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Gerald Chi (talk | contribs)
CMEAdmin, Bureaucrats, bureaucrats, editnews, exportpages, interwiki, nocaptcha, nukepages, smwadministrator, Administrators, Widget editors
17,702 edits
mNo edit summary
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{|class="wikitable" style="width: 80%;"
{|class="wikitable" style="width: 80%;"
|-
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class 1]]
|colspan="1" style="text-align:center; background:LightCoral"|[[ESA guidelines classification scheme#Classification of Recommendations|Class 1]]
|-
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' XXXXX. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' XXXXX. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESA guidelines classification scheme#Classification of Recommendations|Class 2]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESA guidelines classification scheme#Classification of Recommendations|Class 2]]
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' XXXXX.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' XXXXX. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|-
|-
|}
|}
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESA guidelines classification scheme#Classification of Recommendations|Class 2]]
| 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 conjugated [[estrogen]] therapy should be used in [[uremia]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' We suggest that conjugated [[estrogen]] therapy should be used in [[uremia]]. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' We suggest that [[desmopressin]] should be considered for reducing [[bleeding]] during [[surgery]] and for managing acute [[bleeding]] in [[uremic]] patients.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' We suggest that [[desmopressin]] should be considered for reducing [[bleeding]] during [[surgery]] and for managing acute [[bleeding]] in [[uremic]] patients. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
|}


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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESA guidelines classification scheme#Classification of Recommendations|Class 2]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESA guidelines classification scheme#Classification of Recommendations|Class 2]]
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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 [[fibrinolysis|hyperfibrinolysis]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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 [[fibrinolysis|hyperfibrinolysis]]. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' We suggest that a critical [[hemoglobin]] threshold of 8 g/dl for [[RBC]] [[transfusion]] may be safe in severe [[pediatric]] [[perioperative bleeding]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' We suggest that a critical [[hemoglobin]] threshold of 8 g/dl for [[RBC]] [[transfusion]] may be safe in severe [[pediatric]] [[perioperative bleeding]]. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' We suggest that [[transfusion]] of [[platelet]] concentrates may be considered if [[platelet]] count is <50,000–100,000/µl.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' We suggest that [[transfusion]] of [[platelet]] concentrates may be considered if [[platelet]] count is <50,000–100,000/µl. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.''' We suggest that [[FFP]] may be used if no other [[fibrinogen]] source is available.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.''' We suggest that [[FFP]] may be used if no other [[fibrinogen]] source is available. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.''' We suggest against the routine use of [[desmopressin]] in the absence of [[hemophilia A]] or mild [[von Willebrand disease]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.''' We suggest against the routine use of [[desmopressin]] in the absence of [[hemophilia A]] or mild [[von Willebrand disease]]. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''7.''' We suggest that perioperative [[fibrinolytic|antifibrinolytic therapy]] should be used to reduce [[blood loss]] and [[transfusion]] requirements in cardiac and non-cardiac pediatric [[surgery]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''7.''' We suggest that perioperative [[fibrinolytic|antifibrinolytic therapy]] should be used to reduce [[blood loss]] and [[transfusion]] requirements in cardiac and non-cardiac pediatric [[surgery]]. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|}
|}


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|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' We recommend that [[aspirin]] therapy should continue perioperatively in most surgical settings, especially [[cardiac surgery]]. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' We recommend that [[aspirin]] therapy should continue perioperatively in most surgical settings, especially [[cardiac surgery]]. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Where [[aspirin]] withdrawal is considered, we recommend a time interval of 5 days. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Where [[aspirin]] withdrawal is considered, we recommend a time interval of 5 days. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Clopidogrel]] increases perioperative [[bleeding]]. In cases of increased [[bleeding]] risk, we recommend that it should be withdrawn for no more than 5 days. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Clopidogrel]] increases perioperative [[bleeding]]. In cases of increased [[bleeding]] risk, we recommend that it should be withdrawn for no more than 5 days. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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|}
|}


 
{|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.''' For intra- or postoperative [[bleeding]] clearly related to [[aspirin]], we suggest that [[platelet]] [[transfusion]] be considered (dose: 0.7 × 10<sup>11</sup> [i.e. two standard concentrates] per 7 kg body weight in adults). ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
 
|-
 
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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]]. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
 
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' We suggest that [[platelet]] [[transfusion]] should be considered (dose: 0.7 × 10<sup>11</sup> [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]]. ''([[ESA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.''' According to pharmacological characteristics, we suggest that the management of [[ticagrelor]] may be comparable to [[clopidogrel]] (i.e. withdrawal interval of 5 days). ''([[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>
|}


==Sources==
==Sources==

Revision as of 15:30, 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)"

Sources

  • 2013 ESA Guidelines for the Management of Severe Perioperative Bleeding[1]

References

  1. ↑ 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)
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