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At least 127 records · Page 7Linked to original sources
PubMed2003

Evaluation of endoscopic hemostasis with metallic hemoclips for bleeding gastric ulcer: comparison with endoscopic injection of absolute ethanol in a prospective, randomized study.

OBJECTIVE: Although metallic hemoclips have been used for hemostasis of bleeding ulcer, there have been few prospective trials to evaluate their efficacy. In this study, a prospective, randomized trial was performed to evaluate endoscopic hemoclipping for bleeding gastric ulcer in comparison with endoscopic injection of absolute ethanol. METHODS: During the period 1995-1998, 126 gastric ulcer patients with bleeding or nonbleeding visible vessel were considered for entry. They were randomly assigned to one of three groups: endoscopic hemostasis performed with injection of absolute ethanol (group I, n = 42), hemoclipping (group II, n = 42), and a combination of the two methods (group III, n = 42). RESULTS: The permanent hemostatic rate was 85.7% in group I, 90.5% in group II, and 92.9% in group III. The mean volume of blood transfusion was 313 +/- 77 ml in group I, 274 +/- 54 ml in group II, and 163 +/- 42 ml in group III, which was significantly less than in groups I or II (p < 0.05). No patients required emergency surgery. Five patients died within a month after initial hemostasis as a result of unrelated conditions. CONCLUSIONS: Endoscopic hemostasis with hemoclips for bleeding gastric ulcer was as effective and safe as that with injection of absolute ethanol, and a combination of ethanol injection and hemoclips did not result in a great advantage over the two individual procedures.

Equipment Design↗
PubMed2004

Hydroxyethyl starch as a priming solution for cardiopulmonary bypass impairs hemostasis after cardiac surgery.

UNLABELLED: We investigated the influence of hydroxyethyl starch (HES) as a priming solution for the cardiopulmonary bypass (CPB) circuit on postoperative hemostasis in 45 patients undergoing elective coronary artery bypass grafting. In a randomized sequence, 20 mL/kg of low-molecular-weight HES (HES 120; molecular weight 120,000 daltons), high-molecular-weight HES (HES 400; molecular weight 400,000 daltons), or 4% human albumin (ALB) was used as the main component of the CPB priming solution. The thromboelastographic values indicating the speed of solid clot formation (alpha-angle) and the strength of the fibrin clot (maximum amplitude and shear elastic modulus) were decreased up to 2 h after CPB in both HES groups. Four hours after the operation, blood loss through the chest tubes had increased in the HES groups: HES 120, mean 804 mL (range, 330-1390 mL); HES 400, mean 1008 mL (range, 505-1955 mL); and ALB, mean 681 mL (range, 295-1500 mL) (P < 0.05 between the HES 400 and ALB groups). We conclude that HES solutions, when given in doses of 20 mL/kg in connection with the CPB prime, compromise hemostasis after cardiac surgery. This effect appears related to formation of a less stable thrombus compared with that formed in the presence of ALB. IMPLICATIONS: The influence of hydroxyethyl starch (HES) on postoperative hemostasis was investigated in cardiac surgery. The thromboelastographic values indicated that HES solutions, when given in connection with the cardiopulmonary bypass prime, compromise hemostasis after cardiac surgery. This effect seems to occur through the formation of a less stable clot.

Adult↗
PubMed1996

Central venous catheter placement in patients with disorders of hemostasis.

