PRINciples of optimal antithrombotiC therapy and coagulation managEment during elective fenestrated and branched EndovaScular aortic repairS (PRINCE2SS): An International Expert Based Delphi Consensus Study

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D'Oria, MarioUniv Hosp Trieste ASUGI, Cardiovasc Dept, Div Vasc Surg, Str Fiume 447, I-34149 Trieste, TS, Italy. (author)

PRINciples of optimal antithrombotiC therapy and coagulation managEment during elective fenestrated and branched EndovaScular aortic repairS (PRINCE2SS) : An International Expert Based Delphi Consensus Study

Article/chapterEnglish2022

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Elsevier,2022
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LIBRIS-ID:oai:DiVA.org:uu-483909
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-483909URI
https://doi.org/10.1016/j.ejvs.2022.03.002DOI

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Language:English
Summary in:English

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Title in Web of Science: PRINciples of optimal antithrombotiC therapy and coagulation managEment during elective fenestrated and branched EndovaScular aortic repairS ((PRINCESS)-S-2): An International Expert Based Delphi Consensus Study
ObjectiveManagement of antithrombotic therapy in patients undergoing elective fenestrated branched endovascular aortic repair (F-BEVAR) is not standardised, nor are there any recommendations from current guidelines. By designing an international expert based Delphi consensus, the study aimed to create recommendations on the pre-, intra-, and post-operative management of antithrombotic therapy in patients scheduled for elective F-BEVAR in high volume centres.MethodsEight facilitators created appropriate statements regarding the study topic that were voted on, using a four point Likert scale, by a selected panel of international experts using a three round modified Delphi consensus process. Based on the experts’ responses, only those statements reaching Grade A (full agreement ≥ 75%) or B (overall agreement ≥ 80% and full disagreement < 5%) were included in the final document. The round answers’ consistency was graded using Cohen’s k, the intraclass correlation coefficient, and, in case of double re-submission, the Fleiss k.ResultsSixty-seven experts were included in the final analysis and voted the initial 43 statements related to pre- (n = 15), intra- (n = 10), and post-operative (n = 18) management of antithrombotic drugs. At the end of the process, six statements (13%) were rejected, 20 statements (44%) received a Grade B consensus, and 18 statements (40%) reached a Grade A consensus. Most statements (27; 71%) exhibited very high or high consistency grades, and 11 (29%) a fair or poor grading. The intra-operative statements mostly concentrated on threshold for and monitoring of proper heparinisation. The pre- and post-operative statements mainly focused on indications for dual antiplatelet therapy and its management, considering the possible need for cerebrospinal fluid drainage.ConclusionBased on the elevated strength and high consistency of this international expert based Delphi consensus, most of the statements might guide current clinical management of antithrombotic therapy for elective F-BEVAR. Future studies are needed to clarify the debated issues.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kirurgi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Surgery hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kardiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cardiac and Cardiovascular Systems hsv//eng
Anticoagulation
Antiplatelet
Antithrombotic
Branched
Delphi
Endovascular
Fenestrated
Pararenal
Thoraco-abdominal

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Bertoglio, LucaUniv Vita Salute San Raffaele, IRCCS San Raffaele Sci Inst, Div Vasc Surg, Milan, Italy. (author)
Bignamini, Angelo AntonioUniv Milan, Sch Specialisat Hosp Pharm, Milan, Italy. (author)
Mani, Kevin,1975-Uppsala universitet,Kärlkirurgi(Swepub:uu)kevma940 (author)
Kölbel, TiloUniv Heart & Vasc Ctr, German Aort Ctr, Dept Vasc Med, Hamburg, Germany. (author)
Oderich, GustavoUniv Texas Hlth Sci Ctr Houston, Dept Cardiothorac & Vasc Surg, McGovern Med Sch, Houston, TX 77030 USA. (author)
Chiesa, RobertoUniv Vita Salute San Raffaele, IRCCS San Raffaele Sci Inst, Div Vasc Surg, Milan, Italy. (author)
Lepidi, SandroUniv Hosp Trieste ASUGI, Cardiovasc Dept, Div Vasc Surg, Str Fiume 447, I-34149 Trieste, TS, Italy. (author)
Univ Hosp Trieste ASUGI, Cardiovasc Dept, Div Vasc Surg, Str Fiume 447, I-34149 Trieste, TS, Italy.Univ Vita Salute San Raffaele, IRCCS San Raffaele Sci Inst, Div Vasc Surg, Milan, Italy. (creator_code:org_t)

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In:European Journal of Vascular and Endovascular Surgery: Elsevier63:6, s. 838-8501078-58841532-2165

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