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PubMed2006

A systematic review of postcoital bleeding and risk of cervical cancer.

BACKGROUND: Postcoital bleeding may be a symptom of cervical cancer. Guidance to aid a GP in determining whom to investigate or refer exists but recommendations vary. Women need to be involved in decisions about their care and this involves communicating risk and an exploration of the implications of the risk. Risk estimates of postcoital bleeding for cervical cancer are not available. AIM: To provide an estimate of the positive predictive values of postcoital bleeding for cervical cancer to aid decision making in primary care about whom to investigate for cervical cancer. DESIGN OF STUDY: A systematic review. SETTING: Community, primary and secondary care. METHOD: Six electronic databases were searched from the beginning of each of their time frames. Inclusion criteria were that the study was published in English and reported or contained enough data to calculate the prevalence or incidence of postcoital bleeding within the study population. No studies were excluded on issues of methodological quality. RESULTS: The search strategy identified 910 unique articles. The point prevalence of postcoital bleeding in the community ranged from 0.7 to 9% among women. One study reported an annual cumulative incidence of 6% of menstruating women. The prevalence of postcoital bleeding in women with cervical cancer ranged from 0.7 to 39%. Calculation of risk that a woman in the community developing postcoital bleeding has cervical cancer ranges from 1 in 44,000 at age 20-24 years to 1 in 2 400 aged 45-54 years. There was no information allowing the direct calculation of risk in women presenting to primary care. CONCLUSION: The evidence base for management strategies of postcoital bleeding and calculations of risk for cervical cancer in women with postcoital bleeding are poor. Recommendations for clinical practice are made on the current evidence.

Adult↗
PubMed1990

Circadian periodicity of the time of onset of acute lower gastrointestinal bleeding.

We investigated the chronobiological parameters of acute gastrointestinal (GI) bleeding in 51 patients able to time-specify the onset of bleeding within 30 min of occurrence. Bleeding was determined to be either from the upper or lower GI tract. The upper GI bleeding group consisted of 32 patients (22 male, 10 female) who bled from peptic ulcer disease (16), Mallory-Weiss tear (4), gastritis (3), esophageal varices (3), gastric neoplasm (2), Dieulafoy's lesion (1), and unknown (3). The lower GI bleeding group consisted of 19 patients (9 male, 10 female) who bled from diverticulosis coli (5), hemorrhoids (2), arteriovenous malformations (2), colonic polyps (2), cecal ulcer (1), antibiotic-associated colitis (1), and unknown (6). Rhythmicity was evaluated by inferential statistics. The time of onset of lower GI bleeding (34 episodes) displayed significant circadian periodicity (p = 0.014) with its peak at 1100 h. Single cosinor analysis revealed: MESOR-1.42 (95% CI = 0.86- 1.97); amplitude = 1.22 (0.44-1.99); phase angle = -165.12 (-201.66 -128.58). Upper GI bleeding (42 episodes) displayed no circadian periodicity (p = 0.46). When both upper and lower GI bleeding were evaluated together, no circadian rhythm was evident (p = 0.07). We conclude that there is a circadian periodicity in the time of onset of only acute lower GI bleeding with its peak at 1100 h. The pacemaker of this periodicity remains unknown.

Acute Disease↗
PubMed1990

[Diagnosis of acute gastrointestinal bleeding using scintigraphy with 99mTc-labeled red blood cells].

To evaluate the usefulness and clinical significance of scintigraphy using 99mTc-RBC in urgent abdominal bleeding, we performed abdominal bleeding scintigraphy in 20 patients with melena. These patients were admitted to the critical care center. Nine of 20 patients showed positive images with bleeding scintigraphy. Five of 20 patients were referred because of small intestinal bleeding. Four of these 5 patients revealed positive images. Seven of 9 patients who had positive image and four of 11 patients who were negative had open-surgery performed. While angiography was done in 8 patients, only 3 of the 8 patients were proven to have bleeding. These 3 patients also revealed positive images by bleeding scintigraphy. This technique facilitates the screening of bleeding in the ileum, where endoscopic techniques may prove difficult to detect the site of bleeding. We emphasize that abdominal scintigraphy should be performed on patients with G.I. bleeding since this is a more accurate examination than angiography.

