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Common Clotting Pathway

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41. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults

grafts. AV access thrombosis Blood clot obstructing the AV access; indicates loss of anatomic, haemodynamic and clinical patency. AV fistula Surgically created autogenous vascular access used for chronic haemodialysis consisting of an anastomosis between an artery and a vein, with the vein serving as the accessible conduit (synonym: native AV fistula). AV graft Surgically created vascular access used for chronic haemodialysis, whereby an artificial or biological prosthetic segment is used to connect (...) or static dialyser outlet pressure, AV access recirculation or AV access duplex ultrasound assessment. Technical surveillance Assessment of an AV access at regular intervals using a specialized apparatus; distinct from clinical monitoring. AV access Overarching term referring to both AV fistulas and AV grafts. AV access thrombosis Blood clot obstructing the AV access; indicates loss of anatomic, haemodynamic and clinical patency. AV fistula Surgically created autogenous vascular access used for chronic

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2019 European Renal Best Practice

42. Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations.

to retrospective series primarily focused on non–radiology-based procedures, with minimal availability of high-quality, randomized, controlled data. Nonetheless, clinical care decisions need to be made with the intent of minimizing risk and maximizing benefit for patients. Therefore, similar to how other specialty societies have addressed this topic, these guidelines are consensus-based ( x 3 Doherty, J.U., Gluckman, T.J., Hucker, W.J. et al. 2017 ACC Expert Consensus decision pathway for periprocedural (...) = venous thromboembolism; y = years. Unprovoked VTE may be associated with low or high risk after 3 mo and must be considered on a per-patient basis. Table 2 Assessment of Patient Bleeding Risk ( x 3 Doherty, J.U., Gluckman, T.J., Hucker, W.J. et al. 2017 ACC Expert Consensus decision pathway for periprocedural management of anticoagulation in patients with nonvalvular atrial fibrillation: a report of the American College of Cardiology Clinical Expert Consensus Document Task Force. J Am Coll Cardiol

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2019 Society of Interventional Radiology

43. Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part I: Review of Anticoagulation Agents and Clinical Considerations

), which will shut down the tissue factor pathway; and second, thrombin will initiate the intrinsic pathway by activating factors XI and IX. Factor XIa will also convert factor IX to factor IXa, which, along with factor VIIIa, forms an intrinsic tenase to convert factor X to factor Xa. This is the main amplification pathway to generate thrombin. The thrombin converts fibrinogen to fibrin monomers. Factor XIIIa cross-links monomers to polymerize and stabilize the clot. Antithrombin ( AT ) inhibits (...) endothelium is mediated via glycoproteins Ib/IX/V and results in the release of thromboxane A2 and adenosine diphosphate (ADP), which initiate platelet aggregation through glycoprotein IIb/IIIa and fibrinogen. Secondary hemostasis involves activation of the coagulation cascade to form a fibrin clot. Figure 1 illustrates the coagulation pathways, and Figure 2 depicts how anticoagulant medications interact within the cascade. Figure 1 The coagulation cascade. The coagulation cascade is initiated

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2019 Society of Interventional Radiology

44. Risk estimation and the prevention of cardiovascular disease

Risk estimation and the prevention of cardiovascular disease Risk estimation and the prevention of cardiovascular disease| 1 1 Introduction 1.1 THE NEED FOR A GUIDELINE Cardiovascular disease (CVD) is an umbrella term that describes a range of conditions caused by blood clots (thrombosis) or build up of fatty deposits inside an artery that cause the artery to harden and narrow (atherosclerosis). The main underlying causes of CVD are coronary heart disease (CHD), stroke, peripheral arterial disease (...) in the patient’s clinical notes the medicine prescribed and, when not following common practice, the reasons for the choice y take responsibility for prescribing the medicine and for overseeing the patient’ s care, including monitoring the effects of the medicine. Non-medical prescribers should ensure that they are familiar with the legislative framework and their own professional prescribing standards. Prior to any prescribing, the licensing status of a medication should be checked in the summary of product

2017 SIGN

45. Standards for post-concussion care from diagnosis to the interdisciplinary concussion clinic

Introduction and Background 8 Concussion Recovery Pattern and Pathway 11 Standards for High Quality Post-Concussion Services and Concussion Clinics 14 Methods 43 Conclusions 44 Tools and Resources 47 1. Post-Concussion Care Pathway 48 2. Concussion Symptom Management 53 3. Scopes of Practice 54 4. Providing Information to Patients and Families (Patient Education) 63 5. Information Clinic/Networks Should Be Able to Provide to Patients 76 6. Core Services/Functions 77 7. Referral Indicators 79 8. Concussion (...) people who have common medical problems and can provide comprehensive management of a health issue. This person provides continuing care to patients and coordinates referrals to other health care practitioners. This person is most often a physician (family physician, pediatrician or sports medicine physician); however, a PCP may also be a nurse practitioner. ONF Standards for Post- Concussion Care 6 Scope of practice: The services a regulated health care practitioner is permitted to perform

