Dabigatran for thromboprophylaxis after robotic assisted laparoscopic prostatectomy: Retrospective analysis of safety profile and effect on blood coagulation

Säily, V. Matti J.; Pétas, Anssi; Joutsi‐Korhonen, Lotta; Taari, Kimmo; Lassila, Riitta; Rannikko, Antti

doi:10.3109/21681805.2013.817482

Cited by 11 publications

(3 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The literature about risk of bleeding in gynecology is limited to postsurgery complication in a single case (Wagner et al , ). In urology, data about postoperative bleeding is reported as a secondary outcome reaching a rate of 2.3% (Saily et al , ). In urgent care and anesthesiology, the risk of bleeding is extremely important, but a recent publication addressing the topic of perioperative management of new direct oral anticoagulants in these settings described it as ‘a question without answers’ (Ferrandis et al , ).…”

Section: Risk Of Bleedingmentioning

confidence: 99%

Novel anticoagulants: general overview and practical considerations for dental practitioners

et al. 2015

View full text Add to dashboard Cite

Currently, 4 novel Direct Oral Anticoagulants (DOACs) were approved by the FDA. This review focuses on these agents and proposes a matrix for the general dentists to assess bleeding risk in dental management of patient on DOACs. The outline covers the pharmacology of DOACs (rivaroxaban, apixaban, edoxaban and dabigatran), bleeding complications, risk associated with discontinuation, monitoring/reversal, and implications for the dental practitioners. A total of 18 randomized controlled trials were identified with mixed results in regards to the risk for bleeding. Considering the pharmacology of DOACs and challenges in monitoring and reversing their effect, the dentist should consider carefully the management of patients on DOACs as it may differ from patients on conventional anticoagulants. Based on the type of dental procedure and the medical risk assessment, several general treatment approaches can be considered: continue DOACs, time dental treatment as late as possible after the last DOACs dose, discontinue DOACs for 24hrs, or discontinue DOACs for 48hrs. Based on the current reported dental literature, limited dental surgery may benefit from the first 2 conservative options. However, this needs to be proven in comparative clinical trials.

show abstract

Section: Risk Of Bleedingmentioning

confidence: 99%

Novel anticoagulants: general overview and practical considerations for dental practitioners

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Data present in the literature regarding the different risk of thrombosis in patients submitted to LRP or RALP are very few. In a recent study Saily et al [ 36 ] observed that RALP activates coagulation, and thromboprophylaxis for high-risk patients even after minimally invasive surgery may be beneficial. In particular, patients undergoing RALP showed postoperatively increased levels of fibrinogen, factor VIII, d-dimer associated to a thrombocytosis, reflecting a coagulation activity.…”

Section: Discussionmentioning

confidence: 99%

Perioperative changes in pro and anticoagulant factors in prostate cancer patients undergoing laparoscopic and robotic radical prostatectomy with different anaesthetic techniques

Sofra¹,

Antenucci²,

Gallucci³

et al. 2014

J Exp Clin Cancer Res

View full text Add to dashboard Cite

BackgroundLaparoscopic prostatectomy (LRP) may activate clotting system influencing the risk of perioperative thrombosis in patients with prostate cancer. Moreover, different anaesthetic techniques can also modify coagulant factors. Thus, the aim of this study was to investigate the effects on pro- and anti-coagulant and fibrinolytic factors of two established types of anaesthesia in patients with prostate cancer undergoing elective LRP.Methods102 patients with primary prostate cancer, who underwent conventional LRP or robot-assisted laparoscopic prostatectomy (RALP), were studied and divided into 2 groups to receive total intravenous anesthesia with target-controlled infusion (TIVA-TCI) or balanced inhalation anaesthesia (BAL) prior to surgery. Before the induction of anaesthesia (T0), 1 hr (T1) and 24 hrs post-surgery (T2), some pro-coagulant factors, fibronolysis markers, p-selectin and haemostatic system inhibitors were evaluated.ResultsBoth TIVA-TCI and BAL patients showed a marked and significant increase in pro-coagulant factors and consequent reduction in haemostatic system inhibitors in the early post operative period (p???0.004 for each markers). Use of RALP showed a significant increase in prothrombotic markers as compared to LRP. In TIVA patients undergoing LRP, a significant reduction of p-selectin levels between T0 and T2 (p?=?0.001) was observed as compared to BAL, suggesting a better protective effect on platelet activation of anaesthetic agents used for TIVA.ConclusionsBoth anaesthetic techniques significantly seem to increase the risk of thrombosis in prostate cancer patients undergoing LRP, mainly when the robotic device was utilized, encouraging the use of a peri-operative thromboembolic prophylaxis in these patients.

show abstract

“…The new oral anticoagulants have demonstrated effi cacy in preventing or treating thromboembolic disease in patients with cancer 54 and critical illnesses, 55 and in treating acute coronary syndrome [56][57][58] and other conditions. 59 However, their role in these settings is not well established. 60,61 ■ SITUATIONS TO AVOID Valvular heart disease.…”

Section: Except For Dabigatran the New Oral Anticoagulants Lack Antid...mentioning

confidence: 99%

The new oral anticoagulants: Reasonable alternatives to warfarin

Roca

2015

CCJM

View full text Add to dashboard Cite

Dabigatran (a direct thrombin inhibitor) and rivaroxaban, apixaban, and edoxaban (direct activated factor X inhibitors) are increasingly being used in clinical practice. Compared with vitamin K antagonists, they are more convenient, do not require laboratory monitoring, have limited drug and food interactions, and have fixed dosages suitable for most patients. But the shortcomings of these agents can jeopardize their efficacy and increase the risk of bleeding. Their future role in preventing and treating thromboembolic disease will depend on building clinical experience, but current evidence indicates that they are reasonable alternatives to vitamin K antagonists.

show abstract

Dabigatran for thromboprophylaxis after robotic assisted laparoscopic prostatectomy: Retrospective analysis of safety profile and effect on blood coagulation

Abstract: RALP activates coagulation, and thromboprophylaxis for high-risk patients even after minimally invasive surgery may be beneficial. Orally administered dabigatran after discharge from hospital appears safe for venous thromboembolism prophylaxis after RALP.

Cited by 11 publications

References 24 publications

Novel anticoagulants: general overview and practical considerations for dental practitioners

Novel anticoagulants: general overview and practical considerations for dental practitioners

Perioperative changes in pro and anticoagulant factors in prostate cancer patients undergoing laparoscopic and robotic radical prostatectomy with different anaesthetic techniques

The new oral anticoagulants: Reasonable alternatives to warfarin

Contact Info

Product

Resources

About