Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Bleeding”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,207 records · Page 67Linked to original sources
PubMed1999

Vitamin K reduces bleeding in left ventricular assist device recipients.

BACKGROUND: Despite advances in left ventricular assist device (LVAD) design that permit support without anticoagulation, LVAD recipients often suffer profound bleeding complications. This bleeding diathesis may be attributable to pre-operative right-ventricular failure with concomitant hepatic dysfunction. The purpose of this study was to characterize coagulation abnormalities in LVAD recipients and determine the impact of pre-operative vitamin K administration on the incidence of postoperative bleeding. METHODS: Hemostatic and liver function profiles were obtained in 66 recipients of the Heartmate LVAD; 39 of these patients received perioperative vitamin K. RESULTS: During LVAD support, hepatic synthetic function improved as evidenced by increases in clotting factors II, V, VII, XI. There was ongoing fibrinolysis with elevation of fibrinopeptide A and D-dimers and diminution of fibrinogen; however, plasminogen levels did not decline suggesting that systemic disseminated intravascular coagulation (DIC) did not occur. Bleeding requiring re-exploration more than 48 hours postimplantation occurred in 9 of 66 patients (13.6%). Prior to implantation, patients that bled had decreased levels of factor II (52.2 +/- 27.1% vs 69.7 +/- 26.6%; p = 0.048) and prolonged prothrombin times (16.5 +/- 2.4 seconds vs 13.8 +/- 3.1 seconds; p = 0.005) compared to patients that did not bleed. Seven of 27 patients (25.9%) not treated with vitamin K bled, while only 2 of 39 (5.1%) patients treated with vitamin K required re-exploration for bleeding (p = 0.026). CONCLUSIONS: We conclude that: (1) Liver synthetic function improves during LVAD support resulting in increased levels of circulating coagulation factors; (2) ongoing fibrinolysis occurs but likely only represents remodeling of fibrin on the LVAD surface; (3) perioperative vitamin K reduces nonsurgical bleeding in LVAD recipients.

Disseminated Intravascular Coagulation↗
PubMed1999

Gastrointestinal bleeding in infants and children: Meckel's diverticulum and intestinal duplication.

Gastrointestinal bleeding in infants and children can be quite alarming and anxiety-provoking for parents and caregivers alike. In most cases the cause is benign, and the course self-limited. However, in the patient with significant bleeding, an aggressive diagnostic approach is warranted. The differential diagnosis can be extensive and varies depending on the age of the patient. Meckel's diverticula and intestinal duplications may cause gastrointestinal bleeding in almost any age group and require a high index of suspicion for diagnosis. Bleeding usually is painless but may be massive. The advent of technetium (Tc) 99m pertechnetate radionuclide scanning has greatly facilitated the diagnosis of Meckel's diverticula and may also be useful for intestinal duplications. A positive scan requires the presence of ectopic gastric mucosa, which may be identified in both Meckel's diverticula and intestinal duplications. The significance of ectopic gastric mucosa is that it contains acid-secreting parietal cells, which may cause ulceration and bleeding. Only rarely are intestinal duplications diagnosed preoperatively. After initial fluid resuscitation, bleeding from Meckel's diverticula and intestinal duplications require surgical intervention. Resection is the treatment of choice. Diverticulectomy or segmental bowel resection including the diverticulum should be performed for bleeding Meckel's diverticula. It is important to remove the ectopic mucosa and site of ulceration to prevent rebleeding episodes. Intestinal duplications share a common wall and blood supply with native bowel. Segmental resection is indicated if it can be performed without sacrificing a significant portion of bowel. A recent advance has been laparoscopic-assisted resection of Meckel's diverticula and intestinal duplication cysts. With the aid of the laparoscope, extracorporeal or intracorporeal resection may be performed.

Child↗
PubMed2002

Bleeding esophagogastric varices from extrahepatic portal hypertension: 40 years' experience with portal-systemic shunt.

