Guideline-concordant administration of prothrombin complex concentrate and vitamin K is associated with decreased mortality in patients with severe bleeding under vitamin K antagonist treatment (EPAHK study).
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Guideline-concordant VKA reversal with PCC and vitamin K within eight hours after admission was associated with a significant decrease in seven-day mortality.Abstract:
Introduction: In vitamin K antagonist (VKA)-treated patients with severe hemorrhage, guidelines recommend prompt VKA reversal with prothrombin complex concentrate (PCC) and vitamin K. The aim of this observational cohort study was to evaluate the impact of guideline concordant administration of PCC and vitamin K on seven-day mortality. Methods: Data from consecutive patients treated with PCC were prospectively collected in 44 emergency departments. Type of hemorrhage, coagulation parameters, type of treatment and seven-day mortality mortality were recorded. Guideline-concordant administration of PCC and vitamin K (GC-PCC-K) were defined by at least 20 IU/kg factor IX equivalent PCC and at least 5 mg of vitamin K performed within a predefined time frame of eight hours after admission. Multivariate analysis was used to assess the effect of appropriate reversal on seven-day mortality in all patients and in those with intracranial hemorrhage (ICH). Results: Data from 822 VKA-treated patients with severe hemorrhage were collected over 14 months. Bleeding was gastrointestinal (32%), intracranial (32%), muscular (13%), and “other” (23%). In the whole cohort, seven-day mortality was 13% and 33% in patients with ICH. GC-PCC-K was performed in 38% of all patients and 44% of ICH patients. Multivariate analysis showed a two-fold decrease in seven-day mortality in patients with GC-PCC-K (odds ratio (OR) = 2.15 (1.20 to 3.88); P = 0.011); this mortality reduction was also observed when only ICH was considered (OR = 3.23 (1.53 to 6.79); P = 0.002). Conclusions: Guideline-concordant VKA reversal with PCC and vitamin K within eight hours after admission was associated with a significant decrease in seven-day mortality.read more
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2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
Catherine M Otto,Rick A. Nishimura,Robert O. Bonow,Blase A. Carabello,John P. Erwin,Federico Gentile,Hani Jneid,Eric V. Krieger,Michael Mack,Christopher J. McLeod,Patrick T. O'Gara,Vera H. Rigolin,Thoralf M. Sundt,Annemarie Thompson,Christopher Toly +14 more
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Management of severe perioperative bleeding Guidelines from the European Society of Anaesthesiology
Sibylle A. Kozek-Langenecker,Arash Afshari,Pierre Albaladejo,Cesar Aldecoa Alvarez Santullano,Edoardo De Robertis,Daniela Filipescu,Dietmar Fries,Thorsten Haas,Georgina Imberger,Matthias Jacob,Marcus D. Lancé,Juan V. Llau,Susan Mallett,Jens Meier,Niels Rahe-Meyer,Charles Marc Samama,Andrew Smith,Cristina Solomon,Philippe Van der Linden,Anne Wikkelsø,Patrick Wouters,Piet Wyffels +21 more
TL;DR: These guidelines are intended to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthetists throughout Europe to integrate this knowledge into daily patient care wherever possible.
Journal ArticleDOI
Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors
Stuart J. Connolly,Truman J. Milling,John W. Eikelboom,C. Michael Gibson,John T. Curnutte,Alex Gold,Michele D. Bronson,Genmin Lu,Pamela B. Conley,Peter Verhamme,Jeannot Schmidt,Saskia Middeldorp,Alexander T. Cohen,Jan Beyer-Westendorf,Pierre Albaladejo,Jose Lopez-Sendon,Shelly Goodman,Janet M. Leeds,Brian L. Wiens,Deborah M. Siegal,Elena Zotova,Brandi Meeks,Juliet Nakamya,W. Ting Lim,Mark Crowther +24 more
TL;DR: An initial bolus and subsequent 2-hour infusion of andexanet substantially reduced anti-factor Xa activity in patients with acute major bleeding associated with factor Xa inhibitors, with effective hemostasis occurring in 79%.
Journal ArticleDOI
2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease
Catherine M Otto,Rick A. Nishimura,Robert O. Bonow,Blase A. Carabello,John P. Erwin,Federico Gentile,Hani Jneid,Eric V. Krieger,Michael Mack,Christopher J. McLeod,Patrick T. O'Gara,Vera H. Rigolin,Thoralf M. Sundt,Annemarie Thompson,Christopher Toly +14 more
Journal ArticleDOI
Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: First update 2016.
Sibylle A. Kozek-Langenecker,Aamer B Ahmed,Arash Afshari,Pierre Albaladejo,Cesar Aldecoa,Guidrius Barauskas,Edoardo De Robertis,David Faraoni,Daniela Filipescu,Dietmar Fries,Thorsten Haas,Matthias Jacob,Marcus D. Lancé,Juan V.L. Pitarch,Susan Mallett,Jens Meier,Zsolt Molnár,Niels Rahe-Meyer,Charles Marc Samama,Jakob Stensballe,Philippe Van der Linden,Anne Wikkelsø,Patrick Wouters,Piet Wyffels,Kai Zacharowski +24 more
TL;DR: This update includes revisions to existing recommendations with respect to the wording, or changes in the grade of recommendation, and also the addition of new recommendations.
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