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…
Read MoreMore Articles – Cardiovascular diseases, Central line, Chest Tube, Endotracheal Intubation, Featured, Hematology, medical procedures, Thoracentesis
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…
Read MoreMore Tags – coagulopathy, epidural hematoma, featured, HPC updates, lumbar puncture, thrombocytopenia
A recent cohort study using the Danish nationwide medical registry demonstrates that the incidence of a spinal or epidural hematoma from lumbar punctures in patients with pre-existing thrombocytopenia (Platelets<150 K) or coagulopathy (INR>1.4 or aPTT>39 seconds) is not significantly higher…
Read MoreMore Tags – coagulopathy, epidural hematoma, featured, HPC updates, lumbar puncture, thrombocytopenia
Class 1 evidence to inform decisions about the safety of lumbar punctures in patients with a coagulopathy are lacking. The only guidance we have regarding the safety of lumbar punctures is based on clinical guidance from organizations such as the…
Read MoreMore Tags – anticoagulation, antiplatelets, epidural hematoma, featured, HPC updates, lumbar puncture
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…
Read MoreThe evidence base for the safety of ultrasound-guided central line placement with thrombocytopenia or in patients with a bleeding diathesis is not robust. Nevertheless, based on the data available most procedural experts feels that an ultrasound-guided central venous catheter insertion…
Read MoreOver the past several years, there has been a dramatic increase in the use of the new oral anticoagulants (Dabigatran, Rivaroxaban, and Apixaban). The popularity of these medications stems not only from aggressive pharmaceutical monitoring to physicians and to the…
Read MoreTraditionally, it has been promulgated by anesthesiologists that you need a platelet count of 100,000 to safely perform neuraxial regional anesthesia (spinal and epidural anesthesia). This practice pattern has continued even though Children’s Hospitals routinely perform intrathecal injections for prophylactic chemotherapy with…
Read MoreHistorically, it was felt that a platelet count below 50,000 or an INR>1.5 was a contraindication to thoracentesis because of an increased bleeding risk. These were arbitrary cut-offs that have since been challenged with newer kits and the use of…
Read MoreThe 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. …
Read MorePulmonary embolism (PE) is one of the most difficult to diagnose and potentially fatal disorders in medicine. Because of this, CT pulmonary angiograms (CTPA) are over utilized so as to not miss this potentially fatal problem. There are three ways…
Read MoreAn elevated peripheral neutrophil-lymphocyte ratio is an indicator of inflammation. Investigators from a Turkish university hospital hypothesized that this ratio might differ in patients with subarachnoid hemorrhage (SAH) versus those with other headache syndromes. They performed a retrospective study of…
Read MoreThere are multiple noninfectious medical disorders that mimic cellulits. In this retrospective study, researchers focused on misdiagnosis of cellulitis in 259 patients hospitalized with presumed diagnoses of lower extremity cellulitis at a Boston teaching hospital. Patients with complicating factors (e.g.,…
Read MoreThe Universal Termination of Resuscitation Guidelines suggest that resuscitation should be terminated if at least four rounds of CPR have occurred and the following three criteria are met: The arrest was NOT witnessed by emergency medical services (EMS) There has…
Read MoreDefinitions Presumed source with SIRS criteria = infection Infection with life-threatening organ dysfunction = sepsis Sepsis refractory to intravenous fluid challenge = septic shock Treatment of sepsis or septic shock Draw blood cultures x 2 Analyze any fluid that may…
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