The influence of heparin on coagulation function of patients undergoing video-assisted major thoracic surgery

Alai, Gu-Ha; Deng, Han‐Yu; Li, Gang; Luo, Jun; Liu, Lunxu; Lin, Yi‐Dan

doi:10.21037/jtd.2018.04.04

Cited by 7 publications

(6 citation statements)

References 26 publications

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“…The intake of oral anticoagulation also influences the MELD score by raising the INR [ 18 – 20 ]. The deliberate or unintentional concealment of the intake of these drugs could lead to elevated MELD scores and the prioritization of those patients in the process of allocation.…”

Section: Discussionmentioning

confidence: 99%

Experiences from six years of quality assured Model of End Stage Liver Disease (MELD) diagnostics

et al. 2021

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Background The model of end-stage liver disease (MELD) score was established for the allocation of liver transplants. The score is based on the medical laboratory parameters: bilirubin, creatinine and the international normalized ratio (INR). A verification algorithm for the laboratory MELD diagnostic was established, and the results from the first six years were analyzed. Methods We systematically investigated the validity of 7,270 MELD scores during a six-year period. The MELD score was electronically requested by the clinical physician using the laboratory system and calculated and specifically validated by the laboratory physician in the context of previous and additional diagnostics. Results In 2.7% (193 of 7,270) of the cases, MELD diagnostics did not fulfill the specified quality criteria. After consultation with the sender, 2.0% (145) of the MELD scores remained invalid for different reasons and could not be reported to the transplant organization. No cases of deliberate misreporting were identified. In 34 cases the dialysis status had to be corrected and there were 24 cases of oral anticoagulation with impact on MELD diagnostics. Conclusion Our verification algorithm for MELD diagnostics effectively prevented invalid MELD results and could be adopted by transplant centers to prevent diagnostic errors with possible adverse effects on organ allocation.

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Section: Discussionmentioning

confidence: 99%

Experiences from six years of quality assured Model of End Stage Liver Disease (MELD) diagnostics

et al. 2021

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“…UFH was used in the studies of CADE, Kalweit, Tsutsumi, Mason, Deng, and Alai. 26,28,29,31,38,43 Prophylaxis with LMWH was performed in the studies of Daddi, Attaran, Song, Mantziari, Christensen, Song, Pannucci, and Esme. 30,33,35,36,40,41,42,44 Dentali, Agzarian, and Alai 37,47 compared prophylaxis of LMWH or heparin in patients receiving lung surgery; Tanaka 46 compared prophylaxis of an IPC or enoxaparin in patients who underwent esophagectomy for esophageal cancer;…”

Section: Discussionmentioning

confidence: 99%

“…In the studies of Daddi, Rollins, Agzarian, PARRY, Christensen, and Song, 30,34,37,39,40,41 prophylaxis with drugs was used starting before or after the operation to discharge. Deng, Alai, and Alai 38,43,47 declared a duration of prophylaxis from admission and continued until discharge.…”

Section: Discussionmentioning

confidence: 99%

The venous thromboembolism prophylaxis in patients receiving thoracic surgery: A systematic review

Wang

Ding

Yang

2020

Asia-Pac J Clncl Oncology

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Objectives: Venous thromboembolism (VTE) is a significant and preventable cause of mortality and morbidity in thoracic surgery. It usually deep venous thromboembolism (DVT) and pulmonary thromboembolism (PE). We conducted this article to perform a systematic review on prophylaxis of perioperative VTE in patients undergoing thoracic surgery especially lung surgery and esophageal surgery and to identify potential areas for future research. Methods:The systematic review we conducted included studies of patients undergoing thoracic surgery especially lung surgery and esophageal surgery Results:The study identified 2621 references. Finally, 22 trials with a total of 9072 patients were included. Only six studies declared that they continued a follow-up after the discharge of the patients. (range: 1-3 months); three studies reported on major bleeding events as an outcome measure, and the incidence varied from 0.8% to 1.6%.Total 346 VTEs occurred, and the overall mean risk of VTE was estimated at 3.8% (range: 0.77-27%). Conclusions:The evidence for using thromboprophylaxis in thoracic surgery is limited and controversial, predominantly based on clinical consensus. Future research is needed to focus on identifying risk of VTE and providing sufficient evidence with high quality to support clinical strategies concerning the prophylaxis for VTE.

