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Article ; Online: Fluid and blood transfusion management in obstetrics.

Ickx, Brigitte E

2010 Volume 27, Issue 12, Page(s) 1031–1035

Abstract: In this review, we shall consider the oral and intravenous fluid management of pregnant women during labour and operative delivery in the context of neuroaxial blockade. We shall also discuss the use of blood transfusion in the peripartum period, ... ...

Abstract	In this review, we shall consider the oral and intravenous fluid management of pregnant women during labour and operative delivery in the context of neuroaxial blockade. We shall also discuss the use of blood transfusion in the peripartum period, especially during postpartum haemorrhage. Current management of military casualties and major civilian trauma challenges traditional practices of blood product administration in massive haemorrhage and may radically modify transfusion practices during obstetric haemorrhage. Articles for inclusion were selected from medical databases, including MEDLINE and the Cochrane Library, and additional references were obtained from available relevant publications.
MeSH term(s)	Anesthesia, Obstetrical/methods ; Blood Transfusion/methods ; Female ; Fluid Therapy/methods ; Humans ; Labor, Obstetric ; Obstetric Labor Complications/therapy ; Postpartum Hemorrhage/therapy ; Pregnancy
Language	English
Publishing date	2010-12
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	605770-6
ISSN	1365-2346 ; 0265-0215
ISSN (online)	1365-2346
ISSN	0265-0215
DOI	10.1097/EJA.0b013e32833c30e3
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Article ; Online: Fibrinogen Concentrate use in routine practice in an academic hospital: A retrospective study about the effects of Fibrinogen Concentrate administration on biological parameters.

Duranteau, Olivier / Engelman, Edgard / Ickx, Brigitte

Journal of clinical anesthesia

2020 Volume 63, Page(s) 109787

MeSH term(s)	Fibrinogen ; Hemostatics ; Hospitals ; Humans ; Retrospective Studies ; Thrombelastography
Chemical Substances	Hemostatics ; Fibrinogen (9001-32-5)
Language	English
Publishing date	2020-03-16
Publishing country	United States
Document type	Letter
ZDB-ID	1011618-7
ISSN	1873-4529 ; 0952-8180
ISSN (online)	1873-4529
ISSN	0952-8180
DOI	10.1016/j.jclinane.2020.109787
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Zs.A 2622: Show issues

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Article ; Online: Management of the clotting system: a European perspective.

Ickx, Brigitte E / Faraoni, David

Current opinion in anaesthesiology

2012 Volume 25, Issue 1, Page(s) 80–85

Abstract: Purpose of review: Coagulation management remains a challenge for anesthesiologists involved in cardiovascular surgery as the population undergoing surgery becomes older and presents with more comorbidities. These patients are frequently treated with ... ...

Abstract	Purpose of review: Coagulation management remains a challenge for anesthesiologists involved in cardiovascular surgery as the population undergoing surgery becomes older and presents with more comorbidities. These patients are frequently treated with one or more agents that directly affect coagulation. This review will discuss what is known and the treatments available to manage coagulation in the perioperative setting of cardiac surgery. Recent findings: New antithrombotics will be discussed as well as their proposed substitution in the preoperative period. The review will also describe the different products available in Europe for the treatment of bleeding and coagulopathy. Finally, the use of new monitoring devices will be discussed. Summary: The introduction of new drugs with different mechanisms of action adds to the complexity of coagulation management during cardiovascular surgery. Monitoring needs to be developed and improved, especially for evaluating platelet function.
MeSH term(s)	Anticoagulants/therapeutic use ; Blood Coagulation Disorders/therapy ; Blood Loss, Surgical/prevention & control ; Cardiac Surgical Procedures ; Cardiovascular Diseases/therapy ; Erythrocyte Transfusion ; Europe ; Hemorrhage/therapy ; Hemostasis ; Humans ; Plasma ; Preoperative Care
Chemical Substances	Anticoagulants
Language	English
Publishing date	2012-02
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	645203-6
ISSN	1473-6500 ; 0952-7907
ISSN (online)	1473-6500
ISSN	0952-7907
DOI	10.1097/ACO.0b013e32834ef3d1
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Zs.A 2564: Show issues

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Article ; Online: Intravenous lidocaine to prevent endothelial dysfunction after major abdominal surgery: a randomized controlled pilot trial.