OBJECTIVE: To define the incidence of bleeding complications from central venous access procedures performed by a critical care service in patients with disorders of hemostasis. DESIGN: Prospective, consecutive sample, collection of clinical data. SETTING: University teaching hospital. PATIENTS: Seventy-six consecutive patients with disorders of hemostasis who required central venous access for clinical management between October 1992 and October 1993. MEASUREMENTS: Age, sex, clinical diagnosis, most recent platelet count, prothrombin time (PT), and activated partial thromboplastin time (aPTT) were recorded from the medical record of patients with known coagulation or platelet abnormalities. The site of central venous catheter placement, the number of needle passes necessary to complete the procedure, and the occurrence of complications were reported by the critical care attending physician performing or supervising the procedure. RESULTS: One hundred four central venous access procedures were performed on 76 patients with disorders of hemostasis. Seventy-three percent of catheters were placed in patients with platelet counts less than 100,000/mL and 40% of catheters were placed in patients with abnormalities of PT, aPTT, or both. Thirteen percent of patients had abnormalities of both platelets and coagulation profile. There were no serious complications. Bleeding complicated 7 (6.5% of the procedures; 5 patients had bleeding from the skin (from the suture sites in four), and 2 patients developed small periosteal hematomas. All patients with bleeding complications had thrombocytopenia with mean platelet counts of 22,000/mL and a range of 6,000 to 37,000/mL. Most patients with platelet counts in this range did not have clinically evident bleeding. CONCLUSIONS: Central venous access procedures can be done safely in patients with disorders of hemostasis by skilled physicians who frequently perform these procedures. Patients most likely to experience bleeding from these procedures are patients with severe thrombocytopenia. In this series, only a single patient, with a platelet count of 6,000/mL, required therapeutic blood product administration.

Blood Coagulation Disorders↗
PubMed1998

Hemostasis activation markers in acute renal failure.

Fibrinopeptide A and thrombin-antithrombin III complex were used respectively as markers for in vivo thrombin formation and beta-thromboglobulin as a marker for platelet activation. In cases of acute renal failure (ARF) a heightened plasma concentration in the hemostasis activation markers may occur, because of a renal elimination disturbance, without a previous activation of the hemostasis. In order to check the validity of fibrinopeptide A, thrombin-antithrombin III complex and beta-thromboglobulin as markers for the hemostasis activation in cases of ARF we examined 32 patients prior to renal replacement therapy. A significant rise in fibrinopeptide A (x +/- SD: 34 +/- 22 ng/mL, ref < 3.0), thrombin-antithrombin III complex (19 +/- 15 ng/mL, ref 1.0-4.0) and beta-thromboglobulin (149 +/- 58 U/mL, ref 10-40) was found. None of the parameters examined showed a correlation to the serum creatinine. A correlation was observed respectively between fibrinopeptide A (r = 0.34, p < .05), beta-thromboglobulin (r = 0.39, p < .05) and the beta-thromboglobulin/creatinine coefficient (0.50 +/- 0.30, r = 0.72, p < .001) on the one side and the thrombin-antithrombin III complex on the other. A greater rise in the concentration of all parameters in patients with disseminated intravascular coagulation (DIC) was established, in contrast to patients without DIC (fibrinopeptide A: 44 +/- 31 vs. 32 +/- 20 ng/mL, beta-thromboglobulin: 169 +/- 57 vs. 144 +/- 60 U/mL, thrombin-antithrombin III complex 40 +/- 21 vs. 14 +/- 7 ng/mL, p < .05). Fibrinopeptide A and beta-thromboglobulin/creatinine coefficient in combination with the thrombin-antithrombin III complex can be employed as markers for the activation of hemostasis in cases of ARF there is no direct relationship between restricted kidney function in ARF and the plasma concentration of these markers, which behave similarly in spite of their varying elimination patterns.

Acute Kidney Injury↗
PubMed1999

[Effect of compression with aerosolized fibrin sealant on surgical hemostasis].

In order to decrease complications following incomplete hemostasis after surgery, especially in the case of arterial bleeding, we experimentally investigated an effective way of applying fibrin glue as a sealant. Using white rabbits as a model, in which arterial bleeding from the abdominal aorta was induced, fibrin glue and a related hemostatic agent were tested to evaluate the hemostatic effectiveness. Group I (n = 9): Fibrin glue was applied by spraying it on the fingertip and then placing the fingertip on the bleeding part and pressing. Group II (n = 9): Fibrin glue was applied with oxycellulose on the fingertip and then placing the fingertip on the bleeding part and pressing. The results demonstrated that: 1) Although complete hemostasis could not be obtained with finger-pressing alone in 30 second, it could be obtained in 9/9 cases 100%) in Group I but in only 3/9 cases (33%) in Group II. 2) Pressure-resistant force was higher for Group I at an earlier time after hemostasis (p < 0.05). 3) Pathological study reconfirmed the predominance of Group I. We conclude from this study that ideal hemostasis can be obtained with fibrin glue applied simply by spraying it on the fingertip and then placing the fingertip on the bleeding part and pressing.