BACKGROUND: This article discusses the largest and longest experience reported to date of the use of portal-systemic shunt (PSS) to treat recurrent bleeding from esophagogastric varices caused by extrahepatic portal hypertension associated with portal vein thrombosis (PVT). STUDY DESIGN: Two hundred consecutive children and adults with extrahepatic portal hypertension caused by PVT who were referred between 1958 and 1998 after recovering from at least two episodes of bleeding esophagogastric varices requiring blood transfusions were managed according to a well-defined and uniformly applied protocol. All but 14 of the 200 patients were eligible for and received 5 or more years of regular followup (93%); 166 were eligible for and received 10 or more years of regular followup (83%). RESULTS: The etiology of PVT was unknown in 65% of patients. Identifiable causes of PVT were neonatal omphalitis in 30 patients (15%), umbilical vein catheterization in 14 patients (7%), and peritonitis in 14 patients (7%). The mean number of bleeding episodes before PSS was 5.4 (range 2 to 18). Liver biopsies showed normal morphology in all patients. The site of PVT was the portal vein alone in 134 patients (76%), the portal vein and adjacent superior mesenteric vein in 10 patients (5%), and the portal and splenic veins in 56 patients (28%). Postoperative survival to leave the hospital was 100%. Actuarial 5-year, 10-year, and 15-year survival rates were 99%, 97%, and 95%, respectively. Five patients (2.5%), all with central end-to-side splenorenal shunts, developed thrombosis of the PSS, and these were the only patients who had recurrent variceal bleeding. During 10 or more years of followup, 97% of the eligible patients were shown to have a patent shunt and were free of bleeding. No patient developed portal-systemic encephalopathy, liver function tests remained normal, liver biopsies in 100 patients showed normal architecture, hypersplenism was corrected. CONCLUSION: PSS is the only consistently effective therapy for bleeding esophagogastric varices from PVT and extrahepatic portal hypertension, resulting in many years of survival, freedom from recurrent bleeding, normal liver function, and no encephalopathy.

Adolescent↗
PubMed1997

A commonsense approach to variceal bleeding.

A cirrhotic patient with large varices and red color signs at endoscopy, and a portal pressure greater than 12 mmHg, has a high risk of bleeding from those varices in the near future. Prophylactic therapy with a nonselective beta-adrenergic blocking drug or long acting nitroglycerin reduces the risk of developing the first bleed and increases life expectancy. The acute variceal bleed requires prompt resuscitation with volume replacement, early initiation of vasoactive drugs (octreotide, somatosatin, or vasopressin plus nitroglycerin) to reduce portal pressure and decrease splanchnic flow, and early diagnostic endoscopy to determine the cause of bleeding. Variceal banding or sclerotherapy is successful in controlling the acute bleed in up to 90% of cases. Beta-adrenergic blocker therapy should be instituted once the bleed has been controlled and banding/sclerotherapy continued until the varices have been obliterated. In the patient with recalcitrant or recurrent bleeding, TIPS, selective shunt surgery, or liver transplantation may be options depending on the specifics of the particular case.

Acute Disease↗
PubMed2002

[Idiopathic subarachnoid hemorrhage; comparison of different bleeding patterns and long-term outcome].

