• chronic kidney disease
• peritoneal dialysis
• transient hemodialysis
• uremic bleeding

• the 2023 Yeungnam University Research Grant

• antithrombotic therapy
• bleeding complications
• continued aspirin therapy
• gastric cancer
• thromboembolic complications

• antithrombotic
• hemorrhage
• pancreatectomy
• postoperative
• therapy

• the Japanese Society of Hepato-Biliary-Pancreatic Surgery

• Antithrombotic therapy
• Bleeding complications
• Colorectal cancer
• Propensity score matching
• Short-term outcomes

• Ethanol
• Laser
• Microwave
• Patient
• Radiofrequency
• Thyroid nodule

• Catheter Ablation
• Humans
• Physicians
• Practice Guidelines as Topic
• Thyroid Function Tests
• Thyroid Nodule/surgery
• Thyroid Nodule/therapy
• Treatment Outcome

• Hemorrhagic ovarian cysts
• laparoscopic surgery
• left ventricular assist device

• antithrombotic therapy
• bleeding complication
• colorectal cancer surgery
• laparoscopic surgery
• thromboembolic complication

• Antithrombotic therapy
• Gastrectomy
• Gastric cancer
• Laparoscopic surgery
• Long-term prognosis

• Aspirin
• Clinical-malignant
• Colonic diseases
• Colorectal surgery
• Thromboembolism

• Glycocalyx
• Nanotexture
• Nitric oxide
• Polysaccharides
• Refractive index
• Thromboelastography

• R01 HL140301 NHLBI NIH HHS
• National Heart, Lung, and Blood Institute
• U.S. Department of Defense

Postpancreatectomy hemorrhage (PPH) is the most severe type of complication after pancreatic surgery, although the effect of antithrombotic therapy (ATT) on PPH is largely unknown. The safety and efficacy of chemical thromboprophylaxis for venous thromboembolism (VTE) remains controversial.

To elucidate the effect of ATT on PPH.

Published articles between 2013 and 2020 were searched from PubMed and Google Scholar, and after careful reviewing of all studies, studies concerning ATT and pancreatic surgery were included. Data such as study design, type of surgical procedures, type of antithrombotic drugs, and surgical outcome were extracted from the studies.

Nineteen published articles with a total of 37863 patients who underwent pancreatic surgery were included in the systematic review. Fourteen were cohort studies, with only three being prospective in nature. Two studies demonstrated that in patients receiving chronic ATT, which were mostly managed by heparin bridging, the risk of PPH was higher compared with those without ATT, and one study showed that patients with direct-acting oral anticoagulants managed by heparin bridging had significantly higher postoperative bleeding rates than others. The remaining six studies reported that pancreatic surgery can be safely performed in patients receiving chronic ATT, even under preoperative aspirin continuation. Concerning chemical thromboprophylaxis for VTE, most studies have shown a potentially high risk of PPH in patients undergoing chemical thromboprophylaxis; however, its effectiveness against VTE has not been statistically demonstrated, particularly among Asian patients.

Pancreatic surgery in chronically ATT-received patients can be safely performed without an increase in the occurrence of PPH, although the safety and efficacy of chemical thromboprophylaxis for VTE during pancreatic surgery is still controversial. Further investigation using reliable studies with good design is required to establish definite protocols or guidelines.

• Antithrombotic therapy
• Pancreatic surgery
• Perioperative management
• Antiplatelet therapy
• Anticoagulation therapy
• Pancreaticoduodenectomy

Little is unknown about the effect of chronic antithrombotic therapy (ATT) on bleeding complication during or after hepatectomy. In addition, the safety and effectiveness of chemical prevention for venous thromboembolism (VTE) is still controversial.

To clarify the effect of ATT on thromboembolism and bleeding after liver resection.

Articles published between 2011 and 2020 were searched from Google Scholar and PubMed, and after careful reviewing of all studies, studies concerning ATT and liver resection were included. Data such as study design, type of surgery, type of antithrombotic agents, and surgical outcome were extracted from the studies.

Sixteen published articles, including a total of 8300 patients who underwent hepatectomy, were eligible for inclusion in the current review. All studies regarding patients undergoing chronic ATT showed that hepatectomy can be performed safely, and three studies have also shown the safety and efficacy of preoperative continuation of aspirin. Regarding chemical prevention for VTE, some studies have shown a potentially high risk of bleeding complications in patients undergoing chemical thromboprophylaxis; however, its efficacy against VTE has not been shown statistically, especially among Asian patients.

Hepatectomy in patients with chronic ATT can be performed safely without increasing the incidence of bleeding complications, but the safety and effectiveness of chemical thromboprophylaxis against VTE during liver resection is still controversial, especially in the Asian population. Establishing a clear protocol or guideline requires further research using reliable studies with good design.

