当前位置： SCI文献检索 > BRITISH JOURNAL OF ANAESTHESIA期刊下所有文献 > Perioperative management of clopidogrel therapy: the effects on in-hospital cardiac morbidity in older patients with hip fractures.

Perioperative management of clopidogrel therapy: the effects on in-hospital cardiac morbidity in older patients with hip fractures.

Abstract：

BACKGROUND:Increasing numbers of older patients prescribed clopidogrel are presenting for urgent hip fracture surgery. Best practice for the management of clopidogrel therapy is unknown, although delays to surgery are associated with increased mortality. We investigated the influence of perioperative management of clopidogrel therapy on in-hospital cardiac morbidity and transfusion in this population. METHODS:Retrospective review of all patients aged >60 yr, admitted to a single centre with hip fractures between June 2005 and November 2008. Acute coronary syndrome (ACS) was defined as a raised plasma troponin concentration >0.04 µg litre(-1) associated with chest pain, new ECG changes, or both. RESULTS:Of 1381 patients admitted with hip fractures, 114 were receiving regular clopidogrel therapy with a median age of 83.7 (60-98) yr. Clopidogrel was withheld perioperatively in 111 (98%) of these patients. Twenty-three patients (20.2%) suffered an ACS. Risk peaked for ACS [odds ratio (OR) 6.7 (95% confidence interval, CI, 1.7-25.8)] (P=0.006) between days 4 and 8 after clopidogrel withdrawal. The OR for requiring a blood transfusion during or after surgery peaked at day 1 after clopidogrel withdrawal [OR 2.31 (95% CI, 1.02-5.21)] (P=0.044). CONCLUSIONS:The length of withdrawal of clopidogrel therapy perioperatively was associated with a significantly increased incidence of ACS. An association between shorter withdrawal and increased blood transfusion requirements was also seen. The study emphasizes the cardiovascular risks of routinely interrupting clopidogrel therapy in this at-risk population and that a more considered, individualized, evidenced-based approach is needed.

journal_name

Br J Anaesth

journal_title

British journal of anaesthesia

authors

Collyer TC,Reynolds HC,Truyens E,Kilshaw L,Corcoran T

doi

10.1093/bja/aer288

subject

Has Abstract

pub_date

2011-12-01 00:00:00

pages

911-5

issue

6

eissn

0007-0912

issn

1471-6771

pii

S0007-0912(17)32568-0

journal_volume

107

pub_type

杂志文章

相关文献

BRITISH JOURNAL OF ANAESTHESIA文献大全
  • Psychology of pain.

    abstract：:This article briefly reviews psychological aspects of pain, paying special attention to chronic pain. The review considers the interruptive and interference effects of pain and its impact on a person's identity. The importance of processes related to interruption, interference, and identity will vary across people and...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章,评审

    doi：10.1093/bja/aen123

    authors： Morley S

    更新日期：2008-07-01 00:00:00

  • Dexmedetomidine as an anaesthetic adjuvant in patients undergoing intracranial tumour surgery: a double-blind, randomized and placebo-controlled study.

    abstract：BACKGROUND:Dexmedetomidine (DEX) has been shown to provide good perioperative haemodynamic stability with decreased intraoperative opioid requirements. It may have neural protective effects, and thus may be a suitable anaesthetic adjuvant to neurosurgical anaesthesia. METHODS:Fifty-four patients scheduled for elective...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章,随机对照试验

    doi：10.1093/bja/ael220

    authors： Tanskanen PE,Kyttä JV,Randell TT,Aantaa RE

    更新日期：2006-11-01 00:00:00

  • Effect of prostaglandin E1-induced hypotension on carbon dioxide reactivity and local cerebral blood flow after subarachnoid haemorrhage.

    abstract：:The effect of prostaglandin E1 (PGE1) on local cerebral blood flow (LCBF) and carbon dioxide reactivity (CO2R) was studied during cerebral aneurysm surgery for subarachnoid haemorrhage in 24 patients under neuroleptanaesthesia. Eleven patients had good neurological status (Hunt and Kosnik grade I: group A) and 13 pati...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章

    doi：10.1093/bja/68.3.268

    authors： Abe K,Demizu A,Yoshiya I

    更新日期：1992-03-01 00:00:00

  • Intravenous oxytocin bolus of 2 units is superior to 5 units during elective Caesarean section.