Adolescent↗
PubMed1978

Template bleeding time and clinical hemorrhage in myeloproliferative disease.

In 32 patients with myeloproliferative disorders (MPD), correlations were made among clinical observations of hemorrhagic tendency, template Ivy bleeding time, and platelet aggregation studies. Bleeding time was commonly prolonged, particularly in myelofibrosis. In two cases, this prolongation appeared to reflect a defect in platelet function, which resulted in clinical bleeding. Prolongation of bleeding time did not correlate with degree of thrombocytosis. Two patients with thrombocytosis had serious clinical bleeding at a time when bleeding time was normal. Of the patients, 35% had abnormal findings from aggregation studies, but there was no correlation between aggregation studies and prolongation of bleeding time or clinical hemorrhage. We conclude that bleeding in MPD arises either from a defect in platelet function, which is reflected in a prolonged bleeding time, or from thrombocytosis.

Blood Cell Count↗
PubMed1983

Etiology and prevalence of severe persistent upper gastrointestinal bleeding.

A prospective study was undertaken to establish the etiology and prevalence of episodes of upper gastrointestinal bleeding which are severe and persistent. During a 12-mo study period, 175 patients had one or more episodes of upper gastrointestinal bleeding. Thirty-six (20.6%) of the 175 patients had bleeding that was classified as severe and persistent. Upper gastrointestinal bleeding that occurred more than 24 h after admission was more apt to persist than bleeding that was a presenting complaint (32.4% vs. 12.8%, p less than 0.001). Bleeding due to esophageal varices was the single most common cause. Although the majority of upper gastrointestinal bleeding episodes are self-limited, about one-fifth are not. Studies to evaluate the many new therapeutic modalities for upper gastrointestinal bleeding should attempt to exclude patients whose bleeding will abate spontaneously.

Adult↗
PubMed1982

An evaluation of 99mTc-labeled red blood cell scintigraphy for the detection and localization of gastrointestinal bleeding sites.

99mTechnetium-labeled red blood cell scintigraphy was performed upon 39 patients with clinical evidence for acute lower gastrointestinal bleeding from an unknown source. Seventeen of 39 patients (44%) had a scan became positive 6 or more h after injection, consistent with intermittent bleeding, in 8 of 17 patients (47%). In the 11 patients in whom the bleeding site was definitely identified by arteriography, surgery, or colonoscopy, scintigraphy correctly localized the bleeding site in 10 of 11 patients (91%). Four of 11 patients (36%) had an active bleeding site identified by arteriography. Ten of 17 patients (58%) with a positive scan required either gelfoam embolization (4 patients) or surgery (6 patients) to control the bleeding, whereas only 1 of 22 patients (5%) required surgery when the scan was negative. Six deaths occurred in the scan-positive patients compared with no deaths in the scan-negative patients. None of the 8 patients who had arteriography and no active bleeding site by scintigraphy had arteriographically demonstrable active bleeding. Scintigraphy provides a reliable noninvasive test to screen patients in whom arteriography is being considered to localize active bleeding sites. If the arteriogram is negative, the scintigraphic findings alone may guide the surgical or arteriographic intervention. In addition, scintigraphy identifies two patient populations which have considerably different morbidity and mortality.

Adult↗
PubMed1995

Trends in hospitalizations for gastrointestinal bleeding among patients with rheumatoid arthritis in Rochester, Minnesota, 1950-1991.