INTRODUCTION: Idiopathic subarachnoid haemorrhage (ISAH) represents approximately 15-30% of all subarachnoid haemorrhages. On the basis of the diagnostic CT and depending on the location of the subarachnoid bleeding, patients with ISAH may be classified into three groups: a) Patients with normal CT and diagnosis made by lumbar puncture (ISAHNCT); b) patients with a pure perimesencephalic pattern (ISAHPM) and c) patients with a bleeding pattern resembling that of aneurismatic rupture (ISAHA). This classification could permit the establishment of differences in the management and prognosis. OBJECTIVES: To describe the clinical and radiological characteristics of these three classes of patients and analyse their medium and long term outcome and moreover, compare these with those observed in patients suffering aneurysmal subarachnoid haemorrhage (ASAH). MATERIAL AND METHODS: A series of 122 patients consecutively admitted to Hospital 12 de Octubre Madrid between 1990 and 2000 with the diagnosis of ISAH were retrospectively reviewed. Patients were considered to have suffered ISAH when the first complete four vessel angiography did not show the presence of any aneurysm or vascular lesion responsible for the bleeding. Patients were classified depending on the pattern of bleeding into ISAHNCT, ISAHPM as described by Van Gijn et al., and ISAHA. The angiography study was repeated when: a) the first study was incomplete or had poor quality, b) vasospasm was present, c) in those patients who had an aneurysmal pattern of bleeding in the initial CT. Different clinical and radiological characteristics were recorded as well as complications that occurred during the hospital stay. Final outcome was evaluated by means of the Glasgow Outcome Score (GOS). With the purpose of comparing these clinical and radiological characteristics and the outcome of patients with ISAH with those suffering aneurysmal subarachnoid haemorrhage (ASAH), 294 patients diagnosed with ASAH during the same study period were also reviewed. RESULTS: 27% of patients admitted to our hospital with the diagnosis of non-traumatic subarachnoid hemorrhaged were diagnosed as ISAH. Of these, 41% presented with a ISAHA pattern, 39% ISAHPM and 20% ISAHNCT. The average age was similar in the different subgroups of SAH, being around 55 years. There was a greater frequency of male patients in the ISAHNCT and ISAHPM groups. In comparison with ASAH, ISAH characterises by patients presenting with less frequency a bad clinical grade and also loss of consciousness at stroke. There are fewer complications in patients with ISAH than ASAH, with a frequency of rebleeding and ischemia much less (5 and 6% respectively). Within the ISAH group, patients with ISAHA pattern of bleeding present more complications. Outcome is excellent for patients with ISAHNCT and ISAHPM, and rather worse for patients with ISAHA (median followup 5.8 years). CONCLUSIONS: This study confirms that the frequency of ISAH in our environment reaches the higher limit of that shown previously in the literature, replicating the results previously published by our group. Patients with ISAH have a better prognosis and a smaller risk of complications than patients with ASAH, the prognosis of patients with ISAHCTN and ISAHPM being particularly good. Patients with ISAHA present initially with a severe clinical situation, probably related to the bigger amount of bleeding, as well as a higher frequency of systemic complications, cerebral ischemia and hydrocephalus. However, if the absence of vascular lesions is confirmed, the long term prognosis is similar to that of the other subgroups of ISAH.

Aneurysm, Ruptured↗
PubMed2002

Adrenaline plus cyanoacrylate injection for treatment of bleeding peptic ulcers after failure of conventional endoscopic haemostasis.

BACKGROUND: Endoscopic therapy is a safe and effective method for treating non-variceal upper gastrointestinal bleeding. However failure of therapy, in terms of continuing bleeding or rebleeding, is seen in up to 20%. Cyanoacrylate is a tissue glue used for variceal bleeding that has occasionally been reported as an alternative haemostatic technique in non-variceal haemorrhage. AIM: To retrospectively describe personal experience using cyanoacrylate injection in the management of bleeding ulcers after failure of first-line endoscopic modalities. PATIENTS AND METHODS: Between January 1995 and March 1998, 18 [12 M/6 F, mean age 68.1 years) out of 176 patients, referred to our Unit for non-variceal upper gastrointestinal bleeding, were treated with intralesional injection of adrenaline plus undiluted cyanoacrylate. Persistent bleeding after endoscopic haemostasis or early rebleeding were the indications for cyanoacrylate treatment. RESULTS: Definitive haemostasis was achieved in 17 out of 18 patients treated with cyanoacrylate. One patient needed surgery. No early or late rebleeding occurred during the follow-up. No complications or instrument lesions related to cyanoacrylate were recorded. CONCLUSIONS: In our retrospective series, cyanoacrylate plus adrenaline injection was found to be a potentially safe and effective alternative to endoscopic haemostasis when conventional treatment modalities fail in controlling bleeding from gastroduodenal ulcers.