Pustetto, Marco / Goldsztejn, Nicolas / Touihri, Karim / Engelman, Edgard / Ickx, Brigitte / Van Obbergh, Luc

BMC anesthesiology

2020 Volume 20, Issue 1, Page(s) 155

Abstract: Background: Major abdominal surgery is associated with endothelial glycocalyx disruption. The anti-inflammatory effects of lidocaine were recently associated with endothelial barrier protection.: Methods: This was a single-centre, parallel group, ... ...

Abstract	Background: Major abdominal surgery is associated with endothelial glycocalyx disruption. The anti-inflammatory effects of lidocaine were recently associated with endothelial barrier protection. Methods: This was a single-centre, parallel group, randomized, controlled, double blind, pilot trial. Forty adult patients scheduled for major abdominal surgery were included between December 2016 and March 2017 in the setting of a University Hospital in Brussels (Belgium); reasons for non-inclusion were planned liver resection and conditions associated to increased risk of local anesthetics systemic toxicity. Patients were randomized to receive either lidocaine by continuous intravenous administration or an equivalent volume of 0.9% saline. The primary endpoint was the postoperative syndecan-1 concentration (difference between groups). Near-infrared spectroscopy of the thenar eminence in association with the vascular occlusion test, and contemporary analysis of flow-mediated dilation of the brachial artery were the secondary outcomes, along with haemodynamic data. Blood samples and data were collected before surgery (T0), and at 1-3 h (T1) and 24 h (T2) post-surgery. Results: Syndecan-1 concentration increased significantly post-surgery (P < 0.001), but without any difference between groups. The near-infrared spectroscopy-derived and flow-mediated dilation-derived variables showed minor changes unrelated to group assignment. Compared with the placebo group, the intervention group had a significantly lower peri-operative mean arterial pressure and cardiac index, despite equally conducted goal-directed haemodynamic management. Postoperative lactate concentrations were similar between groups. Conclusions: Lidocaine failed to have any effect on endothelial function. Since in comparisons to other types of clinical situations, syndecan-1 was only slightly upregulated, endothelial dysfunction after major abdominal surgery might be overestimated. Trial registration: « ISRCTN Registry » identifier: ISRCTN63417725. Date: 15/06/2020. Retrospectively registered.
MeSH term(s)	Abdomen/surgery ; Adult ; Aged ; Double-Blind Method ; Endothelium, Vascular/drug effects ; Female ; Humans ; Infusions, Intravenous ; Lidocaine/administration & dosage ; Male ; Middle Aged ; Pilot Projects ; Postoperative Complications/prevention & control ; Syndecan-1/blood
Chemical Substances	SDC1 protein, human ; Syndecan-1 ; Lidocaine (98PI200987)
Language	English
Publishing date	2020-06-23
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial
ISSN	1471-2253
ISSN (online)	1471-2253
DOI	10.1186/s12871-020-01075-x
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Article ; Online: Arterial Lactate Concentration at the End of Liver Transplantation is Independently Associated With One-Year Mortality.

Coeckelenbergh, Sean / Drouard, Leonard / Ickx, Brigitte / Lucidi, Valerio / Germanova, Desislava / Desebbe, Olivier / Duhaut, Lea / Moussa, Maya / Naili, Salima / Vibert, Eric / Samuel, Didier / Duranteau, Jacques / Vincent, Jean-Louis / Rinehart, Joseph / Van der Linden, Philippe / Joosten, Alexandre

Transplantation proceedings

2023 Volume 55, Issue 1, Page(s) 147–152

Abstract: Background: Liver transplant patients who develop hyperlactatemia are at increased risk of postoperative morbidity and short-term mortality, but there are few data on longer-term outcomes. We therefore investigated if arterial lactate concentration ... ...