2017 CPG Infobase

46. Guidelines on autopsy practice: Sudden death with likely cardiac pathology

not be missed as a terminal event promoting cardiac dysfunction and dysrhythmias. Structural abnormalities of the conduction system ? Absence of part of the atrioventricular node ? Damage to the His bundle ? Inflammation (e.g. sarcoid) ? Cystic tumour of the atrioventricular node ? Wolfe-Parkinson-White syndrome and other aberrant pathways. Note: It is impractical to serial section the whole conduction system and diagnoses such as Wolfe-Parkinson-White syndrome are made clinically and electrophysiologically (...) disease. Pregnancy ? Ischaemic heart disease ? Congenital heart disease ? Cardiomyopathy ? Coronary artery dissection ? SADS. Note: This list is not exhaustive and all-encompassing, but highlights the common lesions to be considered. 5 Specific health and safety aspects Generally there are no specific infection hazards in this arena of cardiac tissue examination, beyond standard autopsy health and safety realities. However, it should be remembered that many patients have cardiac pacemakers, which may

2017 Royal College of Pathologists

47. Guidelines on autopsy practice: Autopsy in sickle cell disease and persons with sickle trait

, and several have gone to High Court litigation for resolution on causality. Thus the following guidelines represent current thinking and practice among the interested parties. No major organisational changes or cost implications have been identified that would hinder the implementation of the guidelines. However, as sepsis has to be considered in all sickle cell disease patients who die, there must be facilities in mortuaries to undertake routine blood cultures and organ cultures, and a pathway (...) The sickle gene is common in the UK population. Genotypically, there are three main types of sickle cell disease (SCD): the HbSS, HbSC & HbS-beta thalassaemia genotypes. HbSS is the most common. Currently, the birth rate for SCD is about 1 in 2000 births, with more than 15 000 patients living with SCD. Additionally, about 1% of all births have the HbAS genes, giving them sickle cell trait (SCT). 1,2,3 Demographically, these people are concentrated in and around metropolitan areas such as London

2017 Royal College of Pathologists

48. Management of Acute Myocardial Infarction in patients presenting with ST-segment elevation

. MI, even presenting as STEMI, also occurs in the absence of obstructive coronary artery disease (CAD) on angiography. This type of MI is termed ‘myocardial infarction with non-obstructive coronary arteries’ (MINOCA) and is discussed in Chapter 9 of this document. 2.2 Epidemiology of ST-segment elevation myocardial infarction Worldwide, ischaemic heart disease is the single most common cause of death and its frequency is increasing. However, in Europe, there has been an overall trend (...) , the incidence rate ranged from 43 to 144 per 100 000 per year. Similarly, the reported adjusted incidence rates from the USA decreased from 133 per 100 000 in 1999 to 50 per 100 000 in 2008, whereas the incidence of NSTEMI remained constant or increased slightly. There is a consistent pattern for STEMI to be relatively more common in younger than in older people, and more common in men than in women. , The mortality in STEMI patients is influenced by many factors, among them advanced age, Killip class, time

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2017 European Society of Cardiology

49. Diagnosis and Treatment of Peripheral Arterial Diseases

for Peripheral Arterial disease CAS Carotid artery stenting CCA Common carotid artery CEA Carotid endarterectomy CFA Common femoral artery CHA 2 DS 2 - VASc Congestive heart failure, Hypertension, Age ≥75 (2 points), Diabetes mellitus, Stroke or TIA (2 points), Vascular disease, Age 65–74 years, Sex category CHARISMA Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance CI Confidence interval CKD Chronic kidney disease CLEVER Claudication: exercise versus endoluminal (...) events). Each vascular territory affected by atherosclerosis can be considered as marker of CV risk. 3.1 Epidemiology The epidemiology of different patterns of PADs is presented in the . The current background information and detailed discussion of the data for the following section of these Guidelines can be found in . 3.2 Risk factors Although different localizations of PADs share common major risk factors for atherosclerosis, the impact of those and/or available evidence differ per arterial site

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2017 European Society of Cardiology