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“…Due to considering the risk of heparin related bleeding events, most thoracic surgeons chose to administrate anti-coagulant agents after surgery (2). Whereas, it was found the incidence of VTE was still existing from clinical practice, resulting in severe complications even death, which may be formed during or even before surgery, thoracic surgeons started to administrate anti-coagulants heparin sodium preoperatively to avoid VTE in most degree according to the need of actual clinical circumstance, the studies found there were no significant difference of coagulation function and bleeding volume between preoperative and postoperative administration of heparin (14,15). On basis of these outcomes and guidelines recommendation, we continued to further use LMWH preoperatively for providing lung cancer patients intended to receive video-assisted lobectomy with sufficient thromboprophylaxis.…”

Section: Introductionmentioning

confidence: 99%

Preoperative thromboprophylactic administration of low-molecular-weight-heparin significantly decreased the risk of intraoperative bleeding compared with heparin in patients undergoing video-assisted lobectomy for lung cancer

Alai

Zhu

Li³

et al. 2019

Ann. Transl. Med

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Background: Due to the threat from venous thromboembolism (VTE) after major thoracic surgery, especially for cancers, guidelines recommend either heparin sodium (unfractionated heparin) or lowmolecular-weight-heparin (LMWH) for those patients at high risk of deep vein thrombosis (DVT). However, risk of bleeding remains a major concern for pre-operative administration of anti-coagulation agents. Therefore, this study aimed to compare the bleeding risk of preoperative administration of LMWH and heparin in patients undergoing video-assisted thoracic surgery (VATS) lobectomy for lung cancer.Methods: A retrospective, single-center study was designed. A total of 130 patients diagnosed with lung cancer were included from August 2016 to January 2018. These patients were divided into two groups. The preoperative administration of heparin group (PH group) had received heparin 5,000 IU, BID (twice a day) both pre-and post-operatively. And the LMWH group (PL group) had received LMWH 4,000 IU, QD (once a day) both pre-and post-operatively. These anticoagulants would not be ceased until patient was discharged or 24-hour postoperative chest drainage volume exceeded 500 mL. Both preoperative and postoperative coagulation parameters including platelet count (PLT), hemoglobin value (HGB), international normalized ratio (INR), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), thrombin time (TT), postoperative drainage parameters and intraoperative bleeding volume were compared. Results: A total of 62 patients were collected in PH group, while 68 patients comprised PL group. Preoperative coagulation parameters, hematologic data and demographic data were comparable. Preoperative duration of two agents (P=0.414), operation time (P=0.155), postoperative HGB (P=0.943), PLT (P=0.244), INR (P=0.469), PT (P=0.651), TT (P=0.407), FIB (P=0.151), drainage duration (P=0.800), duration of heparin and LMWH (P=0.778) were all comparable between the two groups. Compared with PL group, intraoperative bleeding volume (105.11 and 50.26, P<0.001) and postoperative mean drainage volume (251.52 and 216.90 mL, P=0.025) of PH group were significant more. Postoperative APTT (30.17 vs. 28.20 seconds, P=0.022) was significantly longer in PH group. Conclusions: Compared with preoperative administration of heparin, preoperative thromboprophylactic administration of LMWH significantly decreased the risk of intraoperative bleeding in VATS lobectomy. A-Lai et al. Decreased bleeding risk of LMWH

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The influence of heparin on coagulation function of patients undergoing video-assisted major thoracic surgery

Cited by 7 publications

References 26 publications

Experiences from six years of quality assured Model of End Stage Liver Disease (MELD) diagnostics

Experiences from six years of quality assured Model of End Stage Liver Disease (MELD) diagnostics

The venous thromboembolism prophylaxis in patients receiving thoracic surgery: A systematic review

Preoperative thromboprophylactic administration of low-molecular-weight-heparin significantly decreased the risk of intraoperative bleeding compared with heparin in patients undergoing video-assisted lobectomy for lung cancer

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