Abstract	Background: Liver transplant patients who develop hyperlactatemia are at increased risk of postoperative morbidity and short-term mortality, but there are few data on longer-term outcomes. We therefore investigated if arterial lactate concentration obtained immediately after surgery, at the time of admission to the intensive care unit (ICU), was associated with 1-year mortality. Methods: In this retrospective cohort study, all patients who underwent liver transplant surgery from a deceased donor between September 2013 and December 2019 were screened for inclusion. Patients who underwent combined transplantation surgery and those with a history of previous liver transplantation (ie, redo surgery) were not included. Logistic regression modeling included univariate and multivariate analyses. Receiver operating characteristic curves and areas under the curves were calculated. Lactate thresholds and association with outcome were analyzed for specificity, sensitivity, and Youden's index. Results: Of 226 patients included, 18.4% died within 1 year of liver transplantation. Immediate postoperative lactate concentration was independently associated with 1-year mortality with an adjusted odds ratio of 1.35 (95% CI 1.16-1.59; P < .001) per mmol/L increase in lactate and an area under the curve of 0.80 (95% CI 0.72-0.87; P < .001). A lactate concentration of 2.25 mmol/L (cutoff determined using Youden's index) was associated with increased 1-year mortality with a sensitivity of 0.71 and a specificity of 0.72. Conclusions: Increased arterial lactate concentration on admission to the intensive care unit immediately after orthotopic liver transplantation is independently associated with increased 1-year mortality.
MeSH term(s)	Humans ; Lactic Acid ; Retrospective Studies ; Liver Transplantation ; Intensive Care Units ; ROC Curve
Chemical Substances	Lactic Acid (33X04XA5AT)
Language	English
Publishing date	2023-01-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	82046-5
ISSN	1873-2623 ; 0041-1345
ISSN (online)	1873-2623
ISSN	0041-1345
DOI	10.1016/j.transproceed.2022.11.004
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Article: Perioperative management of patients receiving vitamin K antagonists.

Ickx, Brigitte E / Steib, Annick

Canadian journal of anaesthesia = Journal canadien d'anesthesie

2006 Volume 53, Issue 6 Suppl, Page(s) S113–22

Abstract: Purpose: As the number of patients taking vitamin K antagonists (VKA) is growing, the clinician is increasingly faced with having to make decisions regarding anticoagulation therapy before, during and immediately after surgery. In this article we review ...

Abstract	Purpose: As the number of patients taking vitamin K antagonists (VKA) is growing, the clinician is increasingly faced with having to make decisions regarding anticoagulation therapy before, during and immediately after surgery. In this article we review the indications for VKA and assess their use in the perioperative period based on available pharmacological and clinical data. Source: An on-line computerized search of Medline was conducted limited to English and French language articles. The bibliographies of relevant articles and additional material from other published sources were retrieved and reviewed. Principal findings: Assessment of patients taking VKA who need surgery must include three factors: 1) the indication for anticoagulation, which determines the thromboembolic risk; 2) the pharmacokinetics of VKA, which determine the moment at which treatment should be discontinued; and 3) the type of surgery, which determines the hemorrhagic risk. Some patients will need to stop VKA treatment and start a substitution or "bridging" anticoagulant therapy, such as unfractionated heparin or low molecular weight heparin, prior to and after surgery. In patients requiring emergency surgery, prothrombin complex concentrate can be used to improve coagulation and is preferable to, although more expensive than fresh frozen plasma. Conclusions: For the perioperative setting, further studies are required to determine the optimal substitution ("bridging") regimen and the clinical circumstances that necessitate substitution therapy.
MeSH term(s)	Anticoagulants/adverse effects ; Anticoagulants/pharmacokinetics ; Anticoagulants/therapeutic use ; Contraindications ; Emergency Medical Services ; Humans ; Monitoring, Intraoperative ; Perioperative Care ; Surgical Procedures, Operative ; Vitamin K/antagonists & inhibitors
Chemical Substances	Anticoagulants ; Vitamin K (12001-79-5)
Language	English
Publishing date	2006-05-25
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	91002-8
ISSN	1496-8975 ; 0832-610X
ISSN (online)	1496-8975
ISSN	0832-610X
DOI	10.1007/bf03022258
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Article ; Online: Effect of two doses of tranexamic acid on fibrinolysis evaluated by thromboelastography during cardiac surgery: a randomised, controlled study.