    abstract：BACKGROUND:The optimal dose of oxytocin at Caesarean section is unclear. Oxytocin may cause adverse cardiovascular effects, including tachycardia and hypotension, whereas an inadequate dose can result in increased uterine bleeding. We compared the effects of two doses of oxytocin in a randomized double-blind trial. ME...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章,随机对照试验

    doi：10.1093/bja/aen273

    authors： Sartain JB,Barry JJ,Howat PW,McCormack DI,Bryant M

    更新日期：2008-12-01 00:00:00

  • Ebstein's anomaly--anaesthetic problems. A case report.

    abstract：:A patient with Ebstein's anomaly undergoing anaesthesia for the operation of hysterectomy is reported. The considerations relating to the risk of an increased right-to-left intracardiac shunt are discussed. The patient was anaesthetized successfully with a combination of nitrous oxide, droperidol and fentanyl. ...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章

    doi：10.1093/bja/49.5.501

    authors： Bengtsson IM,Magno R,Wickström I

    更新日期：1977-05-01 00:00:00

  • Does the addition of clonidine affect duration of analgesia of bupivacaine wound infiltration in inguinal hernia surgery?

    abstract：:We conducted a prospective, randomized, double-blind study to compare analgesia obtained by wound infiltration using 29 ml of 0.25% bupivacaine alone, or with the addition of clonidine hydrochloride 150 micrograms. A third group received bupivacaine wound infiltration with clonidine 150 micrograms i.m. to control for ...

    journal_title：British journal of anaesthesia

    pub_type： 临床试验,杂志文章,随机对照试验

    doi：10.1093/bja/79.4.446

    authors： Elliott S,Eckersall S,Fligelstone L,Jothilingam S

    更新日期：1997-10-01 00:00:00

  • Influence of a 30-min break on divided attention and working memory in resident anaesthetists on daily routine.

    abstract：BACKGROUND:The aim of this study is to test the hypothesis that a standard 30-min break in a routine 7.5 h period of work makes a difference in cognitive function. METHODS:In a double-blinded, cross-over trial 30 residents in anaesthesia were randomized to receive or not to receive a 30-min break between the assessmen...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章,随机对照试验

    doi：10.1093/bja/ael151

    authors： Coburn M,Henzler D,Baumert JH,Fimm B,Drüke B,Rossaint R

    更新日期：2006-09-01 00:00:00

  • Does a first-case on-time-start initiative achieve its goal by starting the entire process earlier or by tightening the distribution of start times?

    abstract：BACKGROUND:We explored whether a previously successful initiative to improve first-case on-time starts succeeded because (i) preoperative steps started earlier (but the process did not necessarily improve) or (ii) the process was brought into better control. METHODS:We analysed 35 months of data comprising 28 882 firs...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章

    doi：10.1016/j.bja.2018.05.043

    authors： Tiwari V,Ehrenfeld JM,Sandberg WS

    更新日期：2018-11-01 00:00:00

  • A pharmacokinetic study of midazolam in paediatric patients undergoing cardiac surgery.

    abstract：:Midazolam 0.3 mg kg-1 was given as a single dose to three groups of children undergoing cardiac surgery to determine its pharmacokinetic profile in this situation. The first group, undergoing closed heart surgery, received the midazolam during the operation. The other groups underwent cardiopulmonary bypass (CPB) with...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章

    doi：10.1093/bja/61.3.302

    authors： Mathews HM,Carson IW,Lyons SM,Orr IA,Collier PS,Howard PJ,Dundee JW

    更新日期：1988-09-01 00:00:00

  • Premedication with butorphanol. A comparison with morphine.

    abstract：:A blind comparison was made of butorphanol 2 mg with morphine 10 mg i.m. as the sole premedication in four groups, each of 10 women, undergoing total abdominal hysterectomy. On both subjective and objective grounds, butorphanol was as effective as morphine with the advantage of fewer unwanted side-effects, although on...