Aged↗
PubMed2003

Long-term outcome of argon plasma coagulation therapy for bleeding caused by chronic radiation proctopathy.

BACKGROUND: Radiation-induced proctopathy is a serious complication of radiation therapy for pelvic malignancy. AIM: To assess the safety and efficacy of argon plasma coagulation in the treatment of haemorrhagic radiation-induced proctopathy. PATIENTS: Twenty-four patients with rectal bleeding due to radiation-induced proctopathy were prospectively enrolled in the study. METHODS: Indications for treatment were iron deficiency anaemia (n = 16) and persistent bleeding, despite pharmacotherapy (n = 8). Argon flow and power used were 0.8-1.2 l/min and 40 W, respectively. An interval of at least 4 weeks was allowed between treatment sessions. Haemoglobin level, bleeding severity score, number of admissions and transfusion requirements were recorded after endoscopic coagulation and before 12 and 24 months. RESULTS: A median of 2.5 therapeutic sessions per patient were performed (range 1-6). All patients reported clinical improvement and/or cessation of rectal bleeding. The mean value of the bleeding severity score decreased from 2.9 to 0.8 (P < 0.01), while average haemoglobin levels increased by a mean of 1.9 mg/dl at the end of the treatments (P < 0.05). During a minimum follow-up of 24 months (range 24-60), rectal bleeding recurred in two cases and was successfully retreated endoscopically. One patient developed a recto-vaginal fistula. CONCLUSIONS: Argon plasma coagulation appears to be a safe and effective technique for management of rectal bleeding caused by radiation-induced proctopathy.

Adult↗
PubMed2000

Endoscopic, ultrasonographic, and US-Doppler parameters as indicators of variceal bleeding in patients with schistosomiasis.

Bleeding from esophagogastric varices is a potentially deadly complication in patients with hepatosplenic schistosomiasis. The aim of this study is to establish indicators of variceal bleeding. We studied 40 patients with compensated hepatosplenic schistosomiasis and varices, analyzing four endoscopic (variceal size, red color signs, fundic varices, and congestive gastropathy), nine ultrasonographic (right and left hepatic lobe size, periportal and gallbladder wall thickness, portal and splenic veins diameter, spleen longitudinal axis and volume, and presence of collateral circulation), and five US-Doppler parameters (portal and splenic veins velocity and flow and portal vein congestion index). Patients were divided in two groups according to previous history of variceal bleeding. The group with bleeding episodes was again divided in two groups: with and without treatment, namely endoscopic sclerotherapy. All endoscopic parameters and two ultrasonographic (periportal thickness and portal vein diameter) were statistically different between the groups with and without previous bleeding. The likelihood index, adopted to determine the best parameters related to previous bleeding showed that the most important combinations are: gastropathy and red signs followed by portal vein diameter and variceal size. In conclusion, although aware of the limits of the statistical analysis due to the small number of patients, our results demonstrated that endoscopic and US parameters (isolated or combined) can identify patients with a high risk of variceal bleeding, allowing physicians to optimize prophylactic therapy.

Adolescent↗
PubMed2003

Aspirin use post-acute coronary syndromes: intolerance, bleeding and discontinuation.