Aerosols↗
PubMed1999

Hemostasis and thrombosis research in China.

PURPOSE: To highlight the development and achievements of hemostasis and thrombosis research in China over the past 50 years. DATA SOURCES: Both Chinese and English language literature search using MEDLINE (1990-1998), and original articles published in the main Chinese and international journals. STUDY SELECTION: After reviewing all the main articles on thrombosis and hemostasis, 20 of them were selected that specifically addressed the stated purpose. DATE EXTRATION: The content that could present the progress in hemostasis and thrombosis in China was selected. RESULTS: Monoclonal antibodies have widely been used in basic research and laboratory diagnosis. Several novel gene mutations of coagulation factors have been identified. Some drugs of traditional Chinese medicine have proved to be efficient in treatment of thrombotic diseases. CONCLUSIONS: Significant achievements in basic, clinical and pharmacological research in the field of hemostasis and thrombosis have been made in China in the past 50 years. Some new discoveries in platelet membrane glycoproteins and coagulation factors research are believed to be contributions to the international scientific community. However, a specific effort using advanced techniques should be made for future development, especially in molecular biology research.

Blood Coagulation Factors↗
PubMed1975

The effectiveness and mechanism of collagen-induced topical hemostasis.

Microcrystalline collagen is a recently developed material possessing remarkable topical hemostatic properties. The potential utility of this substance for cardiovascular surgery was evaluated in a canine arterial bleeding model. A hemostatic protocol allowed comparison of initial and final hemostasis rates as well as the time required to accomplish hemostasis. The results of these studies revealed that microcrystalline collagen, or MCC, achieved hemostasis more frequently and rapidly than either pressure alone or oxidized cellulose cloth. MCC also was highly effective initially after large doses of heparin and in the presence of platelets with function rendered deficient by acetyl salicylate. Only in the presence of profound thrombocytopenia was any loss of initial effectiveness observed. Some delayed hemorrhage occurred in the heparin-treated groups leading to a lessened incidence of final hemostasis, a result intimately related to MCC's probable mechanism of action. However, even under the extreme conditions imposed by this severe experimental model, MCC remained effective in greater than 70 percent of the trials. On this basis MCC seems to possess great potential as a useful adjunct during cardiovascular surgical procedures.

Administration, Topical↗
PubMed2000

[Multicenter prospective study of prognostic factors of gastroduodenal ulcer hemorrhages. Reevaluation of clinical and endoscopic factors in the era of endoscopic hemostasis].

AIM: To evaluate in a prospective study the prognostic factors of recurrent bleeding and mortality in patients presenting with high risk peptic ulcer bleeding routinely treated by endoscopic hemostasis. PATIENTS AND METHODS: A multicenter study was carried out in 8 Western French hospitals in 144 patients with gastrointestinal bleeding peptic from ulcer type I or IIa, b as defined by Forrest classification. Thirty four and 38 parameters were studied respectively in order to predict recurrent bleeding and death. Significant predictive factors (P < 0.1) in univariate analysis were entered in a multivariate logistic regression analysis. RESULTS: Endoscopic hemostasis was performed in 108 of 144 cases (75%). Recurrent bleeding and death occurred in 39 (28%) and 22 cases (15%), respectively. By multivariate analysis, the only predictor of rebleeding was hypovolemia at admission. Predictors of death were ASA score, cardiovascular Goldman score and recurrent bleeding. In this study, prevalence of Helicobacter pylori infection was low (41%) but was not a predictive factor. CONCLUSIONS: In a selected population of peptic ulcer bleeding patients with high risk of rebleeding, prevalence of recurrent bleeding and death remains rather high, despite routine endoscopic hemostasis. In the era of endoscopic hemostasis, clinical parameters remain the best prognostic factors of peptic ulcer bleeding outcome.