    journal_title：British journal of anaesthesia

    pub_type： 临床试验,杂志文章,随机对照试验

    doi：10.1093/bja/56.4.363

    authors： Laffey DA,Kay NH

    更新日期：1984-04-01 00:00:00

  • Anaphylactic reaction after methylene blue-treated plasma transfusion.

    abstract：:Methylene blue-treated fresh-frozen plasma (MB-FFP) is mainly used in Europe. The advantage of the methylene blue system is that units can be treated individually. The combined action of methylene blue and illumination is a photodynamic process preventing viral RNA and DNA replication. We report the first immediate al...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章

    doi：10.1093/bja/aer009

    authors： Dewachter P,Castro S,Nicaise-Roland P,Chollet-Martin S,Le Beller C,Lillo-le-Louet A,Mouton-Faivre C

    更新日期：2011-05-01 00:00:00

  • The effect of age on the safety factor in neuromuscular transmission in the isolated diaphragm of the rat.

    abstract：:An analysis of neuromuscular transmission has been made in phrenic nerve/diaphragm preparations from male rats aged 30 days or 110 days. The amplitude of miniature end-plate potentials was found to decrease with age, being 0.969 +/- SEM 0.058 mV at 30 days and 0.510 +/- SEM 0.031 mV at 110 days. Over the same period, ...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章

    doi：10.1093/bja/49.3.217

    authors： Kelly SS,Roberts DV

    更新日期：1977-03-01 00:00:00

  • Blood-gas changes during induced hypotension with sodium nitroprusside.

    abstract：:A blood-gas study of the respiratory effects of sodium nitroprusside during anaesthesia has shown a marked reduction in PaO2 when the drug was administered. After nitroprusside PaO2 returned to the previous values. It is suggested that the reduction in PaO2 is a result of an increased scatter of ventilation/perfusion ...

    journal_title：British journal of anaesthesia

    pub_type： 临床试验,杂志文章

    doi：10.1093/bja/47.11.1205

    authors： Wildsmith JA,Drummond GB,MacRae WR

    更新日期：1975-11-01 00:00:00

  • Isoflurane-induced myocardial preconditioning is dependent on phosphatidylinositol-3-kinase/Akt signalling.

    abstract：BACKGROUND:Isoflurane and other volatile anaesthetics have a cardioprotective effect and limit myocardial infarct size to the same extent as ischaemic preconditioning. Phosphatidylinositol-3-kinase (PI3K) was found to play a key role in myocardial protection by ischaemic preconditioning. The aim of the present investig...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章

    doi：10.1093/bja/aei264

    authors： Raphael J,Rivo J,Gozal Y

    更新日期：2005-12-01 00:00:00

  • Anaesthetic preconditioning but not postconditioning prevents early activation of the deleterious cardiac remodelling programme: evidence of opposing genomic responses in cardioprotection by pre- and postconditioning.

    abstract：BACKGROUND:Anaesthetic preconditioning (A_PreC) and postconditioning (A_PostC) both provide protection against ischaemia-reperfusion in the heart. However, post-ischaemic gene responses may differ between the two therapeutic strategies. METHODS:Isolated perfused rat hearts were exposed to 40 min test ischaemia followe...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章

    doi：10.1093/bja/aei155

    authors： Lucchinetti E,da Silva R,Pasch T,Schaub MC,Zaugg M

    更新日期：2005-08-01 00:00:00

  • Covariates of tramadol disposition in the first months of life.

    abstract：BACKGROUND:Data on contributors to between-individual variability in overall tramadol clearance and O-demethyl tramadol (M1) formation in preterm neonates and young infants are limited. METHODS:A population pharmacokinetic analysis of tramadol and M1 was undertaken using non-linear mixed effects model. Covariate analy...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章

    doi：10.1093/bja/aen019

    authors： Allegaert K,van den Anker JN,de Hoon JN,van Schaik RH,Debeer A,Tibboel D,Naulaers G,Anderson BJ

    更新日期：2008-04-01 00:00:00

  • Recordings of, and an anatomical explanation for, false positive loss of resistance during lumbar extradural analgesia.

