Review of chest tube drainage of the pleural space

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Anticoagulants and Procedures, Anticoagulation, Antiplatelet therapy, antiplatelets, Chest tube, chest tube placement, chest tube position, Chest tube removal, chest tube size, chest tubes, Featured, HPC update, HPC Updates, Plavix, pleural effusions, Pleural space, Pneumothorax, POCUS, re-expansion pulmonary edema, Small-bore chest tube, Tension pneumothorax, Thienopyridines, thrombocytopenia, Tube Thoracostomy
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This blog summarizes recommended management of chest tube drainage of the pleural space. The blog will cover the recommended size of chest tube for different indications, suggestions for chest tube insertion technique, methods to avoid chest tube complications and when…
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Periprocedural Bleeding Risk for Thrombocytopenia, Coagulopathy, Antiplatelets and Anticoagulation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Anticoagulation, antiplatelets, central lines, Chest tube, chest tubes, coagulopathy, Featured Procedure, HPC Updates, Lumbar Puncture, Paracentesis, procedures, Thoracentesis
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This blog summarizes the 2019 Society of Interventional Radiology (SIR) for Periprocedural Management of Image-guided Procedures with regards to thrombocytopenia, coagulopathies, antiplatelets and anticoagulation.  The SIR guidelines are summarized as follows: Anticoagulation with heparin, LMWH, fondaparinux, argatroban, warfarin, DOAC, clopidogrel, ticagrelor…
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Safety of Thoracentesis and Tube Thoracostomy in Patients with Uncorrected Coagulopathies

Tube Thoracostomy Insertion
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Anticoagulants and Procedures, Anticoagulation, Antiplatelet therapy, antiplatelets, Chest tube, chest tube placement, chest tubes, coagulopathy, Featured, HPC Updates, Thoracentesis
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Traditionally, it was felt that the INR had to be less than 1.5 and platelets had to be at least 50,000/µL to perform most bedside procedures. With more clinical evidence, we now know that low-risk bedside procedures can be performed…
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Guidelines for Antiplatelet and Anticoagulation Discontinuation before a Lumbar Puncture

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Anticoagulation, antiplatelets, epidural hematoma, Featured, HPC update, HPC Updates, Lumbar Puncture
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This blog summarizes the guidelines by the European Society of Anesthesiology (ESA), the American Society of Regional Anesthesia (ASRA) and the Association of British Neurologists regarding the timing of antiplatelet and anticoagulation discontinuation before a lumbar puncture.  The following table…
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Anticoagulation is Likely Beneficial for Portal Vein Thrombosis in Cirrhosis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Anticoagulation, Cirrhosis, HPC Updates, portal vein thrombosis
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The optimal treatment of portal vein thrombosis in patients with cirrhosis has been a topic of debate for quite some time.  To this date there have been no large prospective, randomized controlled trials to help guide management in these patients. …
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An Update on the Treatment of Venous Thromboembolic Disease

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Anticoagulation, Cancer, Deep vein thrombosis, DVT, HPC Updates, Updated guidelines, Venous Thromboembolic Disease, VTD
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Every four years the American College of Chest Physicians (ACCP) disseminates a new set of guidelines on the evaluation and management of venous thromboembolic disease (VTE). The ACCP just released its updated guidelines for the treatment of VTE and I…
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New Oral Anticoagulants are as effective as Warfarin for VTE with less major bleeding

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Anticoagulation, Deep venous thrombosis, HPC Updates, Pulmonary Embolism, venous thromboembolism
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The new direct target-specific oral anticoagulants (TSOACs; dabigatran, rivaroxaban, apixaban, and edoxaban) have been compared with vitamin K antagonists (VKAs; warfarin and similar agents) for acute venous thromboembolism (VTE) in six recent phase III clinical trials encompassing more than 27,000…
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Direct-Acting Oral Anticoagulants Have a Lower Mortality than Warfarin for Nonvalvular Afib

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Anticoagulation, atrial fibrillation, HPC Updates, stroke
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Compared with warfarin, the new agents significantly reduced all-cause and vascular mortality. The new direct-acting oral anticoagulants (DOACs; dabigatran, rivaroxaban, apixaban, and edoxaban) have been found to be noninferior to vitamin K antagonists in clinical trials of stroke prevention in…
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