BACKGROUND: Percutaneous dilatational tracheotomy (PDT) is a common procedure. Coagulation disorders represent a relative contraindication for PDT and, therefore, normalization of hemostasis parameters is recommended. Especially patients undergoing cardiac surgery after valve replacement and with any kind of assist device need to require an adequate anticoagulation. This study investigated the impact of impaired hemostasis as a risk factor for bleeding complications retrospectively. METHODS: Patients who underwent PDT (November 2007 to November 2010) were stratified into a high-risk (HR) and low-risk (LR) group in regard to bleeding complications. The following determining factors activated partial thromboplastin time (aPTT > 50 seconds, prothrombin time (PT < 50%), international normalized ratio (INR > 1.4), and platelet count (< 50,000/µL) were assessed. RESULTS: A total of 213 patients underwent PDT (HR = 5/85; LR = 8/128). There was no difference in demographics or intraoperative data. Patients of both groups showed mild bleeding without the need for surgical intervention or transfusion (p = 0.957). There were no severe bleeding nor other procedure-related complications. CONCLUSION: Percutaneous tracheotomy is a safe and feasible procedure in patients with coagulation disorders. Therefore, discontinuation of anticoagulation treatment or normalization of hemostasis prior to the procedure is not necessary. Georg Thieme Verlag KG Stuttgart · New York.
BACKGROUND: Percutaneous dilatational tracheotomy (PDT) is a common procedure. Coagulation disorders represent a relative contraindication for PDT and, therefore, normalization of hemostasis parameters is recommended. Especially patients undergoing cardiac surgery after valve replacement and with any kind of assist device need to require an adequate anticoagulation. This study investigated the impact of impaired hemostasis as a risk factor for bleeding complications retrospectively. METHODS:Patients who underwent PDT (November 2007 to November 2010) were stratified into a high-risk (HR) and low-risk (LR) group in regard to bleeding complications. The following determining factors activated partial thromboplastin time (aPTT > 50 seconds, prothrombin time (PT < 50%), international normalized ratio (INR > 1.4), and platelet count (< 50,000/µL) were assessed. RESULTS: A total of 213 patients underwent PDT (HR = 5/85; LR = 8/128). There was no difference in demographics or intraoperative data. Patients of both groups showed mild bleeding without the need for surgical intervention or transfusion (p = 0.957). There were no severe bleeding nor other procedure-related complications. CONCLUSION: Percutaneous tracheotomy is a safe and feasible procedure in patients with coagulation disorders. Therefore, discontinuation of anticoagulation treatment or normalization of hemostasis prior to the procedure is not necessary. Georg Thieme Verlag KG Stuttgart · New York.
Authors: Stephan Braune; Susanne Kienast; Johannes Hadem; Olaf Wiesner; Dominic Wichmann; Axel Nierhaus; Marcel Simon; Tobias Welte; Stefan Kluge Journal: Intensive Care Med Date: 2013-07-27 Impact factor: 17.440
Authors: Laura Pasin; Elena Frati; Luca Cabrini; Giovanni Landoni; Pasquale Nardelli; Tiziana Bove; Maria Grazia Calabro; Anna Mara Scandroglio; Federico Pappalardo; Alberto Zangrillo Journal: Ann Card Anaesth Date: 2015 Jul-Sep
Authors: Enzo Lüsebrink; Konstantin Stark; Mattis Bertlich; Danny Kupka; Christopher Stremmel; Clemens Scherer; Thomas J Stocker; Mathias Orban; Tobias Petzold; Nikolaus Kneidinger; Hans-Joachim Stemmler; Steffen Massberg; Martin Orban Journal: Crit Care Explor Date: 2019-10-30