50. Stroke in childhood - clinical guideline for diagnosis, management and rehabilitation

. The most important factor in stroke care in adults is being managed on a stroke unit by staff with specific expertise and interest in the disease. Stroke units have never been tested for childhood stroke and as a result are not even mentioned in these guidelines. Clot busting treatment for ischemic stroke, or clot removal, are becoming mainstays of care in adults, yet there is very little evidence for these treatments in children because research has not been done. These guidelines are the first stage (...) , which gives recommendations on how best to support children who had a stroke and also importantly their family. The parent and carer input is a very welcome edition. This clinical guideline is the most comprehensive and up to date document on how stroke care should be provided, covering the whole care pathway from identification, diagnosis and management of children and young people with arterial ischaemic stroke and haemorrhagic stroke until their transition to adult care. It is aimed

2017 Royal College of Paediatrics and Child Health

51. WHO recommendations: intrapartum care for a positive childbirth experience

WHO recommendations: intrapartum care for a positive childbirth experience WHO recommendations Intrapartum care for a positive childbirth experience WHO recommendations Intrapartum care for a positive childbirth experienceWHO recommendations Intrapartum care for a positive childbirth experienceWHO recommendations: intrapartum care for a positive childbirth experience ISBN 978-92-4-155021-5 © World Health Organization 2018 Some rights reserved. This work is available under the Creative Commons (...) your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance

2018 World Health Organisation Guidelines

52. Treatment of Malignant Pleural Mesothelioma

. The randomized clinical trial demonstrating benefit with bevacizumab used cisplatin/pemetrexed; data with carboplatin/pemetrexed plus bevacizumab are insufficient for a clear recommendation (Type of recommendation: evidence based; Evidence quality: high; Strength of recommendation: moderate) Recommendation 3.2: Bevacizumab is not recommended for patients with PS 2, substantial cardiovascular comorbidity, uncontrolled hypertension, age > 75, bleeding or clotting risk, or other contraindications to bevacizumab (...) with suspected MPM presents with a pleural effusion, the diagnostic work-up should begin with an ultrasound-guided thoracentesis with pleural fluid sent to cytopathology for analysis. Although less than one third of MPM can be diagnosed accurately on pleural fluid cytology, thoracentesis is a safe and reliable initial intervention that can also transiently alleviate the common presenting symptoms of dyspnea and chest discomfort. The diagnostic utility of thoracentesis is principally limited

2018 American Society of Clinical Oncology Guidelines

54. Sirens to Scrubs: Acute Coronary Syndromes, Part Two – To the Lab!

in the prehospital environment for patients with ACS? Read on to find out… About Sirens to Scrubs Sirens to Scrubs was created with the goal of helping to bridge the disconnect between pre-hospital and in-hospital care of emergency patients. The series offers in-hospital providers a glimpse into the challenges and scope of practice of out-of-hospital care while providing pre-hospital providers with an opportunity to learn about the diagnostic pathways and ED management of common (or not-so-common) clinical (...) of additional platelet and aggregation, forming platelet plugs. Thus, Aspirin prevents further clot formation, preventing the growth of the troublesome thrombus. Nitroglycerin mimics the actions of endogenous nitric oxide, increasing the levels of intracellular cGMP. Raised levels of intracellular cGMP inhibit the entry of calcium into cells, which is the causative mechanism in the induction of vascular smooth muscle relaxation. Although generally described as a ‘symptom-relief medication’, a 2009 Cochrane

2018 CandiEM

55. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

a cerebral embolic clot markedly decreases after 6 to 8 hours. This implies that anticoagulants will have a hard time lysing a clot after 8 hours. Given the 4-hour time to peak effect with LMWH, the time to subsequent dosing following catheter manipulation would be 8 hours minus 4 hours, or 4 hours. The American Society of Regional Anesthesia and Pain Medicine has consistently incorporated FDA-approved labeling into practice recommendations and as such adopted the changes. This time interval is also (...) %) of the 61 cases, either a clotting abnormality or needle placement difficulty was present. A spinal anesthetic was performed in 15 patients. The remaining 46 patients received an epidural anesthetic, including 32 patients with an indwelling catheter. In 15 of these 32 patients, the spinal hematoma occurred immediately after the removal of the epidural catheter. Nine of these catheters were removed during therapeutic levels of heparinization. Neurologic compromise presented as progression of sensory

2018 American Society of Regional Anesthesia and Pain Medicine

56. Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease

) the response of the neonate and the postoperative patient with complex CHD to phar- macological intervention can differ from the response of infants and children without heart disease. There is a wide spectrum of cardiac disease in infants and children. Cardiac disease in infants and children is primarily congenital but can be acquired. In many cir- cumstances, the heart defects are surgically corrected or palliated, but blood flow pathways are not normal. Patients can carry the burden of residual lesions (...) ) admin- istration of vasoactive agents to maximize shunt per- fusion pressure (eg, phenylephrine, norepinephrine, epinephrine); (3) anticoagulation with heparin (50–100 U/kg bolus) to prevent clot propagation 22,24 ; (4) shunt intervention by catheterization or surgery; and (5) sta- bilization with ECLS. In patients with shunt obstruc- tion, maneuvers to decrease PVR (eg, oxygen, inhaled nitric oxide [iNO]) will provide little benefit and could delay the diagnosis of the actual problem. Reduction

