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PRINciples of optimal antithrombotiC therapy and coagulation managEment during elective fenestrated and branched EndovaScular aortic repairS (PRINCE2SS): An International Expert Based Delphi Consensus Study

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 recomm...

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Published in:European journal of vascular and endovascular surgery 2022, Vol.63 (6), p.838
Main 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
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container_title European journal of vascular and endovascular surgery
container_volume 63
creator 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
description 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. 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. 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. 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.
doi_str_mv 10.1016/j.ejvs.2022.03.002
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Future studies are needed to clarify the debated issues.</description><subject>Anticoagulation</subject><subject>Antiplatelet</subject><subject>Antithrombotic</subject><subject>Branched</subject><subject>Delphi</subject><subject>Endovascular</subject><subject>Fenestrated</subject><subject>Pararenal</subject><subject>Thoraco-abdominal</subject><issn>1078-5884</issn><issn>1532-2165</issn><issn>1532-2165</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNotUcuO1DAQjBBILAs_wMlHkEhw7HUmQVyGbICRVoDIiqvVsTszHmXsyHYG5if5JpxdTv1Qd1WpKstel7QoaVm9PxZ4PIeCUcYKygtK2ZPsqhSc5aysxNPU002di7q-eZ69COFIKRUlF1fZ3x8_d9-UmScMxI3EzdGcYCJgo4kH706Di6Yl8YAe5ktaa6Ic7JcJonGWnMDCvjuhjUQv3tg9wQlVNGckI1oM0UNE_fA2eLDqkIbOaneGXiUMT8D5aBTxOIPxPXmzqmk71vdvP5CtJTsb0dsHriSq-zOjj-QThARzi9N8MKR1NqANSyB9XPTlZfZshCngq__1Orv_3N23X_O771927fYux4Y2uYCNSH5UeqRNIxrQG12zaqxRjXzDB9aUdNSDUg3XDKuaMRhEsz6IkbHVuOvs3SNs-I3zMsjZJ9f8RTow8tb82krn93JZ5E3NE186__h4jknS2aCXQRm0CrXxyS6pnZEllWuS8ijXJOWapKRcpiT5P6UbmAg</recordid><startdate>2022</startdate><enddate>2022</enddate><creator>D’Oria, Mario</creator><creator>Bertoglio, Luca</creator><creator>Bignamini, Angelo Antonio</creator><creator>Mani, Kevin</creator><creator>Kölbel, Tilo</creator><creator>Oderich, Gustavo</creator><creator>Chiesa, Roberto</creator><creator>Lepidi, Sandro</creator><creator>Abisi, Said</creator><creator>Adam, Donald</creator><creator>Antonello, Michele</creator><creator>Austermann, Martin</creator><creator>Beck, Adam W.</creator><creator>Berard, Xavier</creator><creator>Bisdas, Theodosios</creator><creator>Böckler, Dittmar</creator><creator>Budtz-Lilly, Jacob</creator><creator>Cheng, Stephen W.K.</creator><creator>Czerny, Martin</creator><creator>DeMartino, Randall</creator><creator>Dias, Nuno</creator><creator>Donas, Konstantinos P.</creator><creator>Eagleton, Matthew J.</creator><creator>Farber, Mark A.</creator><creator>Fargion, Aaron Thomas</creator><creator>Ferreira, Marcelo</creator><creator>Forbes, Thomas L.</creator><creator>Gargiulo, Mauro</creator><creator>Gasper, Warren J.</creator><creator>Jakimowicz, Tomasz</creator><creator>Haulon, Stéphan</creator><creator>Hockley, Joseph A.</creator><creator>Holden, Andrew</creator><creator>Holt, Peter</creator><creator>Kahlberg, Andrea</creator><creator>Khashram, Manar</creator><creator>Kotelis, Drosos</creator><creator>Lundberg, Göran</creator><creator>Maldonado, Thomas S.</creator><creator>Mangialardi, Nicola</creator><creator>Mastracci, Tara M.</creator><creator>Maurel, Blandine</creator><creator>Milner, Ross</creator><creator>Modarai, Bijan</creator><creator>Pannuccio, Giuseppe</creator><creator>Parlani, Gianbattista</creator><creator>Pratesi, Giovanni</creator><creator>Pulli, Raffaele</creator><creator>Qasabian, Raffi A.</creator><creator>Reijnen, Michel M.P. 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J.</au><au>Resh, Timothy</au><au>Riambau, Vincente</au><au>Settembre, Nicla</au><au>Schanzer, Andres</au><au>Schmidt, Andrej</au><au>Schneider, Darren</au><au>Schurink, Geert Willem H.</au><au>Silingardi, Roberto</au><au>Sobocinski, Jonathan</au><au>Soler, Raphael</au><au>Sweet, Matthew P.</au><au>Leong Tan, Glenn Wei</au><au>Tenorio, Emanuel R.</au><au>Tielliu, Ignace F.J.</au><au>Timaran, Carlos H.</au><au>Tshomba, Yamume</au><au>Tsilimparis, Nikolaos</au><au>Van den Eynde, Wouter</au><au>Vasudevan, Thodur</au><au>Veraldi, Gian Franco</au><au>Verhagen, Hence JM</au><au>Verhoeven, Eric</au><au>Verzini, Fabio</au><au>Wanhainen, Anders</au><au>Zimmermann, Alexander</au><aucorp>SS collaborative study group</aucorp><aucorp>PRINCE</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>PRINciples of optimal antithrombotiC therapy and coagulation managEment during elective fenestrated and branched EndovaScular aortic repairS (PRINCE2SS): An International Expert Based Delphi Consensus Study</atitle><jtitle>European journal of vascular and endovascular surgery</jtitle><date>2022</date><risdate>2022</risdate><volume>63</volume><issue>6</issue><spage>838</spage><pages>838-</pages><issn>1078-5884</issn><issn>1532-2165</issn><eissn>1532-2165</eissn><abstract>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. 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 &lt; 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. 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. 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.</abstract><pub>Elsevier B.V</pub><doi>10.1016/j.ejvs.2022.03.002</doi><orcidid>https://orcid.org/0000-0002-9962-0204</orcidid><orcidid>https://orcid.org/0000-0002-3216-2835</orcidid></addata></record>
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identifier ISSN: 1078-5884
ispartof European journal of vascular and endovascular surgery, 2022, Vol.63 (6), p.838
issn 1078-5884
1532-2165
1532-2165
language eng
recordid cdi_swepub_primary_oai_DiVA_org_uu_483909
source ScienceDirect Journals
subjects Anticoagulation
Antiplatelet
Antithrombotic
Branched
Delphi
Endovascular
Fenestrated
Pararenal
Thoraco-abdominal
title PRINciples of optimal antithrombotiC therapy and coagulation managEment during elective fenestrated and branched EndovaScular aortic repairS (PRINCE2SS): An International Expert Based Delphi Consensus Study
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