OBJECTIVE: Estimates of the incidence of significant gastrointestinal (GI) bleeding among patients with rheumatoid arthritis (RA) vary and population based estimates of this event have been unavailable. We examine the incidence of this event in a well defined cohort of patients with RA. METHODS: The study cohort consisted of patients with RA incident in Rochester, MN, between 1950 and 1974 and reported by Linos, et al (Am J Epidemiol 1980;111:87-98). These patients were followed for up to 40.5 yrs, and retrospective analysis of hospitalization for GI bleeding was performed. RESULTS: A total of 58 patients with RA were hospitalized for GI bleeding, including 46 patients who had a first episode of bleeding after the diagnosis of RA was made, for a first episode incidence rate of 0.52% per person-year of followup. These 46 patients experienced 72 hospitalizations for GI bleeding. Patients diagnosed with RA after 1963 and patients older than 53 yrs of age at the time of diagnosis of RA had a higher incidence of hospitalization for GI bleeding. Overall survival among all patients with RA was slightly less than expected in the general population, while survival in patients hospitalized for GI bleeding was significantly lower than that of nonhospitalized patients. In a nested case-control study, nonsteroidal antiinflammatory drug use was found to be a significant risk factor for hospitalization for GI bleeding (odds ratio 3.25:1 compared with nonusers). CONCLUSION: Estimates of the overall incidence of hospitalization for GI bleeding in this population based cohort of patients with RA may be somewhat lower than some reported for referral populations, but an upward trend in recent years is noted.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1995

Diverticular bleeding: are nonsteroidal anti-inflammatory drugs risk factors for hemorrhage and can colonoscopy predict outcome for patients?

OBJECTIVE: This retrospective study was performed to determine if certain endoscopic features of a bleeding diverticulum predict outcome for patients and to assess the role of nonsteroidal anti-inflammatory drugs (NSAID) as a risk factor for hemorrhage. METHODS: Over a 28-month period, colonoscopy was performed on 13 patients (mean, age 74 yr) in whom a specific diverticulum was unequivocally identified as a cause for bleeding. Endoscopic features of the affected diverticulum were recorded and correlated with outcome for patients. Drug histories were reviewed to document use of NSAID before bleeding. RESULTS: Three patients had a visible vessel located inside a diverticulum, and one subject had an adherent clot with active bleeding. These colonoscopic findings were classified as stigmata of significant hemorrhage (SSH). In the remaining nine patients the diverticula were ulcerated. This endoscopic finding was classified as stigmata of insignificant hemorrhage (SIH). Compared with patients with SIH, individuals with SSH experienced a greater number of bleeding episodes (3.5 vs 1.3, p = 0.006), had a lower initial hemoglobin concentration (8.2 vs 12.5 gm%, p = 0.009), and required more transfusions (3.3 vs 0, p = 0.04) and invasive treatments (75% with SSH were managed by endoscopy or surgery vs 0% for those with SIH, p = 0.01). Ninety-two percent of the patients were taking NSAID (100% with SSH and 89% with SIH). Seventy-five percent of subjects with SSH compared with 0% of patients with SIH had a combined exposure to NSAID and ASA (p = 0.01). CONCLUSIONS: Presence of a visible vessel or an adherent clot with active bleeding is a reliable marker for significant hemorrhage. Ulcerated diverticula are the cause of trivial bleeding, and presence of this endoscopic finding accurately predicts a benign clinical course. NSAID may be an important risk factor for diverticular bleeding. It is possible that combined exposure to NSAID and ASA results in more severe bleeding compared with use of NSAID alone.

Aged↗
PubMed1995

Usefulness of patient interview in bleeding disorders.

