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Review finds 18% mortality in severe DOAC-related bleeding treated with reversal agents - thromboembolic events from 3-10%; high incidence of rebleeding, mainly after restarting anticoagulation. acphospitalist.org/weekly/archive…

These refs are a follow-up to my previous tweets about MINS & risk calculators: Cardiac risk assessment calculators: utility and limitations pubmed.ncbi.nlm.nih.gov/33231943/ Risk calculator comparisons PMID: 29126584 PMID: 31313733 PMID: 31202481 PMID: 32584248 (MINS)

More MACE in elderly pts as expected. Age should be incorporated in risk assessment tools (it was in the original CRI but not in RCRI or MICA). Perioperative cardiovascular outcomes among older adults undergoing in-hospital noncardiac surgery pubmed.ncbi.nlm.nih.gov/34176124/

Meta-analysis providing evidence for a significant association between preop frailty & postop delirium in elective surgical patients age 65 years or older. The Association of Preoperative Frailty and Postoperative Delirium: A Meta-analysis pubmed.ncbi.nlm.nih.gov/34257192/

For pts with pulm hypertension, a 3-factor model (ASA, WHO FC, NT-proBNP) combined with procedure characteristics was best at predicting postop complications. A novel approach to perioperative risk assessment for patients with pulmonary hypertension ncbi.nlm.nih.gov/pmc/articles/P…

Very useful, informative CHEST guideline 2nd update on Antithrombotic Therapy for VTE - covers multiple topics/situations & lists recommendations from other societies as well for comparison. Still some unanswered questions but helpful in general. (link to executive summary)

Did you know there is a new tool for estimating perioperative risk in cirrhosis patients? It's called VOCAL-Penn & may be more predictive than the Mayo calculator. It's been added to the GI section of preopevalguide.com

External Validation of the VOCAL‐Penn Cirrhosis Surgical Risk Score in 2 Large, Independent Health Systems aasldpubs.onlinelibrary.wiley.com/doi/full/10.10…

Perioperative management of patients with pulmonary hypertension undergoing non-cardiothoracic, non-obstetric surgery: a systematic review and expert consensus statement bjanaesthesia.org/article/S0007-…

Pts with ACS & SAP who underwent surgery 1-12 mos after DES had a risk for MI & death similar to that observed in surg pts w/o CAD disease; but much higher risk of MI in 1st mo after DES for ACS. pubmed.ncbi.nlm.nih.gov/34583812/

Meta-Analysis of the Usefulness of Beta-Blockers to Reduce the Risk of Major Adverse Cardiovascular Events in Patients With Stable Coronary Artery Disease Without Prior Myocardial Infarction or Left Ventricular Dysfunction ajconline.org/article/S0002-…

Diagnosis and Management of Patients With Myocardial Injury After Noncardiac Surgery: A Scientific Statement From the American Heart Association ahajournals.org/doi/10.1161/CI…

Nice review of bridging antiplatelet Rx after PCI. Unfortunately small studies & few events. The only time I might possibly bridge is in the 1st mo post-PCI. Even then, not convinced any potential benefit outweighs the bleeding risk. Cangrelor seems safest jacc.org/doi/10.1016/j.…

In contrast to no benefit in pts with stable CAD but no MI, this analysis suggests that pts Rx’d with >12.5%-25% of the target BB dose used in RCTs beyond 1 year after MI may have enhanced survival compared with no beta‐blocker & other BB doses. ahajournals.org/doi/10.1161/JA…

Study finding no difference between GA & spinal anesthesia for hip Fx for mortality, recovery of ambulation, or delirium at 60 days. Did not assess MI or other complications. Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults | NEJM nejm.org/doi/full/10.10…

The MET-REPAIR Questionnaire correlates with measured METs; all utilized forms of self-reported physical activity overestimate measured METs. NT-proBNP correlates poorly with measured METs. Anxiously awaiting results from the 15,000 pt MET-REPAIR trial. pubmed.ncbi.nlm.nih.gov/34687977/

Abstract submissions for the 2022 PeriopSummit are open! Submit your periop research, innovation, or interesting case. A great meeting to network & learn from thought-leaders in perioperative medicine from around the world. Deadline is 12/10/21 Submit at: spaqi.org/2022/abstracts…

Reduction of same-day inpatient surgical cancellations with preoperati... sciencedirect.com/science/articl…

Retrospective study confirming low risk for RCRI scores 0-1;elevated risk if score 2 or more-similar to Lee's original results, but using 30-d outcomes. Cardiac risk assessment with the Revised Cardiac Risk Index index before elective noncardiac surgery pubmed.ncbi.nlm.nih.gov/34772298/

Well-written editorial suggesting a more specific risk stratification for VTE prophylaxis in pts with Covid hx undergoing surgery. Risk stratification for SARS‐CoV‐2‐related venous thromboembolic events: time for a new paradigm? 2022 - Anaesthesia …-publications.onlinelibrary.wiley.com/doi/full/10.11…