Aged↗
PubMed2003

[Endoscopic radio wave hemostasis in combined treatment of gastroduodenal ulcers complicated by bleeding].

Radiowave hemostasis was used for endoscopic stopping of bleeding from gastric and duodenal ulcers in 96 patients. Primary single radiowave hemostasis permitted to achieve stable effect in 80 (83.3%) patients. After repeated radiowave hemostasis bleeding was completely stopped in 14 (14.6%) patients, 2 (2.1%) patients of this group underwent urgent surgery. On day 10 after radiowave hemostasis 95% of mucosal defects epithialized.

Adult↗
PubMedDate not supplied

Effects of Bulgarian red and white wines on primary hemostasis and experimental thrombosis in rats.

A number of epidemiological studies have demonstrated that moderate red wine consumption significantly decreases the risk of ischemic heart disease. Our earlier studies provide evidence that Italian red wine modulates primary hemostasis and prevents experimental venous thrombosis in rats, independently of its alcohol content, by a nitric oxide (NO)-mediated mechanism. In the present study, we have tested whether Bulgarian red and white wines can influence thrombotic process and primary hemostasis in rats. NO and PGI2 were evaluated as possible mediators of these effects. We have found that red wine treatment (for 10 days) induced a marked prolongation of bleeding time, decrease in platelet adhesion to fibrillar collagen, reduction in venous thrombus weight and shortening of occlusion time in arterial thrombosis model. The fall in venous thrombus weight was also observed after white wine supplementation. Red wine affects hemostasis and venous thrombosis after its iv injection 15 min before experiment. These effects were prevented by NO inhibitor (L-NAME) and PGI2 inhibitor (indomethacin). Our results demonstrate the ability of Bulgarian wines to modulate primary hemostasis and prevent venous and arterial thrombosis in rat.

Administration, Oral↗
PubMed2005

The safety and efficacy of "pre-closure" utilizing the Closer suture-mediated vascular closure device for achievement of hemostasis in patients following coronary interventions: results of the second Perclose Accelerated Ambulation and Discharge (PARADISE II) Trial.

BACKGROUND: Suture-mediated closure devices have been developed to improve patient comfort and safety following percutaneous coronary interventions (PCI). The Perclose AcceleRated Ambulation and DISchargE (PARADISE) trial which we reported previously showed that the Prostar XL appears to be a safe and effective device to achieve hemostasis, improve time-to-ambulation and discharge post-PCI. The diameter of suture capture with the Closer 6 Fr suture-mediated closure device is larger than an 8 Fr hole. This study was performed to assess the pre-closure efficacy using the Closer device in terms of time-to-hemostasis, ambulation and discharge, as well as the incidence of peripheral vascular complications. METHODS: Between January and September 2001, 153 consecutive patients were enrolled in this study. In 97 patients, the Closer sutures were introduced prior to insertion of the 8 Fr sheath (pre-closure arm). In 56 patients, the sutures were tied at the conclusion of PCI upon sheath removal (standard arm). RESULTS: The Closer device was successfully placed on 152 of 153 attempts. The time-to-hemostasis, ambulation and discharge of the pre-closure arm patients seemed to be comparable to those of the standard arm and the PARADISE trial. No major complications were reported. CONCLUSION: The Closer seems to be as safe and effective as the Prostar XL device. The pre-closure technique is a safe means of achieving hemostasis post-PCI using large-sized sheaths without major complications.

Adult↗
PubMed2005

[Balloon compression hemostasis in injuries of parenchymatous organs].

Balloon compression method of hemostasis in injuries of parenchymatous organs is described. Developed device consists of inflatable balloon and double-lumen tube for drainage of abdominal cavity and filling of balloon with air. Hemostasis is achieved due to inflation of balloon and pressure on injured surface. Parameters of pressure and time of compression were determined in experimental study. This device can be used both in open and video-assisted laparoscopic surgeries. Described method was used in 29 patients (22 of them underwent laparoscopic surgery and in 7 patients the device was applied during laparotomy). This method permits to achieve reliable sutureless hemostasis, to control hemostasis and pressure on the wound, to drain abdominal cavity.