BACKGROUND: While aspirin's secondary prevention benefit is clear, prior reports indicate that 19-83% of eligible patients may not use aspirin chronically. METHODS: We investigated intolerance and bleeding while on aspirin and aspirin discontinuation using 5337 post-acute coronary syndrome patients considered appropriate for chronic antiplatelet therapy who were randomly assigned to aspirin in SYMPHONY and 2nd SYMPHONY and followed for 94 (64,157) days. Multivariable logistic regression models tested associations between baseline characteristics and aspirin discontinuation and bleeding. RESULTS: Nearly 18% of patients discontinued study aspirin; 48% subsequently used open-label aspirin and 5% other antiplatelet or anticoagulant therapy. Black race, recurrent ischemia, hypertension, chronic obstructive pulmonary disease, lighter weight, shorter time to treatment and use of non-steroidal anti-inflammatory agents, diuretics, and digitalis were independently associated with early discontinuation. Early discontinuation was less likely in Eastern Europe, Latin America and Asia. Although major or minor bleeding was common (12.6%), only 1.0% of aspirin-treated patients were reported to discontinue due to bleeding. Gastrointestinal (10.5%) and puncture site (7.6%) were the most common bleeding locations. Bleeding risk was associated with lower estimated creatinine clearance, shorter time to treatment, smoking, Killip class >II, higher systolic blood pressure, and use of aspirin or heparin prior to starting study aspirin. CONCLUSIONS: Despite early initiation and close follow-up, more than 9% of aspirin-treated patients discontinued therapy early and remained off treatment. Addressing the factors associated with both bleeding and discontinuation during chronic therapy is necessary to improve adherence to this inexpensive, life-saving therapy.

Acute Disease↗
PubMed2006

[Acute upper gastrointestinal bleeding].

The acute upper gastrointestinal bleeding continues to represent one of the most frequent gastrointestinal emergencies both in hospital and out-patient settings. While the underlying etiology is widespread, the leading causes for such bleeding events are gastro-duodenal ulcers and esophageal or gastric varices. Given the potential life-threatening character of the bleeding, the first step in treating such a patient is the assessment of the severity of the bleeding based upon clinical and laboratory parameters. This translates into the time point of performing an endoscopy of the upper gastrointestinal tract. The role of gastro-esophago-duodenoscopy is defined by its dual function for the diagnosis of the exact origin of the bleeding and the therapy of the bleeding during the same examination. Drug administration has to accompany this endoscopic intervention. Effective acid suppression is in the focus of conservative treatment. In case of varices, additional medication has to be given to lower the portovenous pressure. Following persistent bleeding after endoscopic intervention, radiological and surgical treatment options have to be discussed in time.

Acute Disease↗
PubMed2006

[Chronic gastrointestinal bleeding].

Chronic gastrointestinal bleeding can occur as recurrent overt blood loss (hematochezia, melena or hematemesis) or as occult gastrointestinal bleeding. Occult bleeding from the gastrointestinal tract is typically identified by either a positive stool test for occult blood or by the presence of iron deficiency anemia. The major cause of iron deficiency anemia is blood loss from the gastrointestinal tract. In women, menstrual blood loss must also be considered. Approximately 5% of all patients with gastrointestinal bleeding do not have lesions identified by upper or lower endoscopy. In most of these patients, the bleeding source responsible for the chronic blood loss is located in the small bowel. The most common cause for gastrointestinal bleeding of small bowel origin is angiodysplasia, tumors of the small intestine (primary benign or malignant tumors or metastatic lesions) and various other causes (such as ulcers caused by nonsteroidal antiinflammatory drugs, aortoenteric fistula, diverticula, endometriosis and hemobilia). After negative upper and lower endoscopy, examination of the small bowel is warranted. Methods to evaluate the small bowel include enteroscopy, capsule endoscopy, small bowel radiographic studies and angiography. The role of each examination depends upon the clinical setting and available expertise. Explorative surgery with intraoperative enteroscopy is generally reserved for patients with ongoing transfusion requirement and in those under the age of 5O years (to rule out a small bowel neoplasm). This article reviews the concepts of evaluation and care of patients with chronic gastrointestinal bleeding.

Chronic Disease↗
PubMed2002

Longitudinal association between plaque and gingival bleeding in smokers and non-smokers.

