TY - JOUR
T1 - Editor's Choice – PRINciples of optimal antithrombotiC therapy and coagulation managEment during elective fenestrated and branched EndovaScular aortic repairS (PRINCE2SS)
T2 - An International Expert Based Delphi Consensus Study
AU - D'Oria, Mario
AU - Bertoglio, Luca
AU - PRINCESS collaborative study group
AU - Bignamini, Angelo Antonio
AU - Mani, Kevin
AU - Kölbel, Tilo
AU - Oderich, Gustavo
AU - Chiesa, Roberto
AU - Lepidi, Sandro
AU - Abisi, Said
AU - Adam, Donald
AU - Antonello, Michele
AU - Austermann, Martin
AU - Beck, Adam W.
AU - Berard, Xavier
AU - Bisdas, Theodosios
AU - Böckler, Dittmar
AU - Budtz-Lilly, Jacob
AU - Cheng, Stephen W.K.
AU - Czerny, Martin
AU - DeMartino, Randall
AU - Dias, Nuno
AU - Donas, Konstantinos P.
AU - Eagleton, Matthew J.
AU - Farber, Mark A.
AU - Fargion, Aaron Thomas
AU - Ferreira, Marcelo
AU - Forbes, Thomas L.
AU - Gargiulo, Mauro
AU - Gasper, Warren J.
AU - Jakimowicz, Tomasz
AU - Haulon, Stéphan
AU - Hockley, Joseph A.
AU - Holden, Andrew
AU - Holt, Peter
AU - Kahlberg, Andrea
AU - Khashram, Manar
AU - Kotelis, Drosos
AU - Lundberg, Göran
AU - Maldonado, Thomas S.
AU - Mangialardi, Nicola
AU - Mastracci, Tara M.
AU - Maurel, Blandine
AU - Milner, Ross
AU - Modarai, Bijan
AU - Pannuccio, Giuseppe
AU - Parlani, Gianbattista
AU - Pratesi, Giovanni
AU - Pulli, Raffaele
AU - Qasabian, Raffi A.
AU - Verhagen, Hence JM
N1 - Publisher Copyright:
© 2022 European Society for Vascular Surgery
PY - 2022/6/1
Y1 - 2022/6/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85128522279&partnerID=8YFLogxK
U2 - 10.1016/j.ejvs.2022.03.002
DO - 10.1016/j.ejvs.2022.03.002
M3 - Article
C2 - 35568605
AN - SCOPUS:85128522279
SN - 1078-5884
VL - 63
SP - 838
EP - 850
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
IS - 6
ER -