT EDIT)[1]
| Class 1 |
| "1. XXXXX. (Level of Evidence: A)" |
| Class 1 |
| "1. XXXXX. (Level of Evidence: A)" |
| Class 2 |
| "1. XXXXX. (Level of Evidence: A)" |
2013 ESA Guidelines for the Management of Severe Perioperative Bleeding (DO NOT EDIT)[1]
Acute Upper Gastrointestinal Bleeding
| Class 1 |
| "1. We recommend that acute variceal bleeding should be managed by a multidisciplinary team. A specific multimodal protocol for upper gastrointestinal hemorrhage should be available. (Level of Evidence: C)" |
| "2. We recommend that early treatment involves immediate use of vasopressors (somatostatin or terlipressin) to reduce bleeding and early interventional endoscopy. Antibiotics must be started on admission. (Level of Evidence: A)" |
| "3. rFVIIa should be used only as rescue therapy; we recommend against its routine use. (Level of Evidence: C)" |
Coagulopathy and Renal Disease
| Class 2 |
| "1. We suggest that conjugated estrogen therapy should be used in uremia. (Level of Evidence: C)" |
| "2. We suggest that desmopressin should be considered for reducing bleeding during surgery and for managing acute bleeding in uremic patients. (Level of Evidence: C)" |
Pediatric Surgery
| Class 1 |
| "1. We recommend against the use of rFVIIa in children. (Level of Evidence: C)" |
| Class 2 |
| "1. We suggest the use of perioperative coagulation analysis using viscoelastic point-of-care monitoring (ROTEM/TEG) for timely detection of coagulation defects including dilutional coagulopathy and hyperfibrinolysis. (Level of Evidence: C)" |
| "2. We suggest that a critical hemoglobin threshold of 8 g/dl for RBC transfusion may be safe in severe pediatric perioperative bleeding. (Level of Evidence: C)" |
| "3. We suggest that transfusion of platelet concentrates may be considered if platelet count is <50,000–100,000/µl. (Level of Evidence: C)" |
| "4. We suggest that fibrinogen concentrate (30–50 mg/kg) or cryoprecipitate (5 ml/kg) may be used to increase plasma fibrinogen concentrations above trigger values of 1.5–2.0 g/l or FIBTEM MCF > 7 mm in bleeding children. (Level of Evidence: C)" |
| "5. We suggest that FFP may be used if no other fibrinogen source is available. (Level of Evidence: C)" |
| "6. We suggest against the routine use of desmopressin in the absence of hemophilia A or mild von Willebrand disease. (Level of Evidence: C)" |
| "7. We suggest that perioperative antifibrinolytic therapy should be used to reduce blood loss and transfusion requirements in cardiac and non-cardiac pediatric surgery. (Level of Evidence: A)" |
Antiplatelet Agents
| Class 1 |
| "1. We recommend that aspirin therapy should continue perioperatively in most surgical settings, especially cardiac surgery. (Level of Evidence: C)" |
| "2. Where aspirin withdrawal is considered, we recommend a time interval of 5 days. (Level of Evidence: C)" |
| "3. Clopidogrel increases perioperative bleeding. In cases of increased bleeding risk, we recommend that it should be withdrawn for no more than 5 days. (Level of Evidence: C)" |
| "4. Prasugrel increases perioperative bleeding. In cases of increased bleeding risk, we recommend that it should be withdrawn for no more than 7 days. (Level of Evidence: C)" |
| "5. We recommend that antiplatelet agent therapy should resume as soon as possible postoperatively to prevent platelet activation. (Level of Evidence: C)" |
| "6. We recommend postponement of elective surgery following coronary stenting (at least 6 to 12 weeks for bare metal stent and one year for drug-eluting stents). (Level of Evidence: C)" |
| "7. We recommend that a multidisciplinary team meeting should decide on the perioperative use of antiplatelet agents in urgent and semi-urgent surgery. (Level of Evidence: C)" |
| Class 2 |
| "1. For intra- or postoperative bleeding clearly related to aspirin, we suggest that platelet transfusion be considered (dose: 0.7 × 1011 [i.e. two standard concentrates] per 7 kg body weight in adults). (Level of Evidence: C)" |
| "2. We suggest that the first postoperative dose of clopidogrel or prasugrel should be given no later than 24 h after skin closure. We also suggest that this first dose should not be a loading dose. (Level of Evidence: C)" |
| "3. We suggest that urgent or semi-urgent surgery should be performed under aspirin/clopidogrel or aspirin/prasugrel combination therapy if possible, or at least under aspirin alone. (Level of Evidence: C)" |
| "4. We suggest that platelet transfusion should be considered (dose: 0.7 × 1011 [i.e. two standard concentrates] per 7 kg body weight in adults) in cases of intra- or postoperative bleeding clearly related to clopidogrel or prasugrel. (Level of Evidence: C)" |
| "5. According to pharmacological characteristics, we suggest that the management of ticagrelor may be comparable to clopidogrel (i.e. withdrawal interval of 5 days). (Level of Evidence: C)" |
| "6. Platelet transfusion may be ineffective for treating bleeding clearly related to ticagrelor when given 12 h before. (Level of Evidence: C)" |
Heparin
| Class 1 |
| "1. We recommend that severe bleeding associated with intravenous unfractionated heparin (UFH) should be treated with intravenous protamine at a dose of 1 mg per 100 IU UFH given in the preceding 2–3 h. (Level of Evidence: A)" |
| Class 2 |
| "1. We suggest that severe bleeding associated with subcutaneous UFH unresponsive to intravenous protamine at a dose of 1 mg per 100 IU UFH could be treated by continuous administration of intravenous protamine, with dose guided by aPTT. (Level of Evidence: C)" |
| "2. We suggest that severe bleeding related to subcutaneous low molecular weight heparin (LMWH) should be treated with intravenous protamine at a dose of 1 mg per 100 anti-Xa units of LMWH administered. (Level of Evidence: C)" |
| "3. We suggest that severe bleeding associated with subcutaneous LMWH and unresponsive to initial administration of protamine could be treated with a second dose of protamine (0.5 mg per 100 anti-FXa units of LMWH administered). (Level of Evidence: C)" |
Sources
- 2013 ESA Guidelines for the Management of Severe Perioperative Bleeding[1]
References
- ↑ 1.0 1.1 1.2 Kozek-Langenecker, SA.; Afshari, A.; Albaladejo, P.; Santullano, CA.; De Robertis, E.; Filipescu, DC.; Fries, D.; Görlinger, K.; Haas, T. (2013). "Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology". Eur J Anaesthesiol. 30 (6): 270–382. doi:10.1097/EJA.0b013e32835f4d5b. PMID 23656742. Unknown parameter
|month=ignored (help)