Faraoni, David / Cacheux, Christophe / Van Aelbrouck, Caroline / Ickx, Brigitte E / Barvais, Luc / Levy, Jerrold H

European journal of anaesthesiology

2014 Volume 31, Issue 9, Page(s) 491–498

Abstract: Background: Tranexamic acid is used to decrease bleeding and transfusions during cardiac surgery. However, dosing based on pharmacokinetic data to optimally inhibit fibrinolysis is unknown. With increasing concerns regarding seizures associated with ... ...

Abstract	Background: Tranexamic acid is used to decrease bleeding and transfusions during cardiac surgery. However, dosing based on pharmacokinetic data to optimally inhibit fibrinolysis is unknown. With increasing concerns regarding seizures associated with higher doses, lower dosing schemes may be important. Objective: To determine the effect of two dosing schemes compared with placebo on fibrinolysis and clinical outcomes. Design: A double-blind, randomised, controlled, pilot trial. Setting: Single tertiary centre. Patients: Cardiac surgery patients requiring cardiopulmonary bypass. Intervention: Patients were randomised to receive a 30 mg kg(-1) bolus and continuous infusion of 16 mg kg (-1) h(-1) (Group HIGH), a 5 mg kg(-1) bolus followed by 5 mg kg(-1) h(-1) (Group LOW) or Sodium chloride (Placebo). Main outcome measure: Fibrinolysis was evaluated by thromboelastography and D-dimers. Secondary endpoints were blood loss, transfusion requirement and side effects. Results: Thirty-three patients were included. Significant fibrinolysis was defined by LY30 more than 7.5% based on thromboelastography and was not observed after cardiopulmonary bypass in any groups. After protamine administration, LY30 differences between groups were 0.7 [95% confidence interval (95% CI) -0.04 to 1.4] between Groups HIGH and Placebo, -0.08 (95% CI -0.82 to 0.66) between Groups HIGH and LOW, and 0.78 (95% CI 0.02 to 1.5) between Groups LOW and Placebo. A significant increase in D-dimers was observed in the Group Placebo compared with the two treatment groups. There were no differences in bleeding or transfusion requirement. Conclusion: In this dose-finding study, there were no differences in fibrinolysis or clinical outcomes among the two tranexamic acid schemes and placebo. Any difference in fibrinolytic inhibition requires a larger adequately powered study. Trial registration: EudraCT number: 2010-024104-99.
MeSH term(s)	Aged ; Aged, 80 and over ; Antifibrinolytic Agents/administration & dosage ; Antifibrinolytic Agents/pharmacology ; Blood Loss, Surgical/prevention & control ; Cardiopulmonary Bypass/methods ; Dose-Response Relationship, Drug ; Double-Blind Method ; Fibrin Fibrinogen Degradation Products/metabolism ; Fibrinolysis/drug effects ; Humans ; Middle Aged ; Pilot Projects ; Protamines/administration & dosage ; Thrombelastography/methods ; Tranexamic Acid/administration & dosage ; Tranexamic Acid/pharmacology
Chemical Substances	Antifibrinolytic Agents ; Fibrin Fibrinogen Degradation Products ; Protamines ; fibrin fragment D ; Tranexamic Acid (6T84R30KC1)
Language	English
Publishing date	2014-09
Publishing country	England
Document type	Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	605770-6
ISSN	1365-2346 ; 0265-0215
ISSN (online)	1365-2346
ISSN	0265-0215
DOI	10.1097/EJA.0000000000000051
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Article: The effects of colloid solutions on hemostasis.