BACKGROUND: It is not known which questions in a medical interview are most informative for diagnosing mild bleeding disorders, and what the value is of the entire interview in screening for hemostatic disorders. METHODS: A questionnaire was sent to 222 patients with a proven bleeding disorder, to 134 patients suspected of a bleeding disorder but whose hemostasis proved normal, and to 341 healthy volunteers. A first comparison, between patients with a bleeding disorder and patients with bleeding complaints whose hemostasis proved normal, mimics the situation in a department of hematology where patients are referred because of complaints. The second comparison, between patients with a proven bleeding disorder and healthy volunteers, may serve as a model for the situation where the interview is used as a screening tool to detect patients with a bleeding disorder in a population where there is no prior suspicion, eg, before surgical intervention. For each question we calculated a univariate odds ratio, multivariate odds ratios, and a positive and negative likelihood ratio. With a receiver operating characteristic curve analysis we evaluated the value of a simple vs an elaborate interview. RESULTS: Ninety-two percent of the questionnaires were returned. For both comparisons the most informative questions were questions about bleeding disorders in the family and traumatic events, with the exception of delivery. Noninformative questions were frequent gumbleeds and blood in the urine. A receiver operating characteristic curve analysis revealed that a simple interview has a high discriminating power in a screening situation, whereas in a referred situation even an elaborate interview has a low performance. CONCLUSIONS: A simple interview is useful as a screening tool for the dentist or surgeon. In a specialized hematology center with referred patients, however, the interview is of little value in identifying patients with a bleeding disorder.

Blood Coagulation Disorders↗
PubMed1994

[Bleeding and complications related to hemorrhage during transsphenoidal removal of pituitary tumor].

450 cases who undertook the transsphenoidal removal of pituitary tumors from 1982 to 1992 were reviewed. The bleeding during operation and the complications related to the bleeding were reported in 19 cases. The intercavernous sinuses were traumatized during operation in 9 cases. The possibility of abnormal dural arteries existed in 3 cases. The bleeding happened in the course of dissociation of nasal septum in 2 cases. The cause of bleeding in 3 cases were unclear. There was no much bleeding or bleeding record during operation, but postoperative bleeding complications appeared in other 2 cases. Heavy bleeding came from nose repeatedly in 2 cases, one of which was confirmed as pseudoaneurysm. The postoperative subarachnoid haemorrhage in 2 cases, one blindness and one paralysis of abductor nerve happened. The causes of bleeding and complication were discussed.

Adenoma, Acidophil↗
PubMed1994

The effect of Parodontax dentifrice on gingival bleeding.

In this study on twenty-two adult subjects, the effectiveness of Parodontax dentifrice was compared to a control dentifrice on gingival bleeding parameters. The periodontal probe bleeding index of Ainamo and Bay, modified to evaluate slight and moderate bleeding, was used to evaluate efficacy. There was no significant difference between the two groups at baseline. After four weeks, Parodontax dentifrice produced a significant decrease (p < 0.01) in bleeding on probing compared both to baseline (p < 0.01) and to the control group (p < 0.05), and an increase (p < 0.05) in the number of sites with no bleeding compared to the control dentifrice. The control had no significant decrease in bleeding on probing from baseline to four weeks. The number of bleeding sites were significantly reduced in the Parodontax dentifrice group from baseline to week four (p < 0.001), and there was no significant statistical change in the number of bleeding sites for the control group. The Parodontax dentifrice group bleeding sites at four weeks were significantly lower than the control group (p < 0.05).

Adult↗
PubMed1993

Prior esophageal variceal bleeding does not adversely affect survival after orthotopic liver transplantation.

