The Experts below are selected from a list of 210 Experts worldwide ranked by ideXlab platform
Michael J Wahl - One of the best experts on this subject based on the ideXlab platform.
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myths of dental surgery in patients receiving Anticoagulant Therapy
Journal of the American Dental Association, 2000Co-Authors: Michael J WahlAbstract:ABSTRACT Background Continuous Anticoagulant Therapy with warfarin is administered to prevent a variety of medical complications, including thromboembolisms and stroke. When patients receiving continuous Anticoagulant Therapy are scheduled for dental surgery, a decision must be made whether to continue or interrupt the Anticoagulant Therapy. Methods The author reviewed the literature, focusing on dental surgery in patients receiving continuous Anticoagulant Therapy and in patients whose Anticoagulant Therapy was withdrawn before they underwent dental procedures. Results Of more than 950 patients receiving continuous Anticoagulant Therapy (including many whose anticoagulation levels were well above currently recommended therapeutic levels) who underwent more than 2,400 surgical procedures, only 12 ( Conclusions Serious embolic complications, including death, were three times more likely to occur in patients whose Anticoagulant Therapy was interrupted than were bleeding complications in patients whose Anticoagulant Therapy was continued (and whose anticoagulation levels were within or below therapeutic levels). Interrupting therapeutic levels of continuous anticoagulation for dental surgery is not based on scientific fact, but seems to be based on its own mythology. Clinical Implications Dentists should recommend that therapeutic levels of anticoagulation be continued for patients undergoing dental surgery. Practitioners should consult with the patient's physician if necessary to determine his or her level of anticoagulation before performing dental surgery.
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Myths of dental surgery in patients receiving Anticoagulant Therapy.
Journal of the American Dental Association (1939), 2000Co-Authors: Michael J WahlAbstract:Continuous Anticoagulant Therapy with warfarin is administered to prevent a variety of medical complications, including thromboembolisms and stroke. When patients receiving continuous Anticoagulant Therapy are scheduled for dental surgery, a decision must be made whether to continue or interrupt the Anticoagulant Therapy. The author reviewed the literature, focusing on dental surgery in patients receiving continuous Anticoagulant Therapy and in patients whose Anticoagulant Therapy was withdrawn before they underwent dental procedures. Of more than 950 patients receiving continuous Anticoagulant Therapy (including many whose anticoagulation levels were well above currently recommended therapeutic levels) who underwent more than 2,400 surgical procedures, only 12 (< 1.3 percent) required more than local measures to control hemorrhage. Only three of these patients (< 0.31 percent) had anticoagulation levels within or below currently recommended therapeutic levels. Of 526 patients who experienced 575 interruptions of continuous Anticoagulant Therapy, five (0.95 percent) suffered serious embolic complications; four of these patients died. Serious embolic complications, including death, were three times more likely to occur in patients whose Anticoagulant Therapy was interrupted than were bleeding complications in patients whose Anticoagulant Therapy was continued (and whose anticoagulation levels were within or below therapeutic levels). Interrupting therapeutic levels of continuous anticoagulation for dental surgery is not based on scientific fact, but seems to be based on its own mythology. Dentists should recommend that therapeutic levels of anticoagulation be continued for patients undergoing dental surgery. Practitioners should consult with the patient's physician if necessary to determine his or her level of anticoagulation before performing dental surgery.
Satoshi Fujimi - One of the best experts on this subject based on the ideXlab platform.
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benefit profile of Anticoagulant Therapy in sepsis a nationwide multicentre registry in japan
Critical Care, 2016Co-Authors: Kazuma Yamakawa, Yutaka Umemura, Mineji Hayakawa, Daisuke Kudo, Masamitsu Sanui, Hiroki Takahashi, Yoshiaki Yoshikawa, Toshimitsu Hamasaki, Satoshi FujimiAbstract:Background Little evidence supports Anticoagulant Therapy as effective adjuvant Therapy to reduce mortality overall in sepsis. However, several studies suggest that Anticoagulant Therapy may reduce mortality in specific patients. This study aimed to identify a subset of patients with high benefit profiles for Anticoagulant Therapy against sepsis.