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2018 American Heart Association

57. CRACKCast Episode 185 – Alcohol Related Disease

clotting factors, GI variceal formation, and vitamin K deficiency Comorbid substance use disorders: Smoking, cocaine, NSAIDs Increased risk for dieulafoy’s lesions GI trauma from withdrawal or intake leading to mallory-weiss syndrome (or another cause of vomiting such as pancreatitis) [15] List 8 metabolic/electrolyte effects from chronic alcohol use Poor oral intake; intestinal pathology: Diarrhea and impaired intestinal absorption are common problems of the chronic alcoholic. Alcohol increases small (...) -Ar scale. Rosen’s in Perspective Anyone who works in the ER knows well the epidemic extent of alcoholism. Alcohol is the most common recreational drug taken by Americans, and per capita consumption is increasing. Alcohol is the third leading cause of preventable death in the United States; alcoholism permeates all levels of society and is a preventable cause of morbidity and mortality. Today we’ll touch on the key points for four emergent alcohol withdrawal syndromes; here’s a signpost: [1

2018 CandiEM

58. The use of viscoelastic haemostatic assays in the management of major bleeding

to motion from the viscoelastic fluid is detected by an electromechanical transducer. Figure provided courtesy of Sienco Inc, Morrison, CO, USA. Table 1. TEG reagents TEG 5000 (cup and pin method) TEG 6s (cartridge method) What the trace looks at: Sample type Fresh WB Citrated WB Citrated WB – Tests available ‘Plain cup’: Kaolin CK: Kaolin, Ca Standard clot formation – activating the intrinsic pathway ‘Heparinase cup ’ : Kaolin, heparinase CKH: Kaolin, heparinase, Ca When compared to a standard kaolin (...) activated trace a shorter R time suggests the presence of heparin rTEG: Kaolin, TF CRT: Kaolin, TF, Ca Standard clot formation activating both intrinsic and extrinsic pathways (particularly helpful for major haemorrhage and rapid results) FF: TF, Reopro CFF: TF, Reopro, Ca Platelet inhibitor added: contribution of fibrinogen to clot remains. When trace is compared to a standard kaolin trace the platelet contribution can be estimated The words in italics indicate the names given to the assays

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2018 British Committee for Standards in Haematology

59. Perineal care

without limitation, liability in negligence) for all expenses, losses, damages and costs incurred for any reason associated with the use of this guideline, including the materials within or referred to throughout this document being in any way inaccurate, out of context, incomplete or unavailable. © State of Queensland (Queensland Health) 2018 This work is licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 Australia. In essence, you are free to copy and communicate the work (...) Queensland Clinical Guideline: Perineal care Refer to online version, destroy printed copies after use Page 8 of 39 1 Introduction Perineal injury is the most common maternal morbidity associated with vaginal birth. 2 In Queensland in 2016, 73.5% of women who had a vaginal birth experienced perineal trauma and of these, 57.2% required surgical repair. 3 1.1 Women’s Healthcare Australasia (WHA) Table 1. Australian context Aspect Consideration Australian Context · In Australia, the reported rate

2018 Queensland Health

60. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

with age. Igarashi et al demonstrated blood vessel trauma in 28% of patients who underwent an epidural puncture at L2–L3. The size of the venous plexus changes with the segmental localization of the anastomoses. Large-diameter anastomoses exist at the C6–7, superior thoracic, and entire lumbar regions. These vessels are often located at sites of common interventional pain procedures. In addition, venous plexus distention can occur with anatomical changes in the spinal canal including adjacent level (...) enhancement of fibrinolysis. Aspirin, unlike non-ASA NSAIDs, decreases thrombin formation in clotting blood. Aspirin at higher doses prevents endothelial cell prostacyclin production by inhibiting COX-2. Prostacyclin inhibits platelet coagulation and stimulates vasodilation. | Phosphodiesterase Inhibitors Phosphodiesterase (PDE) inhibitors are also used as antiplatelet therapies. Platelets express 3 PDE isoenzymes: PDE-2, PDE-3, and PDE-5. Two commonly encountered PDE inhibitors are dipyridamole, which

2018 American Society of Regional Anesthesia and Pain Medicine

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