• Liver resection
• Bleeding complication
• Antithrombotic therapy
• Thromboembolic complication
• Thromboprophylaxis

• antithrombotic prophylaxis
• kidney transplantation
• renal graft thrombosis
• systematic review
• thrombosis

• Debridement
• Drainage
• Haematoma
• Necrosis
• Skin graft
• Subcutaneous hematoma
• Tension hematoma

• Acute cholecystitis
• Anticoagulation therapy
• Antiplatelet therapy
• Antithrombotic therapy
• Bleeding complication
• Emergency cholecystectomy
• Laparoscopy

• Blood Loss, Surgical
• Cholecystectomy, Laparoscopic/adverse effects
• Cholecystitis, Acute/surgery
• Fibrinolytic Agents/therapeutic use
• Humans
• Italy/epidemiology
• Postoperative Complications/epidemiology
• Postoperative Complications/prevention & control
• Retrospective Studies
• Treatment Outcome

• antiplatelet therapy
• cardiovascular events
• colorectal cancer
• hemorrhagic complication
• laparoscopic surgery

• acute cholecystitis
• antithrombotic therapy
• laparoscopic cholecystectomy

• Bleeding complications
• Colorectal cancer
• Continuous antiplatelet therapy
• Laparoscopic surgery
• Propensity score-matched analyses

• bleeding complication
• liver resection
• preoperative aspirin continuation
• propensity score-matched analysis

P2Y₁₂ inhibitor discontinuation is essential before most surgical interventions to limit bleeding complications. Based on pharmacodynamic data, fixed discontinuation durations have been recommended. However, as platelet function recovery is highly variable among patients, a more individualized approach based on platelet function testing (PFT) has been proposed. The aim of this retrospective single-centre study was to determine whether PFT using whole blood adenosine diphosphate–multiple electrode aggregometry (ADP–MEA) was associated with a safe reduction of preoperative waiting time. Preoperative ADP–MEA was performed for 29 patients on P2Y₁₂ inhibitors. Among those, 17 patients underwent a coronary artery bypass graft. Twenty one were operated with an ADP–MEA ≥ 19 U (quantification of the area under the aggregation curve), and the waiting time was shorter by 1.6 days (median 1.8 days, IQR 0.5–2.9), by comparison with the current recommendations (five days for clopidogrel and ticagrelor, seven days for prasugrel). Platelet function recovery was indeed highly variable among individuals. With the 19 U threshold, high residual platelet inhibition was associated with perioperative platelet transfusion. These results suggest that preoperative PFT with ADP–MEA could help reduce waiting time before urgent surgery for patients on P2Y₁₂ inhibitors.

• P2Y12 inhibitors
• clopidogrel
• multiplate
• multiple electrode aggregometry
• perioperative
• prasugrel
• preoperative
• ticagrelor
• urgent surgery

• Aged
• Aged, 80 and over
• Anticoagulants
• Blood Coagulation/drug effects
• Blood Coagulation Disorders/chemically induced
• Blood Coagulation Disorders/drug therapy
• Blood Coagulation Factors/administration & dosage
• Blood Coagulation Factors/adverse effects
• Female
• Hip Fractures/surgery
• Humans
• International Normalized Ratio
• Male
• Retrospective Studies
• Time Factors
• Time-to-Treatment
• Treatment Outcome
• Warfarin/antagonists & inhibitors

To elucidate the effect of antithrombotic therapy (ATT) on bleeding and thromboembolic complications during or after laparoscopic digestive surgery.

Published articles or internationally accepted abstracts between 2000 and 2017 were searched from PubMed, Cochrane Database, and Google Scholar, and studies involving laparoscopic digestive surgery and antiplatelet therapy (APT) and/or anticoagulation therapy (ACT) were included after careful review of each study. Data such as study design, type of surgical procedures, antithrombotic drugs used, and surgical outcome (both bleeding and thromboembolic complications) were extracted from each study.

Thirteen published articles and two internationally accepted abstracts were eligible for inclusion in the systematic review. Only one study concerning elective laparoscopic cholecystectomy in patients with perioperative heparin bridging for ACT showed that the risk of postoperative bleeding was higher compared with those without ACT. The remaining 14 studies reported no significant differences in the incidence of bleeding complications between the ATT group and the group without ATT. The risk of thromboembolic events (TE) associated with laparoscopic digestive surgery in patients receiving ATT was not significantly higher than those with no ATT or interrupted APT.

Laparoscopic digestive surgery in ATT-burdened patients for prevention of bleeding and TE showed satisfactory results. The risk of hemorrhagic complication during or after these procedures in patients with continued APT or heparin bridging was not significantly higher than in patients with no ATT or interrupted APT.

