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Impact of Hemorrhage, Thrombosis, and Ischemia

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Vascular Complications of Surgery and Intervention

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Abstract

Surgical patients are often afflicted by a multifactorial increased propensity for hemorrhage or thromboembolism. Hemostasis involves the formation of a fibrin-stabilized platelet plug; however, disruptions to these processes can produce severe hemorrhage. Bleeding is further complicated by inherited coagulation disorders, use of antiplatelet and anticoagulant therapies, and a sometimes lethal cycle of acidosis, hypothermia, and coagulopathy. Management includes identifying the source of hemorrhage, analyzing the ability to achieve hemostasis, appropriately resuscitating patients, and reversing coagulation derangements. Virchow’s triad (endothelial injury, venous stasis, and hypercoagulability) identifies a physiologic state of increased risk for venous thromboembolisms (VTE). Disruption of the mechanisms responsible for coagulation counter-regulatory efforts may increase the formation of VTE. Atherosclerotic disease and arrhythmias, particularly atrial fibrillation, are associated with arterial thromboembolism, which can manifest as acute organ system. Interruption of adequate perfusion caused by hemorrhage or thromboembolic disease can result in irreversible ischemic tissue injury. Prolonged disruption of blood flow can manifest as shock and eventually result in multiorgan failure or, worse, prove to be fatal.

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Abbreviations

α:

Alpha angle

AD:

Autosomal dominant

ADP:

Adenosine diphosphate

ALI:

Acute limb ischemia

AR:

Autosomal recessive

ATLS:

Advanced trauma life support

ATP:

Adenosine triphosphate

CABG:

Coronary artery bypass graft

CLI:

Chronic limb ischemia

CO:

Cardiac output

COX:

Cyclooxygenase

Cr:

Creatinine

CT:

Computed tomography

CTA:

Computed tomography angiography

CVP:

Central venous pressure

DAPT:

Dual antiplatelet therapy

DDAVP:

Desmopressin

DIC:

Disseminated intravascular coagulation

DOAC:

Direct oral anticoagulant

DVT:

Deep vein thrombosis

FFP:

Fresh frozen plasma

FIO2:

Fraction of inspired oxygen

GCS:

Glasgow coma scale

Gp1b:

Glycoprotein Ib

GPIIb–IIIa:

Glycoprotein IIb–IIIa

Hb:

Hemoglobin

Hct:

Hematocrit

Hep-PF4:

Heparin-platelet factor 4

HIT:

Heparin-induced thrombocytopenia

HITT:

Heparin-induced thrombocytopenia and thrombosis

INR:

International normalized ratio

IVC:

Inferior vena cava

LMWH:

Low-molecular-weight heparin

LY30:

Fibrinolysis at 30 min

MA:

Maximum amplitude

MAP:

Mean arterial pressure

MTP:

Massive transfusion protocol

NOAC:

Novel oral anticoagulant

NOMI:

Nonocclusive mesenteric ischemia

PaO2:

arterial partial oxygen pressure

PCWP:

Pulmonary capillary wedge pressure

PE:

Pulmonary embolism

PLTs:

Platelets

PT:

Prothrombin time

PTT:

Partial thromboplastin time

RoS:

Reactive oxygen species

SMA:

Superior mesenteric artery

SOFA:

Sequential Organ Failure Assessment

SvO2:

Venous oxygen saturation

SVR:

Systemic vascular resistance

TB:

Total bilirubin

TBI:

Traumatic brain injury

TEG:

Thromboelastography

tPA:

Tissue plasminogen activator

TXA:

Tranexamic acid

TxA2:

Thromboxane A2

V/Q:

Ventilation/perfusion

VTE:

Venous thromboembolism

vWD:

von Willebrand disease

vWF:

von Willebrand factor

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Authors and Affiliations

  1. Micahel E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Jeremy Ward & Arsalan Amin

Authors
  1. Jeremy Ward
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  2. Arsalan Amin
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Correspondence to Jeremy Ward .

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Editors and Affiliations

  1. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Ramyar Gilani

  2. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Joseph L. Mills Sr.

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Ward, J., Amin, A. (2022). Impact of Hemorrhage, Thrombosis, and Ischemia. In: Gilani, R., Mills Sr., J.L. (eds) Vascular Complications of Surgery and Intervention. Springer, Cham. https://doi.org/10.1007/978-3-030-86713-3_2

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  • DOI: https://doi.org/10.1007/978-3-030-86713-3_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-86712-6

  • Online ISBN: 978-3-030-86713-3

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