Abdominal Injuries↗
PubMed2006

[Post-tonsillectomy hemostasis: a prospective, randomized, double-blind study comparing argon beam coagulation and monopolar electrocoagulation].

BACKGROUND: Argon Beam Coagulation (ABC) enables effective hemostasis and limited penetration depth of the coagulation zone. OBJECTIVE: This prospective, randomized, double-blind study compares ABC and monopolar electrocoagulation for post-tonsillectomy hemostasis. METHODS: Fifty patients undergoing elective tonsillectomy were enrolled into the study. Final hemostasis was achieved using ABC in one fossa and electrocoagulation in the other fossa, with the sides chosen at random. Postoperative bleeding, postoperative pain and the healing of the tonsillar fossa were compared for both methods. RESULTS: No differences in any of the outcome measures were found between the two methods. ABC was felt to be faster and more comfortable than monopolar electrocoagulation. CONCLUSION: ABC is an effective and comfortable method for post-tonsillectomy hemostasis.

Blood Coagulation↗
PubMed1996

Hemostasis with endoscopic hemoclipping for severe gastrointestinal bleeding in critically ill patients.

OBJECTIVES: The fact that endoscopic hemostasis is difficult to achieve and that the rebleeding rate is high in critically ill patients with gastrointestinal bleeding has often been reported. The purpose of this study was to examine the efficacy of endoscopic hemoclipping for gastrointestinal bleeding from ulcers and gastrointestinal lesions associated with critical illnesses. METHODS: Critically ill patients who were treated in a university hospital were studied prospectively. For patients with predefined clinically significant gastrointestinal bleeding, an established protocol of endoscopic hemoclipping (including indications and procedures) was used. RESULTS: Ten of 885 patients were treated according to this protocol. All suffered circulatory collapse, and respiratory management required intubation. The initial rate of hemostasis was 100%, and no rebleeding was observed. The APACHE III scores at 24 h after hemostasis were reduced, relative to the time of bleeding (p < 0.01). CONCLUSION: Endoscopic hemoclipping is useful in achieving hemostasis in critically ill patients with severe gastrointestinal bleeding.

APACHE↗
PubMedDate not supplied

A biological model for the regulation of peri-implantational hemostasis and menstruation.

OBJECTIVE: To delineate the physiologic mechanisms whereby the human endometrium maintains hemostasis during endovascular trophoblast invasion but permits menstrual hemorrhage. METHODS: Experimental results are presented that are relevant to developing a comprehensive biological model for studying peri-implantational hemostasis and menstruation. RESULTS: A marked increase in the expression of tissue factor (TF) and type-1 plasminogen activator inhibitor (PAI-1) and an inhibition of tissue-type and urokinase-type plasminogen activators (tPA and uPA, respectively), matrix metalloproteinases (MMP), and endothelin-1 (ET-1) expression accompany progestin-induced decidualization of estrogen-primed endometrial stromal cells both in vivo and in vitro. The presence of these important regulators of hemostasis, fibrinolysis, extracellular matrix (ECM) turnover, and vascular tone in decidualized human stromal cells and decidual cells isolated from gestational endometrium suggests a mechanism to explain the absence of hemorrhage during invasion of the endometrial vasculature by trophoblasts. Conversely, progesterone withdrawal reduces TF and PAI-1 expression and increases tPA, uPA, MMP, and ET-1 expression accounting for the hemorrhage, enhanced fibrinolysis, ECM degradation, and ischemic spiral arterial vascular injury characterizing menstruation. CONCLUSION: Perivascular decidualized endometrial stromal cells are spatially and temporally positioned to promote endometrial hemostasis during implantation but, paradoxically, promote the hemorrhage of menstruation via their hormone-regulated expression of hemostatic, proteolytic, and vasoactive proteins.

Embryo Implantation↗
PubMed1995

[Changes in hemostasis during orthotopic liver transplantation and massive transfusion: a case report].