• Thromboembolic complication
• Bleeding complication
• Laparoscopic surgery
• Anticoagulation therapy
• Digestive surgery
• Antithrombotic therapy
• Antiplatelet therapy

• INR
• NSQIP
• PTT
• coagulation
• pancreas surgery

To assess the impact of laparoscopic liver resection (LLR) on surgical blood loss (SBL), especially in patients with antithrombotics for thromboembolic risks.

Consecutive 258 patients receiving liver resection at our institution between 2010 and 2016 were retrospectively reviewed. Preoperative antithrombotic therapy (ATT; antiplatelets and/or anticoagulation) was regularly used in 100 patients (ATT group, 38.8%) whereas not used in 158 (non-ATT group, 61.2%). Our perioperative management of high thromboembolic risk patients included maintenance of preoperative aspirin monotherapy for patients with antiplatelet therapy and bridging heparin for patients with anticoagulation. In both ATT and non-ATT groups, outcome variables of patients undergoing LLR were compared with those of patients receiving open liver resection (OLR), and the independent risk factors for increased SBL were determined by multivariate analysis.

This series included 77 LLR and 181 OLR. There were 3 thromboembolic events (1.2%) in a whole cohort, whereas increased SBL (≥ 500 mL) and postoperative bleeding complications (BCs) occurred in 66 patients (25.6%) and 8 (3.1%), respectively. Both in the ATT and non-ATT groups, LLR was significantly related to reduced SBL and low incidence of BCs, although LLR was less performed as anatomical resection. Multivariate analysis showed that anatomical liver resection was the most significant risk factor for increased SBL [risk ratio (RR) = 6.54, P < 0.001] in the whole cohort, and LLR also had the significant negative impact (RR = 1/10.0, P < 0.001). The same effects of anatomical resection (RR = 15.77, P < 0.001) and LLR (RR = 1/5.88, P = 0.019) were observed when analyzing the patients in the ATT group.

LLR using the two-surgeon technique is feasible and safely performed even in the ATT-burdened patients with thromboembolic risks. Independent from the extent of liver resection, LLR is significantly associated with reduced SBL, both in the ATT and non-ATT groups.

• Laparoscopic liver resection
• Two-surgeon technique
• Antithrombotic therapy
• Increased surgical blood loss
• Bleeding complication

To determine the best anticoagulation strategy for the patients who underwent splenectomy with cirrhosis through network meta-analysis.

We conducted a systematic review of the literature in PubMed, Embase, and the Cochrane Library database. We extracted data on incidence of Portal vein system thrombosis (PVST) from studies that compared various anticoagulation strategies for use with patients who underwent splenectomy with cirrhosis. Network meta-analysis was conducted in ADDIS by evaluating the different incidence of PVST. Consistency and inconsistency models were developed to identify differences among the therapeutic strategies. Cumulative probability was utilized to rank the strategies under examination. Results. A total of 11 studies containing 1153 patients were included in the network meta-analysis. The results revealed that the application of Antithrombin III was the best anticoagulation option for patients who underwent splenectomy with cirrhosis (P = 0.59). The data of consistency and inconsistency models exhibited basically consistent and showed good convergence.

Application of Antithrombin III seemed to be the best anticoagulation strategy for cirrhotic patients who underwent splenectomy and should be considered a first-choice clinical reference.

• Antiplatelet treatment
• Aspirin
• Bleeding complication
• Liver resection
• Preoperative

Hemorrhage remains the leading cause of intra-operative deaths and those in the first 24 h. Many cardiovascular and hepatobiliary procedures result in massive hemorrhage and postpartum hemorrhage events in labor and delivery place the patient at a high risk for mortality. Both upper and lower gastrointestinal bleeding (e.g., diverticulosis, esophageal and gastric varices, and peptic ulcer disease) can also result in significant blood loss requiring massive transfusion and resuscitation from hemorrhagic shock. Therefore, safe, timely, and effective transfusion of blood products is critical. The aim of this chapter is to provide clinicians with a discussion of the current literature on the various blood component products, their indications, and unique hemostatic conditions in the surgical patient. While the majority of data concerning optimal management of acquired coagulopathy and hemorrhagic shock resuscitation is based on trauma patients, many of the principles can and should be applied to the surgical patient (or likely any patient) with profound hemorrhage.

