PubMed · 6021549
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A J Quick. 1967. The Duke bleeding time.. https://doi.org/10.1093/ajcp%2F47.4.459
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Acetylsalicylic acid (aspirin) induces an irreversible inactivation of cyclo-oxygenase in blood platelets which lasts for the entire period that the platelets remain in the circulatory system, 7 to 10 days. In order to prevent excessive bleeding, patients presenting for surgery are asked to stop using aspirin 10 days before the procedure. Some studies have found that aspirin causes increased peri-operative blood loss, whilst other studies have found that it does not. All effect studies found in Medline (January 1966-May 2002) on surgery and bleeding complications due to aspirin were analysed. The studies available were assessed for methodological quality and the results were summarised in an evidence table. No clinically relevant bleeding complications were reported for cardiovascular, vascular and orthopaedic surgery and epidural anaesthesia. Most studies reported an increase in clinically non-relevant bleeding induced by aspirin. The literature contains too little information on cataract surgery, dermatological surgery, gynaecological and abdominal surgery, ENT and dental surgery, urological surgery, lung biopsy and endoscopic biopsy. In those types of surgery in which even a minor bleeding leads to severe complications, e.g. neurosurgery, aspirin should be withdrawn 5-10 days in advance. Also in patients with coagulation disorders, aspirin should be withdrawn prior to the operation. There is no scientific evidence for the withdrawal of aspirin in all patients, 5-10 days prior to surgery. Indeed for heart patients in particular, the continued use of aspirin is recommended.
PURPOSE: To describe a case of ocular tilt reaction caused by vasculitic lesions in the midbrain in a child with polyarteritis nodosa. DESIGN: Observational case report. METHODS: A 5-year-old girl with a chronic illness developed diplopia associated with a left head tilt, right hypertropia, torsional nystagmus, slowed vertical saccades and poor convergence. Fundoscopic examination demonstrated conjugate leftward torsion of the eyes consistent with a sustained ocular tilt reaction.Renal angiography confirmed polyarteritis nodosa and cerebral magnetic resonance imaging demonstrated mesencephalic pathology. CONCLUSIONS: Polyarteritis nodosa is a difficult condition to diagnose in a child and can cause brainstem lesions. This rare case of ocular tilt reaction of midbrain origin highlights that a sustained head tilt in a child can be due to brainstem pathology, rather than a fourth nerve palsy.