TY  - JOUR
A1  - Lock, J. F.
A1  - Ungeheuer, L.
A1  - Borst, P.
A1  - Swol, J.
A1  - Löb, S.
A1  - Brede, E. M.
A1  - Röder, D.
A1  - Lengenfelder, B.
A1  - Sauer, K.
A1  - Gremer, C. - T.
T1  - Markedly increased risk of postoperative bleeding complications during perioperative bridging anticoagulation in general and visceral surgery
JF  - Perioperative Medicine
N2  - Background 
Increasing numbers of patients receiving oral anticoagulants are undergoing elective surgery. Low molecular weight heparin (LMWH) is frequently applied as bridging therapy during perioperative interruption of anticoagulation. The aim of this study was to explore the postoperative bleeding risk of patients receiving surgery under bridging anticoagulation. 

Methods 
We performed a monocentric retrospective two-arm matched cohort study. Patients that received perioperative bridging anticoagulation were compared to a matched control group with identical surgical procedure, age, and sex. Emergency and vascular operations were excluded. The primary endpoint was the incidence of major postoperative bleeding. Secondary endpoints were minor postoperative bleeding, thromboembolic events, length of stay, and in-hospital mortality. Multivariate analysis explored risk factors of major postoperative bleeding. 

Results 
A total of 263 patients in each study arm were analyzed. The patient cohort included the entire field of general and visceral surgery including a large proportion of major oncological resections. Bridging anticoagulation increased the postoperative incidence of major bleeding events (8% vs. 1%; p < 0.001) as well as minor bleeding events (14% vs. 5%; p < 0.001). Thromboembolic events were equally rare in both groups (1% vs. 2%; p = 0.45). No effect on mortality was observed (1.5% vs. 1.9%). Independent risk factors of major postoperative bleeding were full-therapeutic dose of LMWH, renal insufficiency, and the procedure-specific bleeding risk. 

Conclusion 
Perioperative bridging anticoagulation, especially full-therapeutic dose LMWH, markedly increases the risk of postoperative bleeding complications in general and visceral surgery. Surgeons should carefully consider the practice of routine bridging.
KW  - low molecular heparin
KW  - atrial fibrillation
KW  - postoperative bleeding
KW  - thromboembolism
KW  - anticoagulation
KW  - bridging
KW  - antithrombotic therapy
KW  - warfarin interruption
KW  - oral anticoagulants
KW  - management
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-230690
VL  - 9
ER  - 
TY  - JOUR
A1  - Zhou, Xiang
A1  - Rasche, Leo
A1  - Kortüm, K. Martin
A1  - Danhof, Sophia
A1  - Hudecek, Michael
A1  - Einsele, Hermann
T1  - Toxicities of Chimeric Antigen Receptor T Cell Therapy in Multiple Myeloma: An Overview of Experience From Clinical Trials, Pathophysiology, and Management Strategies
JF  - Frontiers in Immunology
N2  - In the last few years, monoclonal antibodies (mAbs) such as elotuzumab and daratutumab have brought the treatment of multiple myeloma (MM) into the new era of immunotherapy. More recently, chimeric antigen receptor (CAR) modified T cell, a novel cellular immunotherapy, has been developed for treatment of relapsed/refractory (RR) MM, and early phase clinical trials have shown promising efficacy of CAR T cell therapy. Many patients with end stage RRMM regard CAR T cell therapy as their “last chance” and a “hope of cure”. However, severe adverse events (AEs) and even toxic death related to CAR T cell therapy have been observed. The management of AEs related to CAR T cell therapy represents a new challenge, as the pathophysiology is not fully understood and there is still no well-established standard of management. With regard to CAR T cell associated toxicities in MM, in this review, we will provide an overview of experience from clinical trials, pathophysiology, and management strategies.
KW  - CAR T cell
KW  - clinical trial
KW  - multiple myeloma
KW  - toxicity
KW  - pathophysiology
KW  - management
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-219911
SN  - 1664-3224
VL  - 11
ER  -