BACKGROUND/AIMS: Whereas accumulation of dentogingival plaque inevitably leads to inflammatory reactions in the adjacent gingival tissue, there is limited information with regard to factors influencing naturally occurring fluctuation between gingival health and disease. The major aims of the present study were to investigate site-specific associations between plaque and gingivitis as well as transition dynamics of naturally occurring gingivitis in smoking and non-smoking young adults. METHODS: 65 systemically healthy young adults, 19 to 30 years old, participated. 33 volunteers smoked at least 20 cigarettes per day, whereas 32 subjects were non-smokers. Clinical periodontal conditions were assessed four times within a time period of 6 months. An ecological approach in data analysis as well as site-specific analyses considering the correlated structure of data were performed. RESULTS: At the outset and after 6 months, smokers had significantly more supragingival plaque than non-smokers. At the final examination, bleeding upon probing as well as calculus were more prevalent in smokers. A site-by-site analysis revealed that smokers tended to have a weaker association between supragingival plaque and bleeding on probing than non-smokers (median Mantel-Haenszel's common odds ratio 1.91 vs. 2.89, p=0.07). Multiple logistic regression analyses adjusted for periodontal probing depth, plaque and calculus identified smoking status to significantly increase the risk for the first transition of non-bleeding to bleeding upon probing by 86% (p<0.01). In contrast, recovery of bleeding sites was positively influenced by female gender, but not smoking. CONCLUSIONS: In multivariate analyses adjusted for probing depth, plaque and calculus, smokers appeared to be at higher risk for the transition from non-bleeding to bleeding on probing. Weaker associations between plaque and naturally occurring gingivitis in smokers may have important consequences for preventive strategies for gingivitis.

Adult↗
PubMed1993

Nonsteroidal anti-inflammatory drug use in relation to major upper gastrointestinal bleeding.

In a study in the United States, Sweden, and Hungary, 335 cases of gastric bleeding without predisposing factors were compared with 670 control subjects, and 239 cases of duodenal bleeding were compared with 489 control subjects. For aspirin taken at least every other day during the week before the onset of bleeding (regular use), the relative risk of gastric bleeding was 4.4 (95% confidence interval [CI], 2.9 to 6.7); for occasional use, it was 3.3 (95% CI, 2.1 to 5.0). For ibuprofen, the corresponding estimates were 1.0 (95% CI, 0.4 to 2.6) and 1.1 (95% CI, 0.5 to 2.4). For naproxen, the estimate for regular use was 4.0 (95% CI, 1.5 to 11). The estimates for any use of piroxicam (crude estimate), indomethacin, and diclofenac during the week before onset were 18 (95% CI, 4.1 to 83), 1.6 (95% CI, 0.4 to 5.9), and 0.9 (95% CI, 0.2 to 4.2), respectively. The corresponding relative risks of duodenal bleeding were 7.1 (95% CI, 4.2 to 12) and 2.2 (95% CI, 1.3 to 3.7) for the regular and occasional use of aspirin, 2.4 (95% CI, 0.5 to 11) and 0.8 (95% CI, 0.3 to 2.0) for ibuprofen, 12 (95% CI, 2.8 to 54) and 9.9 (95% CI, 2.3 to 44) for naproxen, 17 (95% CI, 3.6 to 79) for any use of piroxicam (crude estimate), and 1.7 (95% CI, 0.2 to 14) for any use of indomethacin. There was a significant trend in the risk of gastric bleeding with increasing dose of regular aspirin use (p = 0.002). The relative risk estimates for the regular use of 325 mg or less were significantly elevated for both gastric and duodenal bleeding at 3.1 and 6.4, respectively.

Aged↗
PubMed2005

Drug insight: bleeding after percutaneous coronary intervention-risks, measures and impact of anticoagulant treatment options.

