By Atul Gawande

ISBN-10: 0312421702

ISBN-13: 9780312421700

In gripping money owed of precise instances, health practitioner Atul Gawande explores the facility and the bounds of medication, providing an unflinching view from the scalpel’s aspect. problems lays naked a technology no longer in its idealized shape yet because it truly is—uncertain, confusing, and profoundly human.

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Additional resources for Complications: A Surgeon's Notes on an Imperfect Science

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However, the intensity of treatment varies according to the type of mechanical prosthesis implanted. First generation mechanical valves, namely the Starr-Edwards caged ball valve and Bjork-Shiley standard valves, have a high thromboembolic risk; single tilting disc valves have an intermediate thromboembolic risk; and the newer (second and third generation) bileaflet valves have low thromboembolic risks. In patients with a bioprosthesis in sinus rhythm, antithrombotic therapy with an antiplatelet drug may suffice, whereas patients with homografts in sinus rhythm may not need any antithrombotic therapy.

Thrombolytic treatment should be given within six hours of the onset of symptoms and electrocardiographic changes for patients to derive full benefit. Patients with persisiting pain and ST segment elevation may still benefit from thrombolysis up to 12 hours from the onset of symptoms. Beyond that, few patients will benefit, and there is no clear evidence of whether this benefit outweighs the risk of haemorrhage. Thrombolytic treatment should be offered to all eligible patients presenting with an acute myocardial infarction regardless of age, sex, or site of infarct.

Mitral valve prolapse per se does not require anticoagulant cover, although sometimes aspirin is recommended because of the association with cerebrovascular events. Percutaneous balloon valvuloplasty In patients with mitral stenosis, the presence or absence of left atrial thrombus is first confirmed by transoesophageal echocardiography. In the presence of thrombus, valvuloplasty is deferred and anticoagulant treatment started for two months before the procedure, with a target INR range of 2-3. In the absence of atrial thrombus but in the presence of risk factors— namely, previous thromboembolism, enlarged left atrium, spontaneous echocontrast, or atrial fibrillation—oral anticoagulant treatment should be started a month before the procedure.

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Complications: A Surgeon's Notes on an Imperfect Science by Atul Gawande


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