Objective:Photoselective vaporization of the prostate(PVP)is a widely performed surgical procedure for benign prostatic obstruction.This approach has become particular favoured for men on anti-platelet and anticoagula...Objective:Photoselective vaporization of the prostate(PVP)is a widely performed surgical procedure for benign prostatic obstruction.This approach has become particular favoured for men on anti-platelet and anticoagulation agents such as clopidogrel and warfarin but there is minimal published experience in the setting of novel oral anticoagulants(NOACs).This study was to examine the perioperative outcomes in men on NOACs undergoing PVP,with particular reference to perioperative morbidity.Methods:A retrospective analysis of PVP datasets was undertaken from three centres in Sydney(Australia),Toulouse(France)and Boston(USA).Subjects who had been treated whilst on NOACs without discontinuation or bridging were identified.Perioperative outcomes and treatment parameters were examined and morbidity recorded according to Clavien-Dindo(CD)classification.Results:There were a total of 20 subjects who had undergone PVP whilst NOACs had been continued during the perioperative period.The mean age was 776.5 years.The mean prostate volume,energy utilization and vaporisation time was 9456 mL,301211 kJ,and 3521 min respectively.The mean postoperative duration of catheterization and duration of hospitalization was 2.22.4 days and 2.42.4 days respectively.There was a single episode of urinary tract infection and four subjects required re-catheterisation for non-hematuric retentions.Conclusions:This study supports the safety of men on NOACs undergoing PVP.Whilst this study represents the largest experience of PVP in these men,larger studies are necessary to confirm the safety of PVP in this group of men undergoing BPH-related surgery.展开更多
Bleeding is the most important complication of oral anticoagulation (OAC) with vitamin K-antagonists. Whilst bleeding is unavoidably related to OAC, it may have a great impact on the prognosis of treated subjects by l...Bleeding is the most important complication of oral anticoagulation (OAC) with vitamin K-antagonists. Whilst bleeding is unavoidably related to OAC, it may have a great impact on the prognosis of treated subjects by leading to discontinuation of treatment, permanent disability or death. The yearly incidence of bleeding during OAC is 2%-5% for major bleeding, 0.5%-1% for fatal bleeding, and 0.2%-0.4% for intracranial bleeding. While OAC interruption and/or antagonism, as well as administration of coagulation factors, represent the necessary measures for the management of bleeding, proper stratification of the individual risk of bleeding prior to start OAC is of paramount importance. Several factors, including advanced age, female gender, poor control and higher intensity of OAC, associated diseases and medications, as well as genetic factors, have been proven to be associated with an increased risk of bleeding. Most of these factors have been included in the development of bleeding prediction scores, which should now be used by clinicians when prescribing and monitoring OAC. Owing to the many limitations of OAC, including a narrow therapeutic window, cumber-some management, and wide interand intra-individual variability, novel oral anticoagulants, such as factor Xa inhibitors and direct thrombin inhibitors, have been recently developed. These agents can be given in f ixed doses, have little interaction with foods and drugs, and do not require regular monitoring of anticoagulation. While the novel oral anticoagulants show promise for effective thromboprophylaxis in atrial f ibrillation and venous thromboembolism, def initive data on their safety and eff icacy are awaited.展开更多