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Benefit profile of Anticoagulant Therapy in sepsis: a nationwide multicentre registry in Japan
Critical care (London England), 2016Co-Authors: Kazuma Yamakawa, Yutaka Umemura, Mineji Hayakawa, Daisuke Kudo, Masamitsu Sanui, Hiroki Takahashi, Yoshiaki Yoshikawa, Toshimitsu Hamasaki, Satoshi FujimiAbstract:Little evidence supports Anticoagulant Therapy as effective adjuvant Therapy to reduce mortality overall in sepsis. However, several studies suggest that Anticoagulant Therapy may reduce mortality in specific patients. This study aimed to identify a subset of patients with high benefit profiles for Anticoagulant Therapy against sepsis. This post hoc subgroup analysis of a nationwide multicentre retrospective registry was conducted in 42 intensive care units in Japan. Consecutive adult patients with sepsis were included. Treatment effects of Anticoagulants, e.g. antithrombin, recombinant thrombomodulin, heparin, and protease inhibitors, were evaluated by stratifying patients according to disseminated intravascular coagulation (DIC) and Sequential Organ Failure Assessment (SOFA) score. Intervention effects of Anticoagulant Therapy on in-hospital mortality and bleeding complications were analysed using Cox regression analysis stratified by propensity scores. Participants comprised 2663 consecutive patients with sepsis; 1247 patients received Anticoagulants and 1416 received none. After adjustment for imbalances, Anticoagulant administration was significantly associated with reduced mortality only in subsets of patients diagnosed with DIC, whereas similar mortality rates were observed in non-DIC subsets with Anticoagulant Therapy. Favourable associations between Anticoagulant Therapy and mortality were observed only in the high-risk subset (SOFA score 13-17; adjusted hazard ratio 0.601; 95 % confidence interval 0.451, 0.800) but not in the subsets of patients with sepsis with low to moderate risk. Although the differences were not statistically significant, there was a consistent tendency towards an increase in bleeding-related transfusions in all SOFA score subsets. The analysis of this large database indicates Anticoagulant Therapy may be associated with a survival benefit in patients with sepsis-induced coagulopathy and/or very severe disease. University Hospital Medical Information Network Clinical Trial Registry (UMIN-CTR ID: UMIN000012543 ). Registered on 10 December 2013.
Haim Matzkin - One of the best experts on this subject based on the ideXlab platform.
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SPONTANEOUS SUBCAPSULAR RENAL HEMATOMA SECONDARY TO Anticoagulant Therapy
The Journal of urology, 2001Co-Authors: Nicola J. Mabjeesh, Haim MatzkinAbstract:Patients on Anticoagulant Therapy may have urological complications. The most common complication is hematuria. Less common but more serious is spontaneous hemorrhage arising from urological structures, such as spontaneous perirenal hematoma. We report on a 70-year-old patient on oral Anticoagulant Therapy with spontaneous subcapsular renal hematoma who presented with abdominal pain and vomiting. The Anticoagulant Therapy was stopped and the patient was expectantly followed by serial abdominal computerized tomography (CT) every 3 months. To our knowledge a spontaneous subcapsular renal hematoma occurring in a patient being treated with anticoagulation has not been previously described.
Sam Schulman - One of the best experts on this subject based on the ideXlab platform.
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care of patients receiving long term Anticoagulant Therapy
The New England Journal of Medicine, 2003Co-Authors: Sam SchulmanAbstract:A 75-year-old man with diabetes mellitus is found to have chronic atrial fibrillation, and warfarin Therapy is begun for the prevention of thromboembolic stroke. How should the Anticoagulant Therapy be initiated and managed?