Van der Linden, Philippe / Ickx, Brigitte E

Canadian journal of anaesthesia = Journal canadien d'anesthesie

2006 Volume 53, Issue 6 Suppl, Page(s) S30–9

Abstract: Purpose: Colloid solutions are widely used to prevent or to correct hypovolemia in surgical patients. Although more efficacious than crystalloids, they are more expensive and can be associated with adverse effects, in particular when they interfere with ...

Abstract	Purpose: Colloid solutions are widely used to prevent or to correct hypovolemia in surgical patients. Although more efficacious than crystalloids, they are more expensive and can be associated with adverse effects, in particular when they interfere with the hemostatic system. Methods: This narrative review focuses on the effects of albumin and synthetic colloids on the biological markers of coagulation and their clinical consequences. Results: All colloidal plasma substitutes interfere with the physiological mechanisms of hemostasis either through a non-specific effect correlated to the degree of hemodilution or through specific actions of these macromolecules on platelet function, coagulation proteins, and the fibrinolytic system. Albumin has the least effect, while high molecular weight (Mw) dextrans and hydroxyethyl starches (HES) have the most significant effects. Gelatins and medium Mw HES with a low molar substitution ratio have moderate and, probably, comparable effects. The use of dextrans and high in vivo Mw HES may be associated with increased bleeding, while gelatins and low in vivo Mw HES are unlikely to have such an effect. Conclusions: In most cases, the clinical consequences of the biological effects of colloids on hemostasis are limited, provided that safety considerations are observed (maximum daily dosage, duration of treatment, patient's hemostatic status, clinical conditions). The implications may be different in patients with hemostatic disorders, either inherited or related to preoperative antiplatelet or anticoagulant treatment. In these patients, crystalloids, gelatins or even albumin solutions should be preferred when hemodilution exceeds 30% of the circulating blood volume.
MeSH term(s)	Animals ; Colloids/administration & dosage ; Colloids/therapeutic use ; Dextrans/therapeutic use ; Gelatin/therapeutic use ; Hemostasis/drug effects ; Hemostatics/administration & dosage ; Hemostatics/therapeutic use ; Humans ; Hydroxyethyl Starch Derivatives/therapeutic use ; Plasma Substitutes/adverse effects ; Plasma Substitutes/therapeutic use ; Serum Albumin/therapeutic use
Chemical Substances	Colloids ; Dextrans ; Hemostatics ; Hydroxyethyl Starch Derivatives ; Plasma Substitutes ; Serum Albumin ; Gelatin (9000-70-8)
Language	English
Publishing date	2006-05-25
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	91002-8
ISSN	1496-8975 ; 0832-610X
ISSN (online)	1496-8975
ISSN	0832-610X
DOI	10.1007/bf03022250
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Article ; Online: Management of antiplatelet therapy for non-elective invasive procedures or bleeding complications: Proposals from the French Working Group on Perioperative Haemostasis (GIHP) and the French Study Group on Thrombosis and Haemostasis (GFHT), in collaboration with the French Society for Anaesthesia and Intensive Care (SFAR).

Godier, Anne / Garrigue, Dephine / Lasne, Dominique / Fontana, Pierre / Bonhomme, Fanny / Collet, Jean-Philippe / de Maistre, Emmanuel / Ickx, Brigitte / Gruel, Yves / Mazighi, Mikael / Nguyen, Philippe / Vincentelli, André / Albaladejo, Pierre / Lecompte, Thomas

Archives of cardiovascular diseases

2019 Volume 112, Issue 3, Page(s) 199–216

Abstract: The French Working Group on Perioperative Haemostasis (GIHP) and the French Study Group on Haemostasis and Thrombosis (GFHT), in collaboration with the French Society for Anaesthesia and Intensive Care (SFAR), drafted up-to-date proposals on the ... ...

