0
Editorials: POINT/COUNTERPOINT EDITORIALS |

Rebuttal From Dr GoldhaberRebuttal From Dr Goldhaber

Samuel Z. Goldhaber, MD, FCCP
Author and Funding Information

From the Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School.

Correspondence to: Samuel Z. Goldhaber, MD, FCCP, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115; e-mail: sgoldhaber@partners.org


Financial/nonfinancial disclosures: The author has reported to CHEST the following conflicts of interest: Dr Goldhaber serves as a consultant for the following companies: Baxter, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Eisai, Medscape, Merck, Portola, and Sanofi Aventis.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(5):1145-1146. doi:10.1378/chest.11-3236
Text Size: A A A
Published online

Extract

Dr Baron1 has presented a balanced argument in the debate about repairing coagulopathy prior to central venous line insertion. There are many points on which we agree.

First, the literature and evidence favoring reversal of a laboratory coagulopathy are thin and essentially nonexistent. As shown in Dr Baron’s Table 1,1 laboratory-defined coagulation abnormalities did not predict procedural complications in the Della Vigna et al2 study from Italy or the Weigand et al4 study from Germany. In the Theodoro et al4 study from the United States, patients with end-stage renal disease have more procedural complications with central venous line insertion than other patients, but there is no way to infuse a “repair agent” to reverse renal failure. The Tercan et al4 study from Turkey showed there were more complications when inserting central venous lines in patients with an international normalized ratio (INR)>1.5, but these investigators did not provide even a shred of evidence to support the notion that reversal agents could lower the complication rate.

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543