UNLABELLED: Changes in hemostasis during orthotopic liver transplantation (OLT) and an intraoperative bleeding complication requiring massive transfusion are discussed. DESIGN: The monitoring of hemostasis included bed-sided thromboelastography, measurement of in vitro platelet function with the thrombostat and routine coagulation tests as well as retrospective analysis of coagulation factors. RESULTS: Changes in hemostasis during OLT were documented as reported previously until reperfusion of the donor organ. Due to an incongruence between the caval veins and massive surgical bleeding, the liver had to be clamped again for reconstruction and perfused with University-of-Wisconsin solution. The second reperfusion was technically uncomplicated. However, the coagulation profile deteriorated dramatically: especially a decrease in platelet function and hyperfibrinolysis led to massive oozing. Successful therapeutical intervention included substitution of packed red blood cells. fresh frozen plasma, platelets. concentrates of hemostatic factors, and aprotinin. The patient was discharged from hospital after 5 weeks with a good liver function and a normal coagulation profile. CONCLUSION: During OLT, clinically relevant changes in hemostasis can occur suddenly. Therefore. a close perioperative monitoring of primary and secondary coagulation is mandatory.

Blood Coagulation Tests↗
PubMed1997

Hemostasis in endodontic microsurgery.

There are numerous ways to achieve hemostasis. With the abundance of hemostatic agents available and with the introduction of new products, one has to make an objective decision. A good agent achieves hemostasis within a short period of time, is easy to manipulate, is biocompatible, does not impair or retard healing, must be relatively inexpensive, is reliable, and works best for the particular surgical procedure. With these purposes in mind, the following sequence is recommended to achieve hemostasis during endodontic microsurgery. I. Presurgical: Give 2 to 3 Carpules of 1:50,000 epinephrine local anesthetic with multiple infiltration sites throughout the entire surgical field. II. Surgical: A. Remove all granulation tissue. B. Place an epinephrine pellet into the bony crypt followed by dry sterile cotton pellets. Apply pressure for 2 minutes. Remove all the cotton pellets except the first epinephrine pellet. Continue with the surgical procedure and remove the epinephrine pellet before final irrigation and closure. C. Alternatively, calcium sulfate can be mixed into a thick putty and packed against the bone cavity. Because it is a biodegradable material, calcium sulfate can be left in situ. In fact, in large bone defects and through-and-through lesions, additional calcium sulfate can be placed to fill the entire bone cavity as a barrier material. Healing is more predictable with little chance of scar tissue formation. Calcium sulfate resorbs in 2 to 4 weeks. D. Small bleeding sites in the bone can be brushed with ferric sulfate solution. III. Postsurgical: Tissue compression before and after suturing cuts down on postsurgical bleeding and swelling. Hemostasis is imperative in endodontic microsurgery for better visualization, a good environment for placement of retrograde filling material, and a more efficient surgical procedure with less blood loss.

Alveolectomy↗
PubMed2001

A new vascular sealant (Sealgel) to achieve rapid hemostasis after percutaneous angioplasty in anticoagulated patients: clinical feasibility and preliminary results.

The aim of this study was to assess the feasibility of a new vascular sealant (Sealgel) to provide rapid hemostasis in anticoagulated patients after percutaneous transluminal angioplasty (PTA). Sealgel was designed with ancrod (10 mg) and tranexamic acid (80 mg) dissolved in a hyaluronic acid gel (3 ml). Fifty anticoagulated patients (heparin, aspirin, ticlopidin) who underwent PTA of coronary artery were enrolled in the study. Sealgel (3 ml) was delivered under manual compression through a 9-F cannula at the arterial puncture site after the introducer sheath removal at the end of PTA procedure. Hemostasis time as well as complications were recorded. Sealgel was successfully delivered in 98 % of patients. Hemostasis occurred within 15 mn of manual compression in 82 % of patients, within 25 mn in 98 %, and failed in 1 patient (2 %). Hematoma (6-cm diameter) was observed in 1 patient and late bleeding in another one. There were no clinical signs of embolism, inflammatory swelling, local infection, vascular fistula, or pseudoaneurysm. No surgery or blood transfusion was required. Sealgel application after PTA in anticoagulated patient is feasible and secure. Preliminary results suggest that the Sealgel brought about rapid hemostasis; however further studies are needed to determine its clinical efficacy.

Aged↗