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A Case Report of Extra-pericardial Tamponade From a Low-Level Fall.
Cureus
November 2024
Cardiothoracic Surgery, Mater Misericordiae University Hospital, Dublin, IRL.
Article Synopsis
- A 61-year-old man with a history of COPD, ongoing anticoagulant therapy, and pneumonia was admitted to the emergency department in critical condition due to chest pain and shortness of breath.
- A chest X-ray and CT scan revealed a large mediastinal hematoma, rib fractures, and significant blood loss requiring urgent reversal of his anticoagulant medication before surgery.
- After an emergency sternotomy to evacuate the hematoma, the patient made a full recovery, highlighting the importance of imaging in older patients with fall-related injuries and the need for careful management of anticoagulants.
The effects between andexanet alpha and four-factor prothrombin complex concentrate on DOACs anticoagulation reversal.
Crit Care
November 2024
Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning Province, China.
Functionally distinct anticoagulant mechanisms of endothelial cells.
Thromb Res
December 2024
Synapse Research Institute Maastricht, Kon. Emmaplein 7, 6217, KD, Maastricht, the Netherlands.
Antithrombin and tissue factor pathway inhibitor (TFPI) provide different anticoagulant mechanisms. Having established a potent anticoagulant role of cultured human umbilical vein endothelial cells in vessel-on-a-chip microfluidic models, we now investigated how these cells modulated thrombin generation under stasis through antithrombin and TFPI pathways. We observed that endothelial monolayers in 96 well-plates strongly delayed and suppressed the thrombin generation process induced by tissue factor, regardless of the presence of whole blood, platelet-rich plasma or platelet-free plasma.
View Article and Find Full Text PDFDoes Andexanet Alpha Improve Outcomes Compared With Four-Factor Prothrombin Complex Concentrate for Reversal of Direct Oral Anticoagulants?
Ann Emerg Med
October 2024
Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX.
Perioperative Management of Patients Taking Direct Oral Anticoagulants: A Review.
JAMA
September 2024
Department of Medicine, Anticoagulation and Clinical Thrombosis Service, Northwell Health at Lenox Hill Hospital, New York, New York.
Importance: Direct oral anticoagulants (DOACs), comprising apixaban, rivaroxaban, edoxaban, and dabigatran, are commonly used medications to treat patients with atrial fibrillation and venous thromboembolism. Decisions about how to manage DOACs in patients undergoing a surgical or nonsurgical procedure are important to decrease the risks of bleeding and thromboembolism.
Observations: For elective surgical or nonsurgical procedures, a standardized approach to perioperative DOAC management involves classifying the risk of procedure-related bleeding as minimal (eg, minor dental or skin procedures), low to moderate (eg, cholecystectomy, inguinal hernia repair), or high risk (eg, major cancer or joint replacement procedures).
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