In Europe, the use of interventional cardiology, including percutaneous coronary intervention (PCI), is increasing rapidly. The use of anticoagulation agents in PCI procedures is essential, but despite technical improvements, a significant associated bleeding risk still exists: more than 5% of patients are estimated to require transfusion, and around a further 13% experience minor bleeding. The methods used to detect and measure blood loss following PCI, however, vary widely between institutions and clinical trials. The risk of bleeding is influenced by therapeutic options and patient-specific characteristics, such as age, anemia and previous exposure to anticoagulants. Bleeding is associated with death, and also with less severe conditions such as thrombocytopenia, anemia, and hematoma, which have major impacts on patients' welfare and length of hospital stay, and on hospital budgets. Unfractionated heparin is the most widely used anticoagulant during PCI. Heparin, antiplatelet agents and other anticoagulants, however, have limitations that make it difficult to achieve a level of anticoagulation that prevents ischemic events without promoting bleeding. The use of low-molecular-weight heparin and the addition of glycoprotein IIb/IIIa inhibitors offer improved outcomes, but safer and more effective therapeutic agents are still required. New anticoagulants, including direct thrombin inhibitors such as bivalirudin, show similar levels of efficacy to heparin plus glycoprotein IIb/IIIa inhibitors, but with fewer hemorrhagic complications, and might advance clinical practice. This review evaluates the impact of PCI-related bleeding on patients' outcomes and hospital resources, examines methods for the detection and measurement of bleeding, and appraises the therapeutic options--particularly the newer agents--available to minimize hemorrhagic complications.

Age Factors↗
PubMed2002

Recombinant factor VIIa in the management of surgery and acute bleeding episodes in children with haemophilia and high responding inhibitors.

The management of acute and surgical bleeding episodes in children with severe factor VIII or IX deficiency who develop high responding inhibitors presents a major therapeutic challenge to clinicians. Recombinant factor VIIa (rVIIa) is an effective, reliable and safe treatment that can be used to treat acute bleeding episodes prior to commencing an immune tolerance programme and to cover surgical procedures until the immune tolerance programme is successful. In a significant minority of patients, immune tolerance therapy is ineffective and an alternative haemostatic agent such as rVIIa is required for life-long treatment. The present study evaluated the use of rVIIa in a paediatric setting. Twelve children, aged 1-16 years, were treated successfully with rVIIa to prevent surgical bleeding in 20 surgical procedures (19 central venous access device insertion or removal, 1 dental extraction). Minor postoperative haematomata developed in 2 out of 20 cases after regular rVIIa therapy had been discontinued and resolved with a short course of rVIIa in both cases. Three children had six life- or limb-threatening bleeding episodes. All bleeding episodes resolved with regular rVIIa treatment although topical fibrin glue was needed in one child with a frenulum tear. One patient required two red cell transfusions for symptomatic anaemia resulting from two separate bleeding episodes. The rVIIa therapy was well tolerated and there was no evidence of treatment-related complications. We conclude that rVIIa is the treatment of choice for the management of surgery and acute life- or limb-threatening bleeding in children with haemophilia and high responding inhibitors.

Acute Disease↗
PubMed2001

Effects of bleeding on uteroplacental, umbilicoplacental and yolk-sac hemodynamics in early pregnancy.

OBJECTIVE: To determine the influence of vaginal bleeding with or without a persisting subchorionic hematoma on uteroplacental, umbilicoplacental and yolk-sac hemodynamics in early pregnancy. DESIGN: Twenty-six consecutive patients with vaginal bleeding entered this longitudinal study 1-3 days after the beginning of vaginal bleeding and were re-examined every 1-2 weeks. In three cases vaginal bleeding occurred at the 5th completed gestational week, in 13 at the 7th week, in nine at the 8th week and in one case at the 10th week. A subchorionic hematoma was identified in one case at the 5th week, in nine cases at the 7th week, in nine cases at the 8th week, and in seven cases at the 10th week. Four pregnancies ended in miscarriage. Blood velocity waveforms of uterine, arcuate, radial, spiral, umbilical, chorionic and yolk-sac arteries were obtained by transvaginal pulsed Doppler ultrasound and peak systolic velocities, time-averaged maximum velocities and pulsatility indices were calculated. The results were compared with our earlier observations in normal pregnancy obtained with a similar study protocol. RESULTS: At the 7th week, radial artery pulsatility-index values (mean (SD)) were higher in pregnancies with vaginal bleeding (1.84 (0.59); P = 0.04) and in pregnancies with a subchorionic hematoma (1.96 (0.63); P = 0.03) than in normal pregnancies (1.40 (0.46)). The pulsatility-index values of uterine, arcuate, spiral, umbilical and chorionic arteries did not differ between the groups. Vaginal bleeding with or without a subchorionic hematoma at the 8th week did not affect any of the measured parameters. Persistence of the subchorionic hematoma until the 10th week did not affect uterine, arcuate, radial, spiral, umbilical or chorionic artery hemodynamics. Yolk-sac hemodynamic parameters did not differ between the groups. CONCLUSIONS: Vaginal bleeding with or without a subchorionic hematoma is associated with increased radial artery impedance at the 7th week of pregnancy. Persistence of the subchorionic hematoma does not affect utero- and umbilicoplacental circulation.

