Editor's Choice – PRINciples of optimal antithrombotiC therapy and coagulation managEment during elective fenestrated and branched EndovaScular aortic repairS (PRINCE2SS): An International Expert Based Delphi Consensus Study. (June 2022)

• Record Type: Journal Article
• Authors: D'Oria, Mario; Bertoglio, Luca; Bignamini, Angelo Antonio; Mani, Kevin; Kölbel, Tilo; Oderich, Gustavo; Chiesa, Roberto; Lepidi, Sandro; Abisi, Said; Adam, Donald; Antonello, Michele; Austermann, Martin; Beck, Adam W.; Berard, Xavier; Bisdas, Theodosios; Böckler, Dittmar; Budtz-Lilly, Jacob; Cheng, Stephen W.K.; Czerny, Martin; DeMartino, Randall; Dias, Nuno; Donas, Konstantinos P.; Eagleton, Matthew J.; Farber, Mark A.; Fargion, Aaron Thomas; Ferreira, Marcelo; Forbes, Thomas L.; Gargiulo, Mauro; Gasper, Warren J.; Jakimowicz, Tomasz; Haulon, Stéphan; Hockley, Joseph A.; Holden, Andrew; Holt, Peter; Kahlberg, Andrea; Khashram, Manar; Kotelis, Drosos; Lundberg, Göran; Maldonado, Thomas S.; Mangialardi, Nicola; Mastracci, Tara M.; Maurel, Blandine; Milner, Ross; Modarai, Bijan; Pannuccio, Giuseppe; Parlani, Gianbattista; Pratesi, Giovanni; Pulli, Raffaele; Qasabian, Raffi A.; Reijnen, Michel M.P. J.; Resh, Timothy; Riambau, Vincente; Settembre, Nicla; Schanzer, Andres; Schmidt, Andrej; Schneider, Darren; Schurink, Geert Willem H.; Silingardi, Roberto; Sobocinski, Jonathan; Soler, Raphael; Sweet, Matthew P.; Leong Tan, Glenn Wei; Tenorio, Emanuel R.; Tielliu, Ignace F.J.; Timaran, Carlos H.; Tshomba, Yamume; Tsilimparis, Nikolaos; Van den Eynde, Wouter; Vasudevan, Thodur; Veraldi, Gian Franco; Verhagen, Hence JM.; Verhoeven, Eric; Verzini, Fabio; Wanhainen, Anders; Zimmermann, Alexander;
• Is Part Of: European journal of vascular and endovascular surgery. Volume 63:Number 6(2022)
• Page Start: 838
• Page End: 850
• Publication Date: 2022-06
• Subjects: Anticoagulation -- Antiplatelet -- Antithrombotic -- Branched -- Delphi -- Endovascular -- Fenestrated -- Pararenal -- Thoraco-abdominal; Blood-vessels -- Endoscopic surgery -- Periodicals; Blood-vessels -- Surgery -- Periodicals; Vascular Surgical Procedures -- Periodicals; Vascular Surgical Procedures -- methods -- Periodicals; Vaisseaux sanguins -- Chirurgie -- Périodiques; Vaisseaux sanguins -- Chirurgie endoscopique -- Périodiques; Blood-vessels -- Endoscopic surgery; Blood-vessels -- Surgery; Endoscopy; Electronic journals; Periodicals; Electronic journals; 617.413005
• DOI: 10.1016/j.ejvs.2022.03.002
• Languages: English
• ISSNs: 1078-5884

Abstract

Abstract : Objective: Management 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. Methods: Eight 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. Results: Sixty-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. Conclusion: Based 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.