Thread by @MABonizzoni

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Second day of @Smart_Meeting_M

Professor @giovannilandoni talking about management of #anticoagulant in #perioperative patients 💉

✅You surely all know how to deal with #antithrombotic and #regionalanesthesia, here the guidelines:

pubmed.ncbi.nlm.nih.gov/34980845/

#FOAMed #FOAMcc

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💡Let's focus on perioperative #DOAC /#NOAC / #TSOAC

➡️Consider both #surgical blood loss risk and #patient characteristics.

⚠️Remember NOT to bridge with #LMWH or #UFH.

pubmed.ncbi.nlm.nih.gov/33895845/

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What if it's not an elective patient??

Use #reversal agents when needed❗

🔹#Idarucizumab for #dabigatran
🔹#Andexanet for #apixaban and #rivaroxaban
💡#Prothrombin complex concentrates in addiction

pubmed.ncbi.nlm.nih.gov/36988142/

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Case report: #hemorrhage in patient on #tPA

➡️ Use #Tranexamic acid immediatly!

But pay attention❗

✅ Beneficial within the first 3 hours
🚫 Detrimental after 3 hours

5/

Case report: hemorrhage in patient on #UFH

➡️ Use #Protamine sulfate

🚫 Not 1:100 with #heparin ➡️ elongation of clotting time
✅ But 2/3 of the dosage ➡️ full reversal without clotting issues (link)

➡️Protamine is useful also for #LMWH❗

pubmed.ncbi.nlm.nih.gov/26495270/

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Case report: patient on #Aspirin with microvascular bleeding after surgery

➡️ Use #Desmopressin (DDAVP)

pubmed.ncbi.nlm.nih.gov/27117753/

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