Prior variceal bleeding may adversely affect the prognosis of orthotopic liver transplantation. We studied this question by evaluating all 175 adult patients undergoing orthotopic liver transplantation at our institution to determine risk factors associated with mortality after transplantation. Seventy patients demonstrated prior variceal bleeding, and of those, 32 had a course of sclerotherapy. Thirteen also had portal systemic shunts. Compared with the 105 transplant patients who had no prior bleeding, patients who bled were more likely to have parenchymal liver disease (74% vs. 50%), equally likely to have cholestatic liver disease (19%), and less likely to have malignancy (6% vs. 19%) or fulminant liver failure (1% vs. 12%). Bleeding patients also were more likely to be Child-Pugh class C (46% vs. 35%). By the common closing date of December 31, 1990, 26 patients (37%) with prior bleeding and 48 patients (46%) without bleeding died after transplantation. From survival curves, patients with prior bleeding had improved survival rates at 1 yr (65% vs. 54%), at 3 yr (60% vs. 47%) and at 5 yr (55% vs. 43%), although the differences were not statistically significant. With a proportional hazards model to adjust for confounding effects, the relative risk of mortality among patients with prior bleeding was 0.60 (95% confidence interval, 0.27 to 1.30). Sclerotherapy or portal systemic shunts did not alter survival. Important adverse risk factors for mortality included older age at transplantation, black race, malignant disease and more advanced Child-Pugh class. This study suggests that prior esophageal variceal bleeding did not adversely affect the mortality of patients undergoing orthotopic liver transplantation.

Adult↗
PubMed1993

Management of sudden profuse bleeding from varicose veins.

Varicose vein bleeding of the lower extremities is an unusual but pressing indication for treatment and can be lethal. This series reviews operative and injection treatment of such veins in patients with bleeding. During a 49-month period 14 patients (eight men and six women) with a mean age of 62.1 years (range, 23 to 93 years) were seen after venous bleeding related to varicosities of the lower extremity. They described between one and five episodes of bleeding (mean, 2.4), but only one patient required transfusion. The site of bleeding was the lower calf or foot in 11 and affected the thigh in three patients. One was in the third trimester of pregnancy. Nine patients had lesions involving clustered small 1 mm or less diameter varicose veins, whereas five had large diffuse varicose vein formation. None had evidence of coagulopathy, and the inciting episode was either unknown or related to minor trauma. Treatment of eight patients with small-diameter veins was instituted with 0.2% sodium tetradecyl injection with a 30-gauge needle, thrombosing veins within 5 cm of the bleeding focus. A total of 13 ml solution (1.0 to 27 ml) per patient was used during two or three treatment periods (mean, 2.5 treatment periods) spaced 2 weeks apart. Six patients were treated by means of standard vein-stripping techniques or local branch removal at the bleeding site. Effective thrombosis was achieved in all eight patients with small (less than 1 mm) varicose veins treated with sclerosis. In five patients who underwent surgery there was effective resolution of the hemorrhage. One patient with small-diameter varicose veins clustered about the ankle underwent operative treatment and had venous stasis ulceration requiring compression dressings for healing. In all 14 cases control of bleeding was obtained, with follow-up to 49 months (mean, 21.3 months); one had rebleeding from a site 32 cm remote from the original injected area 11 months after treatment. Bleeding from small-diameter varicose veins of the lower extremity can be controlled effectively by sclerosing techniques with sodium tetradecyl. Larger veins are managed with operative removal. Combining these techniques provides efficient management of often-elderly patients, many in an outpatient setting.

Adult↗
PubMed1996

Terlipressin (glypressin) versus somatostatin in the treatment of bleeding esophageal varices--final report of a placebo-controlled, double-blind study.

One hundred and six episodes of bleeding from esophageal or gastric varices in 72 patients with cirrhosis of the liver were randomized to treatment either with intravenous terlipressin 2 mg initially and 1 mg every four hours for 24 hours together with bolus injection and continuous infusion of placebo, or with somatostatin 250 micrograms as a bolus and continuous infusion of 250 micrograms/h somatostatin for 24 hours and placebo injections. Standard treatment with transfusions, fluid and electrolyte correction, and lactulose was administered in both groups. In the terlipressin group, 48 out of 53 bleeding episodes (91%) and in the somatostatin group 43 out of 53 bleeds (81%) were initially stopped by the vasoactive drugs. Four of the five bleeds not arrested by terlipressin, and nine of the ten bleeds not arrested by somatostatin, were stopped by balloon tamponade. In one patient in each group variceal bleeding could not be stopped initially, and both patients died. The failure rate of the vasoactive treatment alone, including rebleeds within the study period, was 17% in the terlipressin, and 28% in the somatostatin, group. The initial hemostasis, including balloon tamponade, were 98%, and the definitive bleeding control rates were 89% in both groups. The hospital mortality rate was 21% (11/53) in the terlipressin, and 21% (11/53) in the somatostatin, group. Blood transfusions and duration of bleeding did not differ significantly. The study indicates that a large proportion of bleeds from esophageal and fundic varices can be stopped initially (86%) and definitively controlled (77%) by vasoactive drugs alone.

