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  • br MODEL br Antithrombotics and intraoperative transfusion

    2020-08-14


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    Antithrombotics and intraoperative transfusion 3
    Table 1 Preoperative medications reviewed during thecomprehensive geriatric Gly Pro pNA assessment.
    Therapeutic Category Medications
    Potentially inappropriate medication Delirium risk
    Anticholinergics
    First-generation Chlorpheniramine, antihistamines Hydroxyzine Antispasmodics Chlordiazepoxide, Scopolamine Antipsychotics Quetiapine Benzodiazepines
    Short- and Alprazolam, Triazolam intermediate -acting
    Long-acting Clonazepam, Diazepam Chlorpromazine
    Corticosteroids Prednisolone H2-receptor Cimetidine, Ranitidine antagonists
    Sedative hypnotics Zolpidem Fall risk
    Anticonvulsants Carbamazepine, Valproate Antipsychotics Chlorpromazine, Quetiapine Benzodiazepines
    Short- and Alprazolam, Triazolam intermediate-acting
    Long-acting Diazepam Nonbenzodiazepine Zolpidem benzodiazepine
    receptor agonist
    hypnotics
    Tricyclic Amitriptyline, Imipramine antidepressants
    Selective serotonin Duloxetine, Paroxetine reuptake inhibitors
    Opioids Fentanyl, Morphine Preoperative discontinuation-requiring medications Bleeding risk
    Anticoagulant agents
    Short-acting Dabigatran, Dalteparin,
    Rivaroxaban Long-acting Mesoglycan, Sulodexide,
    Warfarin Antiplatelet agents
    Short-acting Beraprost, Cilostazol,
    Indobufen, Sarpogrelate Long-acting Aspirin, Clopidogrel, Triflusal NSAID
    Short-acting Aceclofenac, Dexibuprofen,
    Ibuprofen, Loxoprofen,
    Mefenamic acid, Talniflumate Long-acting Celecoxib, Meloxicam,
    Naproxen Peripheral vasodilator Ibudilast, Kallidinogenase,
    Limaprost, Nafronyl oxalate,
    Nicergoline Streptokinase/streptodornase Others
    Herbal medications Angelica extract, Artemisia
    asiatica extract, Avocado-soya
    titrated extract, Cimicifugae
    Table 1 (continued )
    Therapeutic Category Medications
    rhizoma extract, Clematidis
    Radix/Trichosanthes root/
    Prunella spike extract, Coptis
    rhizome extract, Ginkgo biloba
    leaf extract, Hedera helicis
    folia extract, Hypericum
    extract, Milk-thistle extract,
    Motilitone, Pelargonium
    sidoides extract, Petasites
    hybridus folium extract,
    Phellinus linteus extract,
    Vaccinium myrtillus extract,
    Vitis vinifera extract, Zea mays
    L. titrated extract
    Hormone-related Anastrozole, Letrozole,
    agents Raloxifene, Tibolone
    Metformin
    PIMs were evaluated based on the 2015 Beers criteria.19 Among the PIMs, those associated with a high risk of delirium or a high risk of falls were included in the analysis. Levosulpiride (a prokinetic agent available in Korea) was also included; although it is not listed in the Beers criteria, it is known to frequently cause drug-induced movement disorders20 and safer alternatives are available (Table 1).21
    The high delirium-risk medications, which may induce adverse events such as delirium, confusion, or hallucina-tion, included anticholinergics, antipsychotics, benzodiaz-epines, chlorpromazine, corticosteroids, H2-receptor antagonists, and sedative hypnotics (Table 1).19 Anticon-
    vulsants, antipsychotics, benzodiazepines, non-benzodiazepines (benzodiazepine receptor agonist hypnotics), tricyclic antidepressants, selective serotonin reuptake inhibitors, and opioids were classified as high fall-risk medications (Table 1).19
    The number of medications was calculated based on the number of active ingredients. Multi-component digestives, antacids, multivitamins, or herbal extracts were considered a single ingredient because they possess a single efficacy. Topical drugs and eye drops were not included because they are uncommonly associated with systemic adverse events. Polypharmacy and excessive polypharmacy was defined as regularly taking five or more medications and ten or more medications, respectively.22e24 Post-operative delirium was diagnosed by psychiatric consultation using DSM-V criteria.25
    2.3. Outcome measures
    The primary outcome was intraoperative transfusion requirement.
    2.4. Statistical analyses
    The chi-square test was used to compare categorical vari-ables. Multivariate logistic regression analysis was used to identify independent risk factors for intraoperative
    Please cite this article as: Jeong YM et al., Association between preoperative use of antithrombotic medications and intraoperative transfusion in older patients undergoing cancer surgery, Asian Journal of Surgery, https://doi.org/10.1016/j.asjsur.2019.06.005
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    Table 2 Factors associated with intraoperative transfusion.