Predictors of Intraoperative Hypotension and Bradycardia

Cheung, Christopher C.; Martýn, A.J. Muñoz; Campbell, Norman R.C.; Frost, Shaun D.; Gilbert, Ken; Michota, Franklin A.; Seal, Douglas; Ghali, William A.; Khan, Nadia

doi:10.1016/j.amjmed.2014.11.030

Cited by 82 publications

(65 citation statements)

References 31 publications

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“…Indeed, the mechanisms of perioperative arterial thromboembolism may be more closely related to factors such as the type of procedure 33 and to intraoperative alterations in blood pressure. 34 The premise that warfarin interruption leads to rebound hypercoagulability and that the milieu of the procedure confers a prothrombotic state, which in turn leads to arterial thromboembolism, is not supported by the results of this trial. [35][36][37] There are potential limitations of the BRIDGE trial.…”

Section: Author Manuscript Author Manuscriptmentioning

confidence: 38%

Perioperative Bridging Anticoagulation in Patients With Atrial Fibrillation

Douketis¹,

Spyropoulos²,

Kaatz³

2016

Journal of Vascular Surgery

120

204

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BACKGROUND-It is uncertain whether bridging anticoagulation is necessary for patients with atrial fibrillation who need an interruption in warfarin treatment for an elective operation or other elective invasive procedure. We hypothesized that forgoing bridging anticoagulation would be noninferior to bridging with low-molecular-weight heparin for the prevention of perioperative arterial thromboembolism and would be superior to bridging with respect to major bleeding.

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Section: Author Manuscript Author Manuscriptmentioning

confidence: 38%

Perioperative Bridging Anticoagulation in Patients With Atrial Fibrillation

Douketis¹,

Spyropoulos²,

Kaatz³

2016

Journal of Vascular Surgery

120

204

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show abstract

Section: Discussionmentioning

confidence: 83%

Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation

et al. 2015

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BACKGROUND It is uncertain whether bridging anticoagulation is necessary for patients with atrial fibrillation who need an interruption in warfarin treatment for an elective operation or other elective invasive procedure. We hypothesized that forgoing bridging anticoagulation would be noninferior to bridging with low-molecular-weight heparin for the prevention of perioperative arterial thromboembolism and would be superior to bridging with respect to major bleeding. METHODS We performed a randomized, double-blind, placebo-controlled trial in which, after perioperative interruption of warfarin therapy, patients were randomly assigned to receive bridging anticoagulation therapy with low-molecular-weight heparin (100 IU of dalteparin per kilogram of body weight) or matching placebo administered subcutaneously twice daily, from 3 days before the procedure until 24 hours before the procedure and then for 5 to 10 days after the procedure. Warfarin treatment was stopped 5 days before the procedure and was resumed within 24 hours after the procedure. Follow-up of patients continued for 30 days after the procedure. The primary outcomes were arterial thromboembolism (stroke, systemic embolism, or transient ischemic attack) and major bleeding. RESULTS In total, 1884 patients were enrolled, with 950 assigned to receive no bridging therapy and 934 assigned to receive bridging therapy. The incidence of arterial thromboembolism was 0.4% in the no-bridging group and 0.3% in the bridging group (risk difference, 0.1 percentage points; 95% confidence interval [CI], −0.6 to 0.8; P = 0.01 for noninferiority). The incidence of major bleeding was 1.3% in the no-bridging group and 3.2% in the bridging group (relative risk, 0.41; 95% CI, 0.20 to 0.78; P = 0.005 for superiority). CONCLUSIONS In patients with atrial fibrillation who had warfarin treatment interrupted for an elective operation or other elective invasive procedure, forgoing bridging anticoagulation was noninferior to perioperative bridging with low-molecular-weight heparin for the prevention of arterial thromboembolism and decreased the risk of major bleeding. (Funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health; BRIDGE ClinicalTrials.gov number, NCT00786474.)

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“…Pre‐operative hypotension is associated with intra‐operative hypotension in children . In a prospective study of patients undergoing elective, non‐cardiac surgery, intra‐operative hypotension was associated with pre‐operative diastolic blood pressure < 60 mmHg . There was an association between a pre‐operative diagnosis of hypertension and postoperative kidney injury.…”

Section: Discussionmentioning

confidence: 99%

The association between pre-operative variables, including blood pressure, and postoperative kidney function

et al. 2016

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SummaryWe used multivariate analyses to assess the association of pre-operative variables with kidney function in 41,523 adults after scheduled surgery in a single large academic hospital. Eight variables were independently associated with a reduction in postoperative estimated glomerular filtration rate: pre-operative renal function; age; ASA physical status; cardiac failure; anaemia; cancer; type of surgery; and the lowest quartile of pre-operative mean arterial blood pressure (< 71 mmHg). The estimated glomerular filtration rate fell by a mean (95% CI) of 2.7 (0.04-5.40) ml.min À1.1.73 m À2 for patients with a pre-operative mean arterial pressure < 71 mmHg, p = 0.047. The same variables and male sex were associated with postoperative acute kidney injury. The odds ratio (95% CI) for acute postoperative kidney injury was 1.9 (1.2-2.9) for patients with a pre-operative mean arterial blood pressure < 71 mmHg, p = 0.005.

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Predictors of Intraoperative Hypotension and Bradycardia

Cited by 82 publications

References 31 publications

Perioperative Bridging Anticoagulation in Patients With Atrial Fibrillation

Perioperative Bridging Anticoagulation in Patients With Atrial Fibrillation

Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation

The association between pre-operative variables, including blood pressure, and postoperative kidney function

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