• antithrombotic activity
• chitosan nanoparticles
• ionic gelation
• platelet aggregation
• red ginseng extracts

• Animals
• Chitosan/chemistry
• Disease Models, Animal
• Drug Carriers/chemistry
• Drug Carriers/pharmacology
• Fibrinolytic Agents/administration & dosage
• Fibrinolytic Agents/chemistry
• Fibrinolytic Agents/pharmacology
• Male
• Mice, Inbred ICR
• Nanoparticles/administration & dosage
• Nanoparticles/chemistry
• Panax/chemistry
• Plant Extracts/administration & dosage
• Plant Extracts/chemistry
• Plant Extracts/pharmacology
• Platelet Aggregation/drug effects
• Polyglutamic Acid/chemistry
• Polysaccharides/chemistry
• Rabbits
• Rats, Sprague-Dawley
• Thrombosis/chemically induced
• Thrombosis/drug therapy

• Antiplatelet therapy
• Antithrombotic therapy
• Laparoscopic gastrectomy
• Morbidity

• anticoagulation
• antiplatelet
• pancreatic surgery
• postpancreatectomy hemorrhage
• thromboprophylaxis

• Adult
• Aged
• Attitude of Health Personnel
• Delivery of Health Care/organization & administration
• Female
• Humans
• Male
• Middle Aged
• Trauma Centers
• Wounds and Injuries/epidemiology
• Wounds and Injuries/therapy

• R03 AG042361 NIA NIH HHS

• Administration, Oral
• Anticoagulants/administration & dosage
• Anticoagulants/adverse effects
• Drug Administration Schedule
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/adverse effects
• Hemorrhage/chemically induced
• Hemorrhage/prevention & control
• Humans
• Patient Safety
• Predictive Value of Tests
• Risk Assessment
• Risk Factors
• Thyroid Nodule/pathology

• Acute cholecystitis
• Aspirin therapy
• Emergent cholecystectomy
• Hemorrhagic complications

AIM: To determine whether patients taking aspirin during carpal tunnel release had an increase of complications.

METHODS: Between January 2008 and January 2010, 150 patients underwent standard open carpal tunnel release (CTR) under intravenous regional anaesthesia. They were divided into three groups: groups 1 and 2 were made of 50 patients each, on aspirin 100 mg/d for at least a year. In group 1 the aspirin was never stopped. In group 2 it was stopped at least 5 d before surgery and resumed 3 d after. Group 3 acted as a control, with 50 patients who did not take aspirin. The incidence of clinically significant per- or post-operative complications was recorded and divided into local and cardio-cerebro-vascular complications. Local complications were then divided into minor and major according to Page and Stern. Local haematomas were assessed at 2 d (before resuming aspirin in group 2) and 14 d (after resuming aspirin in group 2) postoperatively. Patients were reviewed at 2, 14 and 90 d after surgery.

RESULTS: There was no significant difference in the incidence of complications in the three groups. A total of 3 complications (2 major and 1 minor) and 27 visible haematomas were recorded. Two major complications were observed respectively in group 1 (non stop aspirin) and in group 3 (never antiaggregated). The minor complication, observed in one patient of group 2 (stop aspirin), consisted of a wound dehiscence, which only led to delayed healing. All haematomas were observed in the first 48 h, no haematoma lasted for more than 2 wk and all resolved spontaneously. A major haematoma (score > 20 cm²) was observed in 8 patients. A minor haematoma (score < 20 cm²) was recorded in 19 patients. All patients at 90 d after surgery were satisfied with the result in terms of relief of their preoperative symptoms. Major and minor haematomas did not impair hand function or require any specific therapy.

CONCLUSION: Our study demonstrates that continuation of aspirin did not increase the risk of complications. It is unnecessary to stop aspirin before CTR with good surgical techniques.

• Carpal tunnel syndrome
• Aspirin
• Antiaggregation therapy
• Hand surgery
• Carpal tunnel release

• APT
• CDC
• Clavien-Dindo classification
• DES
• NYHA
• New York Heart Association
• OR
• PCI
• antiplatelet therapy
• cAPT
• drug-eluting stent
• iAPT
• interrupted antiplatelet therapy
• noninterrupted antiplatelet therapy
• odds ratio
• percutaneous coronary intervention

Hemorrhage is the leading cause of intraoperative deaths. Many cardiovascular and hepatobiliary procedures result in massive hemorrhage and postpartum hemorrhage events in labor and delivery place the patient at a high risk for mortality. Gastrointestinal bleeding from diverticulosis, varices, and ulcer disease can result in significant blood loss requiring massive transfusion and resuscitation from hemorrhagic shock. Timely and effective transfusion of blood products is of critical in these scenarios. The frequency in which blood component products are transfused in surgical patients begs for a greater understanding of them. The aim of this chapter is to provide clinicians with a discussion of the current literature on the various blood component products, their indications, and unique hemostatic conditions in the surgical patient. While the majority of data concerning optimal management of acquired coagulopathy and hemorrhagic shock resuscitation is based on trauma patients, many of the principles can and should be applied to the surgical patient (or likely any patient) with profound hemorrhage.