Background Triple therapy(TT)with vitamin K-antagonists(VKA),aspirin and clopidogrel is the recommended antithrombotic treatment following percutaneous coronary intervention with stent implantation(PCI-S)in patients w...Background Triple therapy(TT)with vitamin K-antagonists(VKA),aspirin and clopidogrel is the recommended antithrombotic treatment following percutaneous coronary intervention with stent implantation(PCI-S)in patients with an indication for oral anticoagulation.TT is associated with an increased risk of bleeding,but available evidence is flawed by important limitations,including the limited size and the retrospective design of most of the studies,as well as the rare reporting of the incidence of in-hospital bleeding and the treatment which was actually ongoing at the time of bleeding.Since the perceived high bleeding risk of TT may deny patients effective strategies,the determination of the true safety profile of TT is of paramount importance.Methods All the 27 published studies where the incidence of bleeding at various time points during follow-up has been reported separately for patients on TT were reviewed,and the weakness of the data was analyzed.Results The absolute incidence of major bleeding upon discharge at in-hospital,≤1 month,6 months,12 months and≥12 months was:3.3%±1.9%,5.1%±6.7%,8.0%±5.2%,9.0%±8.0,and 6.2%±7.8%,respectively,and not substantially different from that observed in previous studies with prolonged dual antiplatelet treatment with aspirin and clopidogrel.Conclusions While waiting for the ongoing,large-scale,registries and clinical trials to clarify the few facts and to answer the many questions regarding the risk of bleeding of TT,this treatment should not be denied to patients with an indication for VKA undergoing PCI-S provided that the proper measures and cautions are implemented.展开更多
目的評估NOACs(Non-vitamin K antagonist oral anticoagulants)在NVAF(Non-valvular atrial fibrillation)患者中胃腸道出血的風險,分析不同NOACs與華法林比較消化道出血差異。方法各數據庫建庫至2017年8月,從數據庫檢索Cochrane Libr...目的評估NOACs(Non-vitamin K antagonist oral anticoagulants)在NVAF(Non-valvular atrial fibrillation)患者中胃腸道出血的風險,分析不同NOACs與華法林比較消化道出血差異。方法各數據庫建庫至2017年8月,從數據庫檢索Cochrane Library、PubMed、Web of Sciences、EMBASE、萬方數據知識服務平台,篩選關於NOACs與華法林對NVAF患者治療比較的隨機對照研究(Randomized controlled trials,RCTs),提取及納入文獻相關信息,並以GRADE(The Grading of Recommendations Assessment,Development and Evaluation)評分系統對文獻質量進行評價,並對亞洲人群、不同NOACs及劑量進行亞組分析。結果納入10篇高質量隨機對照研究共73314例患者,結果顯示服用NOACs的NVAF患者總體上發生消化道出血與服用華法林的NVAF患者相比差別無統計學意義。亞組分析顯示,相比華法林,高劑量(150mg每天2次)的達比加群酯和高劑量(60mg每天1次)的依度沙班有較高的消化道出血風險;不論人群和劑量,利伐沙班相關的消化道出血均高於華法林;而低劑量(30mg每天1次)的依度沙班相比華法林的消化道出血則較少;另外亞洲人群使用阿哌沙班發生消化道出血的風險也較華法林低。結論NVAF患者總體上NOACs引起消化道出血的風險與華法林相當(TTR55%~67%),對於消化道出血高危人群,推薦使用低劑量依度沙班或阿哌沙班,慎用利伐沙班、高劑量達比加群酯或高劑量依度沙班。展开更多
文摘Objective:Photoselective vaporization of the prostate(PVP)is a widely performed surgical procedure for benign prostatic obstruction.This approach has become particular favoured for men on anti-platelet and anticoagulation agents such as clopidogrel and warfarin but there is minimal published experience in the setting of novel oral anticoagulants(NOACs).This study was to examine the perioperative outcomes in men on NOACs undergoing PVP,with particular reference to perioperative morbidity.Methods:A retrospective analysis of PVP datasets was undertaken from three centres in Sydney(Australia),Toulouse(France)and Boston(USA).Subjects who had been treated whilst on NOACs without discontinuation or bridging were identified.Perioperative outcomes and treatment parameters were examined and morbidity recorded according to Clavien-Dindo(CD)classification.Results:There were a total of 20 subjects who had undergone PVP whilst NOACs had been continued during the perioperative period.The mean age was 776.5 years.The mean prostate volume,energy utilization and vaporisation time was 9456 mL,301211 kJ,and 3521 min respectively.The mean postoperative duration of catheterization and duration of hospitalization was 2.22.4 days and 2.42.4 days respectively.There was a single episode of urinary tract infection and four subjects required re-catheterisation for non-hematuric retentions.Conclusions:This study supports the safety of men on NOACs undergoing PVP.Whilst this study represents the largest experience of PVP in these men,larger studies are necessary to confirm the safety of PVP in this group of men undergoing BPH-related surgery.