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The duration of oral Anticoagulant Therapy after a second episode of venous thromboembolism
The New England journal of medicine, 1997Co-Authors: Sam Schulman, Staffan Granqvist, Margareta Holmström, A. Carlsson, Per Lindmarker, Nicol P, Nordlander S, G Lärfars, Barbro LeijdAbstract:Background A consensus has not been reached about the optimal duration of oral Anticoagulant Therapy after a second episode of venous thromboembolism. Methods In a multicenter trial, we compared six months of oral Anticoagulant Therapy with Anticoagulant Therapy continued indefinitely in patients who had had a second episode of venous thromboembolism. Of 227 patients enrolled, 111 were randomly assigned to six months of anticoagulation and 116 were assigned to receive Anticoagulant Therapy indefinitely; for both groups, the target international normalized ratio was 2.0 to 2.85. The initial episodes of deep-vein thrombosis (n = 193) and pulmonary embolism (n = 34), as well as recurrent episodes, were all objectively confirmed. Results After four years of follow-up, there were 26 recurrences of venous thromboembolism that fulfilled the diagnostic criteria, 23 in the group assigned to six months of Therapy (20.7 percent) and 3 in the group assigned to continuing Therapy (2.6 percent). The relative risk of re...
Kazuma Yamakawa - One of the best experts on this subject based on the ideXlab platform.
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benefit profile of Anticoagulant Therapy in sepsis a nationwide multicentre registry in japan
Critical Care, 2016Co-Authors: Kazuma Yamakawa, Yutaka Umemura, Mineji Hayakawa, Daisuke Kudo, Masamitsu Sanui, Hiroki Takahashi, Yoshiaki Yoshikawa, Toshimitsu Hamasaki, Satoshi FujimiAbstract:Background Little evidence supports Anticoagulant Therapy as effective adjuvant Therapy to reduce mortality overall in sepsis. However, several studies suggest that Anticoagulant Therapy may reduce mortality in specific patients. This study aimed to identify a subset of patients with high benefit profiles for Anticoagulant Therapy against sepsis.
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Benefit profile of Anticoagulant Therapy in sepsis: a nationwide multicentre registry in Japan
Critical care (London England), 2016Co-Authors: Kazuma Yamakawa, Yutaka Umemura, Mineji Hayakawa, Daisuke Kudo, Masamitsu Sanui, Hiroki Takahashi, Yoshiaki Yoshikawa, Toshimitsu Hamasaki, Satoshi FujimiAbstract:Little evidence supports Anticoagulant Therapy as effective adjuvant Therapy to reduce mortality overall in sepsis. However, several studies suggest that Anticoagulant Therapy may reduce mortality in specific patients. This study aimed to identify a subset of patients with high benefit profiles for Anticoagulant Therapy against sepsis. This post hoc subgroup analysis of a nationwide multicentre retrospective registry was conducted in 42 intensive care units in Japan. Consecutive adult patients with sepsis were included. Treatment effects of Anticoagulants, e.g. antithrombin, recombinant thrombomodulin, heparin, and protease inhibitors, were evaluated by stratifying patients according to disseminated intravascular coagulation (DIC) and Sequential Organ Failure Assessment (SOFA) score. Intervention effects of Anticoagulant Therapy on in-hospital mortality and bleeding complications were analysed using Cox regression analysis stratified by propensity scores. Participants comprised 2663 consecutive patients with sepsis; 1247 patients received Anticoagulants and 1416 received none. After adjustment for imbalances, Anticoagulant administration was significantly associated with reduced mortality only in subsets of patients diagnosed with DIC, whereas similar mortality rates were observed in non-DIC subsets with Anticoagulant Therapy. Favourable associations between Anticoagulant Therapy and mortality were observed only in the high-risk subset (SOFA score 13-17; adjusted hazard ratio 0.601; 95 % confidence interval 0.451, 0.800) but not in the subsets of patients with sepsis with low to moderate risk. Although the differences were not statistically significant, there was a consistent tendency towards an increase in bleeding-related transfusions in all SOFA score subsets. The analysis of this large database indicates Anticoagulant Therapy may be associated with a survival benefit in patients with sepsis-induced coagulopathy and/or very severe disease. University Hospital Medical Information Network Clinical Trial Registry (UMIN-CTR ID: UMIN000012543 ). Registered on 10 December 2013.