Female↗
PubMed2000

Non-steroidal anti-inflammatory drugs, Helicobacter pylori and bleeding gastric ulcer.

BACKGROUND: Helicobacter pylori infection and NSAID usage are considered to be independent risk factors for gastric ulcer (GU). Whether they interact to influence the risk of bleeding in GU is unclear. AIM: To determine the prevalence of H. pylori infection and NSAID ingestion in a group of patients with GU and determine their roles in bleeding and non-bleeding GU. METHODS AND RESULTS: From January 1993 to June 1996, a total of 217 GU patients (150 male, 67 female, median age 61 years, range 26-94) were eligible for the study. Eighty-five per cent were H. pylori-positive and 15% were H. pylori-negative. NSAID usage within 4 weeks prior to endoscopy was present in 30%, more in the H. pylori-negative than H. pylori-positive patients (59% vs. 25% P = 0.0002). Aspirin was most commonly used (43%). One hundred patients bled from GU (69 male, 31 female, mean age 67 years, range 26-94) and 117 did not (81 male, 36 female, mean age 57 years, range 28-86). Univariate logistic regression showed that advanced age (>/= 65 years) and NSAID usage carried an increased risk of bleeding GU (odds ratio 3.4 and 6.8, respectively) while H. pylori infection alone was not associated with additional risk (OR = 0.8). However, when three variables were considered jointly in a multiple logistic regression, the OR associated with H. pylori infection increased to 2.4, suggesting that in the presence of NSAIDs and advanced age, H. pylori also increases the risk of bleeding GU, indicating an interaction between the variables. CONCLUSION: NSAID usage and advanced age are risk factors for bleeding GU, whereas H. pylori infection by itself is not. In the presence of NSAIDs and advanced age, an increased risk of bleeding GU with H. pylori is observed, indicating the possibility of an interaction between these factors.

Adult↗
PubMed2001

Review article: current endoscopic therapeutic options in the management of variceal bleeding.

Variceal bleeding is a frequent and life-threatening complication of portal hypertension. The first episode of variceal bleeding is not only associated with a high mortality, but also with a high recurrence rate in those who survive. Therefore, many studies and randomized clinical trials have focused on different therapeutic strategies aiming to prevent the first episode of variceal bleeding (primary prophylaxis), to control haemorrhage during the acute bleeding episode (emergency treatment), and to prevent re-bleeding (secondary prophylaxis). These strategies involve pharmacological, endoscopic, surgical, and interventional radiological modalities. This review concentrates on the clinical aspects of the endoscopic modalities used to treat oesophageal variceal haemorrhage, including variceal injection sclerotherapy, variceal band ligation, and the use of tissue adhesives (glue) and their substitutes. We also draw conclusions from the available literature regarding the use of endoscopic modalities in primary prophylaxis, emergency treatment, and secondary prophylaxis of variceal re-bleeding. The management of gastric varices and variceal bleeding during pregnancy is also addressed.

Clinical Trials as Topic↗