文摘Bleeding is the most important complication of oral anticoagulation (OAC) with vitamin K-antagonists. Whilst bleeding is unavoidably related to OAC, it may have a great impact on the prognosis of treated subjects by leading to discontinuation of treatment, permanent disability or death. The yearly incidence of bleeding during OAC is 2%-5% for major bleeding, 0.5%-1% for fatal bleeding, and 0.2%-0.4% for intracranial bleeding. While OAC interruption and/or antagonism, as well as administration of coagulation factors, represent the necessary measures for the management of bleeding, proper stratification of the individual risk of bleeding prior to start OAC is of paramount importance. Several factors, including advanced age, female gender, poor control and higher intensity of OAC, associated diseases and medications, as well as genetic factors, have been proven to be associated with an increased risk of bleeding. Most of these factors have been included in the development of bleeding prediction scores, which should now be used by clinicians when prescribing and monitoring OAC. Owing to the many limitations of OAC, including a narrow therapeutic window, cumber-some management, and wide interand intra-individual variability, novel oral anticoagulants, such as factor Xa inhibitors and direct thrombin inhibitors, have been recently developed. These agents can be given in f ixed doses, have little interaction with foods and drugs, and do not require regular monitoring of anticoagulation. While the novel oral anticoagulants show promise for effective thromboprophylaxis in atrial f ibrillation and venous thromboembolism, def initive data on their safety and eff icacy are awaited.
文摘Background Triple therapy(TT)with vitamin K-antagonists(VKA),aspirin and clopidogrel is the recommended antithrombotic treatment following percutaneous coronary intervention with stent implantation(PCI-S)in patients with an indication for oral anticoagulation.TT is associated with an increased risk of bleeding,but available evidence is flawed by important limitations,including the limited size and the retrospective design of most of the studies,as well as the rare reporting of the incidence of in-hospital bleeding and the treatment which was actually ongoing at the time of bleeding.Since the perceived high bleeding risk of TT may deny patients effective strategies,the determination of the true safety profile of TT is of paramount importance.Methods All the 27 published studies where the incidence of bleeding at various time points during follow-up has been reported separately for patients on TT were reviewed,and the weakness of the data was analyzed.Results The absolute incidence of major bleeding upon discharge at in-hospital,≤1 month,6 months,12 months and≥12 months was:3.3%±1.9%,5.1%±6.7%,8.0%±5.2%,9.0%±8.0,and 6.2%±7.8%,respectively,and not substantially different from that observed in previous studies with prolonged dual antiplatelet treatment with aspirin and clopidogrel.Conclusions While waiting for the ongoing,large-scale,registries and clinical trials to clarify the few facts and to answer the many questions regarding the risk of bleeding of TT,this treatment should not be denied to patients with an indication for VKA undergoing PCI-S provided that the proper measures and cautions are implemented.
文摘目的評估NOACs(Non-vitamin K antagonist oral anticoagulants)在NVAF(Non-valvular atrial fibrillation)患者中胃腸道出血的風險,分析不同NOACs與華法林比較消化道出血差異。方法各數據庫建庫至2017年8月,從數據庫檢索Cochrane Library、PubMed、Web of Sciences、EMBASE、萬方數據知識服務平台,篩選關於NOACs與華法林對NVAF患者治療比較的隨機對照研究(Randomized controlled trials,RCTs),提取及納入文獻相關信息,並以GRADE(The Grading of Recommendations Assessment,Development and Evaluation)評分系統對文獻質量進行評價,並對亞洲人群、不同NOACs及劑量進行亞組分析。結果納入10篇高質量隨機對照研究共73314例患者,結果顯示服用NOACs的NVAF患者總體上發生消化道出血與服用華法林的NVAF患者相比差別無統計學意義。亞組分析顯示,相比華法林,高劑量(150mg每天2次)的達比加群酯和高劑量(60mg每天1次)的依度沙班有較高的消化道出血風險;不論人群和劑量,利伐沙班相關的消化道出血均高於華法林;而低劑量(30mg每天1次)的依度沙班相比華法林的消化道出血則較少;另外亞洲人群使用阿哌沙班發生消化道出血的風險也較華法林低。結論NVAF患者總體上NOACs引起消化道出血的風險與華法林相當(TTR55%~67%),對於消化道出血高危人群,推薦使用低劑量依度沙班或阿哌沙班,慎用利伐沙班、高劑量達比加群酯或高劑量依度沙班。
