PubMed · 13611450
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W B MANTER. 1958. Long-term anticoagulation therapy.. https://pubmed.ncbi.nlm.nih.gov/13611450/
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We report on a patient who suffered sudden diplopia after heart surgery. Computed tomography of the orbita revealed a subperiosteal hemorrhage as the underlying cause. We discuss possible mechanisms that may have led to the bleeding as well as therapeutic options.
BACKGROUND: A clinical dilemma exists in the management of patients undergoing radical prostatectomy (RP) whereby measures taken to reduce the risk of thrombotic events may adversely affect efforts to limit blood loss. No consensus exists in the literature on the ideal management of thromboprophylaxis in these patients. Our aim is to examine and compare current thromboprophylactic policy and practice between the centres involved in performing RP. METHODS: A questionnaire was forwarded to all urology residency programmes in Ireland, the United Kingdom, and the United States, regarding their current practice with respect to thromboprophylaxis in RP. Completed questionnaire were returned by fax and the data entered into a computer database. RESULTS: An overall response rate of 60% was achieved. The questionnaires demonstrated a significant difference in clinical practice between Urologists in the United States and the United Kingdom. Just 24% of American Urologists use pharmacological thromboprophylaxis in contrast to 100% of British Urologists. There was no difference in the use of non-pharmacological thromboprophylaxis. Pharmacological thromboprophylaxis is mainly administered by units, mostly in the United Kingdom, doing fewer radical prostatectomies. CONCLUSIONS: While there have been studies advocating the use of pharmacological thromboprophylaxis in patients undergoing major pelvic surgery, there is no consensus on it is use in urological practice. This study has demonstrated significant differences in the management of thromboprophylaxis between the USA and the UK/Ireland. Units performing the largest number of radical prostatectomies, mostly in the USA, do not use pharmacological thromboprophylaxis and most do not use compression boots.
Implementation of the numerous lifestyle and medical management options for secondary prevention of cardiovascular disease remains a daunting goal for primary care physicians and cardiologists alike. Despite the existence of expert consensus guidelines on cardiovascular prevention by the American College of Cardiology and the American Heart Association, therapies known to improve patient care and decrease morbidity and mortality remain underutilized. This review attempts to simplify cardiovascular risk reduction by summarizing key clinical trials in an "ABC" format. We believe that if health care providers and patients use such a format, important lifestyle and pharmacologic options will more likely be addressed.