Adult↗
PubMed1996

[Magnetic resonance imaging usefulness in the diagnosis of intratumor bleeding in hypophyseal adenomas].

Hypophyseal adenomas are the most frequent intrasella tumours. They are classified as macroadenomas or as microadenomas depending on whether their size is greater or less than 1 cm. Hypophyseal tumours may undergo ischaemic necrosis and haemorrhage when the blood supply is reduced. Intratumoural bleeding is found in varying percentages, between 9.9% and 26%. We review our series of 122 patients with hypophyseal adenomas in whom MR was done. Signs of bleeding were found in 12 patients (9%). In five cases, bleeding had presented as hypophyseal apoplexy, in five cases with subacute symptoms and in two cases was asymptomatic and diagnosis fortuitous. Of the adenomas with intratumoural bleeding, 9 were functioning tumours (4 secreted PRL, 4 ACTH and 1 GH) and 3 non-functioning. The risk factors considered in the pathogenesis of intratumoural bleeding are numerous. The increased incidence of bleeding in large and in invasisve adenomas, especially when treated with bromocriptin, is well established. MR is the ideal technique to detect intratumoural bleeding, T2 weighted sequences being very useful in the diagnosis of bleeding in the acute phase. In the subacute phase, focal areas of hyperintensity are seen in T1 and of hypo/hyperintensity in T2. In the chronic phase, areas of hypodensity are seen both in T1 and in T2. In our study we analyze the clinico-radiological correlation in patients with signs of intratumoural bleeding.

Adenoma↗
PubMedDate not supplied

Efficacy of repeated therapeutic endoscopy in patients with bleeding ulcer.

BACKGROUND/AIMS: Although therapeutic endoscopy is regarded as the procedure of choice for bleeding ulcers, the disease mortality is barely altered. The aim of the present study was to evaluate the efficacy of repeated therapeutic endoscopy in patients with bleeding ulcer. METHODS: From January 1990 to April 1995, 727 patients with bleeding ulcers were admitted to hospital under the care of one gastroenterologist who endoscoped every patient within 18 hours of admission. Epinephrine (1:10,000) was injected into the lesions of patients found to have active bleeding, a non-bleeding visible vessel, or adherent red clot. After the initial diagnostic-therapeutic procedure, all patients admitted from 1990-92 (group A) were treated conservatively, and referred for operation if re-bleeding was uncontrolled. Patients admitted from 1993 to April 1995 (group B) were treated aggressively with re-endoscopy one day later, and repeat hemostasis if re-bleeding was evident. During hospitalization, diagnostic/therapeutic endoscopy was then repeated if re-bleeding was diagnosed by either a fall in hematocrit of > 3%, or on clinical criteria. Patients were transfused if the hematocrit fell to < 30%. RESULTS: Repeated hemostasis was needed in 30 group B patients; one patient requiring 7 therapeutic endoscopies. The outcome of patients in group B was better than group A, with fewer emergency operations (3 vs 10) (p < 0.05) and deaths (0 vs 4) (p < 0.05), while no difference was seen in transfusion requirements (4.1 vs 3.9 units) (p > 0.1), or in length of hospital stay (6.8 vs 7.1 days) (p > 0.1). CONCLUSION: Repeated diagnostic/therapeutic endoscopy benefits patients with bleeding ulcers.