    abstract：:Loss of resistance dorsal to the ligamentum flavum was recorded in 10 of 16 patients aged 43--75 yr whilst performing extradural anaesthesia at the L2--3 interspace via the midline approach. Degeneration of the interspinous ligament with cavity formation is observed frequently in the elderly and may account for false ...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章

    doi：10.1093/bja/51.3.253

    authors： Sharrock NE

    更新日期：1979-03-01 00:00:00

  • Cardiorespiratory effects of high frequency intermittent positive pressure ventilation in the dog.

    abstract：:The cardiorespiratory effects of increasing respiratory frequency were investigated in two groups of dogs ventilated mechanically with a system which minimized apparatus and anatomical deadspace. In one group minute volume was constant whilst frequency was increased; in the second group minute volume was increased to ...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章

    doi：10.1093/bja/52.5.475

    authors： Chakrabarti MK,Sykes MK

    更新日期：1980-05-01 00:00:00

  • Results of a phase 1 multicentre investigation of dexmedetomidine bolus and infusion in corrective infant cardiac surgery.

    abstract：BACKGROUND:Dexmedetomidine (DEX) is increasingly used intraoperatively in infants undergoing cardiac surgery. This phase 1 multicentre study sought to: (i) determine the safety of DEX for cardiac surgery with cardiopulmonary bypass; (ii) determine the pharmacokinetics (PK) of DEX; (iii) create a PK model and dosing for...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章,多中心研究

    doi：10.1016/j.bja.2019.06.026

    authors： Zuppa AF,Nicolson SC,Wilder NS,Ibla JC,Gottlieb EA,Burns KM,Stylianou M,Trachtenberg F,Ni H,Skeen TH,Andropoulos DB,Pediatric Heart Network Investigators.

    更新日期：2019-12-01 00:00:00

  • Metoclopramide in the prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized, placebo-controlled studies.

    abstract：:Metoclopramide has been used for almost 40 yr to prevent postoperative nausea and vomiting (PONV). We have reviewed the efficacy and safety of metoclopramide for the prevention of PONV. A systematic search (MEDLINE, EMBASE, manufacturers' databases, hand searching, bibliographies, all languages, up to June 1998) was p...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章,meta分析

    doi：10.1093/bja/83.5.761

    authors： Henzi I,Walder B,Tramèr MR

    更新日期：1999-11-01 00:00:00

  • High-sensitive cardiac troponin T measurements in prediction of non-cardiac complications after major abdominal surgery.

    abstract：BACKGROUND:Postoperative non-cardiac complication rates are as high as 11-28% after high-risk abdominal procedures. Emerging evidence indicates that postoperative cardiac troponin T elevations are associated with adverse outcome in non-cardiac surgery. The aim of this study was to determine the relationship between pos...

    journal_title：British journal of anaesthesia

    pub_type： 临床试验,杂志文章

    doi：10.1093/bja/aev027

    authors： Noordzij PG,van Geffen O,Dijkstra IM,Boerma D,Meinders AJ,Rettig TC,Eefting FD,van Loon D,van de Garde EM,van Dongen EP

    更新日期：2015-06-01 00:00:00

  • Effect of age, gender and anaesthetic technique on the pharmacodynamics of atracurium.

    abstract：:We have measured in 38 patients the plasma concentration profile of atracurium and its effect on the electromyographic first response of the train-of-four. One of three techniques was used to supplement anaesthesia with 66% nitrous oxide in oxygen, 0.9% isoflurane (end-tidal), 0.5% halothane (end-tidal) or midazolam 3...

    journal_title：British journal of anaesthesia

    pub_type： 临床试验,杂志文章

    doi：10.1093/bja/70.1.38

    authors： Parker CJ,Hunter JM,Snowdon SL

    更新日期：1993-01-01 00:00:00

  • Therapeutic potential of cannabis in pain medicine.

    abstract：:Advances in cannabis research have paralleled developments in opioid pharmacology whereby a psychoactive plant extract has elucidated novel endogenous signalling systems with therapeutic significance. Cannabinoids (CBs) are chemical compounds derived from cannabis. The major psychotropic CB delta-9-tetrahydrocannabino...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章,评审

    doi：10.1093/bja/aen119

    authors： Hosking RD,Zajicek JP

    更新日期：2008-07-01 00:00:00

  • Sources of error in partial rebreathing pulmonary blood flow measurements in lungs with emphysema and pulmonary embolism.