Abstract	The French Working Group on Perioperative Haemostasis (GIHP) and the French Study Group on Haemostasis and Thrombosis (GFHT), in collaboration with the French Society for Anaesthesia and Intensive Care (SFAR), drafted up-to-date proposals on the management of antiplatelet therapy for non-elective invasive procedures or bleeding complications. The proposals were discussed and validated by a vote; all proposals could be assigned with a high strength. Management of oral antiplatelet agents in emergency settings requires knowledge of their pharmacokinetic and pharmacodynamic parameters, evaluation of the degree of alteration of haemostatic competence and the associated bleeding risk. Platelet function testing may be considered. When antiplatelet agent-induced bleeding risk may worsen the prognosis, measures should be taken to neutralize antiplatelet therapy, by considering not only the efficacy of available means (which can be limited for prasugrel and even more for ticagrelor), but also the risks that these means expose the patient to. The measures include platelet transfusion at the appropriate dose and haemostatic agents (tranexamic acid; recombinant activated factor VII for ticagrelor). When possible, postponing non-elective invasive procedures at least for a few hours until the elimination of the active compound (which could compromise the effect of transfused platelets) or, if possible, for a few days (reduction of the effect of antiplatelet agents) should be considered.
MeSH term(s)	Administration, Oral ; Blood Loss, Surgical/prevention & control ; Consensus ; Drug Administration Schedule ; Drug Monitoring/standards ; Humans ; Perioperative Care/methods ; Platelet Aggregation Inhibitors/administration & dosage ; Platelet Aggregation Inhibitors/adverse effects ; Platelet Aggregation Inhibitors/pharmacokinetics ; Platelet Function Tests/standards ; Platelet Transfusion ; Postoperative Hemorrhage/blood ; Postoperative Hemorrhage/chemically induced ; Postoperative Hemorrhage/prevention & control ; Risk Assessment ; Risk Factors ; Societies, Medical/standards ; Treatment Outcome
Chemical Substances	Platelet Aggregation Inhibitors
Language	English
Publishing date	2019-01-06
Publishing country	Netherlands
Document type	Journal Article ; Practice Guideline
ZDB-ID	2408778-6
ISSN	1875-2128 ; 1875-2136
ISSN (online)	1875-2128
ISSN	1875-2136
DOI	10.1016/j.acvd.2018.10.004
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Article ; Online: Position of the French Working Group on Perioperative Haemostasis (GIHP) on viscoelastic tests: What role for which indication in bleeding situations?

Roullet, Stéphanie / de Maistre, Emmanuel / Ickx, Brigitte / Blais, Normand / Susen, Sophie / Faraoni, David / Garrigue, Delphine / Bonhomme, Fanny / Godier, Anne / Lasne, Dominique

Anaesthesia, critical care & pain medicine

2018 Volume 38, Issue 5, Page(s) 539–548

Abstract: Purpose: Viscoelastic tests (VETs), thromboelastography (TEG: Methods: A review of the literature.: Principal findings: The role of the VETs seems established in the management of severe trauma and in cardiac surgery, both adult and paediatric. In ...

Abstract	Purpose: Viscoelastic tests (VETs), thromboelastography (TEG Methods: A review of the literature. Principal findings: The role of the VETs seems established in the management of severe trauma and in cardiac surgery, both adult and paediatric. In other situations, their role remains to be defined: hepatic transplantation, postpartum haemorrhage, and non-cardiac surgery. They must be part of the global management of haemostasis based on algorithms defined in each centre and for each population of patients. Their position at the bedside or in the laboratory is a matter of discussion between clinicians and biologists. Conclusion: VETs must be included in algorithms. In consultation with the biology laboratory, these devices should be situated according to the way each centre functions.
MeSH term(s)	Adult ; Algorithms ; Blood Coagulation ; Cardiac Surgical Procedures ; Child ; Emergencies ; Female ; France ; Hemorrhage/therapy ; Hemostasis, Surgical/methods ; Hemostasis, Surgical/standards ; Humans ; Liver Transplantation ; Male ; Postpartum Hemorrhage/blood ; Societies, Medical ; Thrombelastography/methods ; Thrombelastography/standards ; Wounds and Injuries/blood
Language	English
Publishing date	2018-02-03
Publishing country	France
Document type	Journal Article ; Review
ISSN	2352-5568
ISSN (online)	2352-5568
DOI	10.1016/j.accpm.2017.12.014
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