Adolescent↗
PubMed1997

Factors affecting delection of bleeding lesions in the stomach by initial emergency endoscopy.

BACKGROUND: Accurate endoscopic diagnosis of acute gastric bleeding can be problematic and missing diagnoses are not uncommon. However, the causes of diagnostic difficulty and the most common locations of bleeding resulting in missed diagnosis are not well known. METHODS: To determine the causative factors of incomplete study, we analyzed the medical records and performed follow-up on 64 patients for whom initial emergency endoscopy had failed to identify the sites of acute gastric bleeding. The bleeding sites were confirmed by the findings of subsequent endoscopic examination or operation in these cases. RESULTS: Excessive blood covering the examination field was the most frequent cause of incomplete endoscopic study (60/64). Underlying gastric lesions which were later identified as sources of gastric bleeding included: 30 gastric ulcers, 9 gastric varices, 6 acute gastric mucosal lesions, 3 Dieulafoy's lesions, 3 portal hypertensive gastropathies, 2 gastric tumors, 1 Mallory-Weiss tear and 2 unidentified bleeding sites. Eight patients refused further evaluation. The locations of the bleeding sites included: 1 esophagocardiac junction, 8 cardia, 5 fundus, 21 body, 9 antrum, 7 stoma, 3 diffuse pattern. The 42-day mortality rate of these patients was 20%. Of these patients, decompensated liver cirrhosis (8/13) and hepatic failure (7/13) were the most common underlying diseases. CONCLUSION: Inadequate preparation was the most frequently procedural problem associated with missed diagnosis. Lesions located in the body of the stomach were most likely to go undiagnosed. Gastric ulcers were the most common type of unidentified bleeding ulcer site. Hepatic failure was the most common cause of death. The high mortality rate of these patients appeared to be related to underlying diseases rather than to the nature of the lesions responsible for gastric bleeding.

Adult↗
PubMed1992

Bleeding tendency, platelet function, and pharmacokinetics of ibuprofen and zidovudine in HIV(+) hemophilic men.

The use of ibuprofen (IBP) in hemophilic men for chronic hemophilic arthropathy is associated with transient coagulation abnormalities, but usually does not cause bleeding symptoms. However, when hemophilic men are treated with ibuprofen while also receiving zidovudine (ZDV), excess bleeding has occurred in some. In order to evaluate platelet function and pharmacokinetics of combination IBP and ZDV, we measured platelet aggregation, platelet adhesive index, bleeding time, and IBP and ZDV drug levels by high performance liquid chromatography on five patients receiving chronic oral IBP, 400 mg every 6 hr, and on ten patients receiving both IBP and ZDV, 100 or 200 mg every 4 hr five times daily. Samples were obtained at baseline (ZDV alone), acutely (IBP+ZDV acutely), and chronically (2 weeks on IBP and ZDV). Abnormal platelet aggregation with arachidonic acid occurred in four of five (80%) of those receiving IBP alone and in 7 of 10 (70%) at baseline, 9 of 10 (90%) at acute, and 8 of 10 (80%) at chronic IBP and ZDV treatment, most commonly at 2 hr following dosing, when peak IBP levels occurred, and persisting 4 hr in those on chronic dosing. Half or more of those on combination IBP+ZDV showed a lowered platelet adhesive index and/or prolonged bleeding time. Excess bleeding symptoms occurred in three on chronic combination IBP+ZDV, two with increased frequency of spontaneous hemorrhages, and one with prolonged traumatic bleeding. Bleeding tendency was unrelated to the degree of platelet function abnormality, to peak drug levels of IBP or ZDV, or degree of liver function abnormality (SGPT). The clearance of IBP alone and ZDV alone were not different from the clearance of combination IBP and ZDV. Caution is urged regarding potential enhanced bleeding tendency in hemophiliacs receiving both IBP and ZDV in combination.

Acute Disease↗