    abstract：BACKGROUND:Studies of the accuracy of partial rebreathing measurements of pulmonary blood flow (PBF) in patients with abnormal lungs have not fully explained the sources of error. METHODS:We used computer models of emphysema and pulmonary embolism incorporating both ventilation-perfusion (V/Q) and ventilation-volume (...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章

    doi：10.1093/bja/ael214

    authors： Yem JS,Turner MJ,Baker AB

    更新日期：2006-11-01 00:00:00

  • Effects of amrinone on left and right ventricular function in patients with impaired myocardial performance during general anaesthesia.

    abstract：:We have studied the effects of amrinone on left and right ventricular haemodynamics in patients with impaired ventricular performance caused by coronary artery disease. Anaesthesia was achieved with fentanyl, flunitrazepam and pancuronium. After reaching steady state, a bolus dose of amrinone 0.5 mg kg-1 was administe...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章

    doi：10.1093/bja/72.5.567

    authors： Petry A,Dütschke P

    更新日期：1994-05-01 00:00:00

  • Influence of oral clonidine on the ventilatory response to acute and sustained isocapnic hypoxia in human males.

    abstract：:Animal studies suggest that alpha 2 agonists inhibit the chemoreceptor response to hypoxia. We have examined the effect of oral clonidine on the ventilatory response to sustained, isocapnic hypoxia (SpO2 79.7% (SD 1.1%) for 20 min) in eight male subjects. The hypoxic ventilatory response was measured before and after ...

    journal_title：British journal of anaesthesia

    pub_type： 临床试验,杂志文章

    doi：10.1093/bja/76.2.214

    authors： Foo IT,Warren PM,Drummond GB

    更新日期：1996-02-01 00:00:00

  • Milrinone decreases both pulmonary arterial and venous resistances in the hypoxic dog.

    abstract：:We have studied the effect of milrinone on pulmonary vascular resistance (PVR) in dogs with hypoxic pulmonary vasoconstriction (HPV). Using a pulmonary arterial occlusion method, we measured effective pulmonary capillary pressure (Pcap) by which total PVR was partitioned into arterial (PVRa) and venous (PVRv) componen...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章

    doi：10.1093/bja/81.6.920

    authors： Kato R,Sato J,Nishino T

    更新日期：1998-12-01 00:00:00

  • Neurological biomarkers in the perioperative period.

    abstract：:The rapid detection and evaluation of patients presenting with perioperative neurological dysfunction is of great clinical relevance. Biomarkers have been defined as biological molecules that can be used as an indicator of new onset or progression of a biological process or effect of treatment. Biomarkers have become ...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章,评审

    doi：10.1093/bja/aer338

    authors： Cata JP,Abdelmalak B,Farag E

    更新日期：2011-12-01 00:00:00

  • Pharmacokinetic and clinical study of ropivacaine and bupivacaine in women receiving extradural analgesia in labour.

    abstract：:We have compared, in a randomized, double-blind study, the pharmacokinetics of ropivacaine and bupivacaine during labour. Total and free plasma concentrations of ropivacaine and bupivacaine were measured after the first of two extradural doses. The main dose was 20 mg (test dose) and 30 mg, with a top-up dose of 25 mg...

    journal_title：British journal of anaesthesia

    pub_type： 临床试验,杂志文章,随机对照试验

    doi：10.1093/bja/79.5.558

    authors： McCrae AF,Westerling P,McClure JH

    更新日期：1997-11-01 00:00:00

  • Printed three-dimensional airway model assists planning of single-lung ventilation in a small child.

    abstract：BACKGROUND:Single-lung ventilation in infants and small children is challenging because suitable sizes of double-lumen cuffed tracheal tubes are not available. A 6-yr-old child required pulmonary saline washout for primary alveolar proteinosis, and therefore needed sequential single-lung ventilation in order to achieve...

    journal_title：British journal of anaesthesia

    pub_type： 杂志文章

    doi：10.1093/bja/aev305

    authors： Wilson CA,Arthurs OJ,Black AE,Schievano S,Hunt C,van Hoog S,Wallis C,Sury MR

    更新日期：2015-10-01 00:00:00