ABSTRACT
As many as 25% of all patients undergoing invasive pulmonary procedures are receiving at least one antiplatelet or anticoagulant agent. For those undergoing elective procedures, the decision-making process is uncomplicated and the procedure may be postponed until the antiplatelet or anticoagulant agent may be safely held. However, many invasive pulmonary procedures are semi-elective or emergent in nature in which case a risk-benefit calculation and discussion occur between the provider and patient or surrogate decision-maker. Therefore, it is critical for providers to have an awareness of the risk of bleeding complications with different pulmonary procedures on various antiplatelet and anticoagulant agents. This systematic review summarizes the bleeding complications associated with different pulmonary procedures in patients on various antiplatelet or anticoagulant agents in the literature and reveals a paucity of high-quality evidence across a wide spectrum of pulmonary procedures and antiplatelet or anticoagulant agents. The results of this review can help inform providers of the bleeding risk in these patients to aid in the shared decision-making process and risk vs benefit discussion.
Subject(s)
Anticoagulants/adverse effects , Diagnostic Techniques and Procedures/adverse effects , Hemorrhage/etiology , Lung Diseases/surgery , Platelet Aggregation Inhibitors/adverse effects , Pleural Diseases/surgery , Adult , Anticoagulants/therapeutic use , Awareness , Bronchoscopy/adverse effects , Clinical Decision-Making , Hemorrhage/physiopathology , Humans , Lung Diseases/diagnostic imaging , Lung Diseases/pathology , Male , Platelet Aggregation Inhibitors/therapeutic use , Pleural Diseases/diagnostic imaging , Pleural Diseases/pathology , Postoperative Hemorrhage/chemically induced , Postoperative Hemorrhage/prevention & control , Thoracentesis/adverse effects , Tracheostomy/adverse effects , Tracheostomy/trendsABSTRACT
Evidence-based medicine is an increasingly important concept in continuing medical education and medical school curricula. To cope with the rapid evolution of medicine, physicians need to remain abreast of the many new therapies and diagnostic tools that affect their practices. Unfortunately, along with the many changes there is also a surplus of relevant written material. Physicians are unable to read all of this information due to time constraints. Instead, they must choose information efficiently. Tools are needed to facilitate this process. Over a two-month period, a demonstration model was carried out at the Ottawa General Hospital to encourage faculty, residents, and students to incorporate evidence-based medicine into their daily practice. A study was conducted to investigate the level and type of information required by these individuals in a clinical setting. A literature searching service was introduced six months after the formal introduction of evidence-based medicine in the Department of Medicine. The logistics of and recommendations for providing such a service are presented in this paper.
