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At least 145 records · Page 8Linked to original sources
PubMed1993

Recombinant activated factor VII in the treatment of bleeding episodes in patients with inherited and acquired bleeding disorders.

The FVIII/FIX by-passing agent, rFVIIa, offers an alternative approach to the treatment of hemophilia patients as well as nonhemophiliacs with antibodies against FVIII/FIX. Such treatment can be administered regardless of the inhibitor titer in these patients, and rFVIIa is active hemostatically in hemophilia B patients also. It is easy to administer but seems to need repeated dosing at 2 to 3-hour intervals, at least initially, in patients with severe bleeding, with a dose of 70 to 100 micrograms/kg body weight required to induce hemostasis. Depending on the severity of the bleeding the dose intervals may be prolonged to every 3 hours for 1 to 2 days or until clinical improvement is observed. Thereafter, the dosage interval can be increased to every 4 hours if continued therapy is required.

Blood Coagulation Disorders↗
PubMed2003

Effect of oral omeprazole in reducing re-bleeding in bleeding peptic ulcers: a prospective, double-blind, randomized, clinical trial.

BACKGROUND: Endoscopic therapies and continuous intravenous omeprazole can decrease the morbidity and duration of hospital stay of patients with high-risk peptic ulcer. AIM: To evaluate the role of oral omeprazole in high-risk bleeders. METHODS: After injection therapy of 160 patients with high-risk peptic ulcer, 80 received oral omeprazole and 80 received placebo, and all were followed up. RESULTS: One hundred and forty-nine patients (71 omeprazole and 78 placebo) completed the study. Eleven patients were excluded from the study. Thirty-seven (25%) patients had gastric ulcer and 112 (75%) had duodenal ulcer. Fifty-seven (38%) ulcers showed visible vessels, 80 (54%) showed oozing of blood and 12 (8%) showed a spurting artery. Only one patient died (placebo group). The mean hospital stays were 62.8 +/- 28.6 h and 75 +/- 39 h in the omeprazole and placebo groups, respectively (P = 0.032). The mean amounts of blood transfused were 1.13 +/- 1.36 and 1.68 +/- 1.68 bags in the omeprazole and placebo groups, respectively (P = 0.029). The re-bleeding rate was lower in the omeprazole group than in the placebo group (12 vs. 26, respectively; P = 0.022). CONCLUSION: Oral omeprazole is effective in decreasing the hospital stay, re-bleeding rate and the need for blood transfusion in high-risk ulcer bleeders treated with endoscopic injection therapy.

Administration, Oral↗
PubMed1989

Technetium-99m RBC bleeding images in normal subjects: confusion with gastrointestinal bleeding sites.

The normal appearance of a gastrointestinal bleeding study using labeled red blood cells has been discussed frequently, but the actual appearance is not well known. In this atlas article, the authors report on unusual findings in non-bleeding subjects and have tabulated the visualization of various structures. Vascular structures other than the aorta and inferior vena cava were seen in 42 of 48 patients. One or both kidneys were seen in 10 (21%) of 48 patients. The urinary bladder was seen in 23 (48%) of 48 patients, although gastric activity caused by free pertechnetate was never observed.

Erythrocytes↗
PubMed2005

To bleed or not to bleed? Is that the question for the PTT?

The activated partial thromboplastin time (PTT) is the grandchild of the Lee-White whole blood clot time (WBCT). Both tests were developed to assist the diagnostic process for patients who exhibited features consistent with hemophilia, i.e., the pretest probability was extremely high. Probably <0.1%-1.0% of PTTs ordered in current medical practice fit that indication with the most common indication now being routine admission order; i.e., a pretest probability that is extremely low. The question asked of the PTT has evolved from 'why does this patient bleed?' to 'will this patient bleed?' As the PTT was never intended to answer that question, one must be careful regarding interpretation of results of that test. As many situations not related to hemorrhage are associated with perturbations of the PTT, a prolonged PTT is not strongly predictive of hemorrhage nor does a normal PTT provide shelter against hemorrhagic risk.

Blood Loss, Surgical↗
PubMed1988

Prospective comparison of double contrast barium enema plus flexible sigmoidoscopy v colonoscopy in rectal bleeding: barium enema v colonoscopy in rectal bleeding.

Rectal bleeding often heralds serious colonic disease. The literature suggests that colonoscopy is superior to barium enema plus sigmoidoscopy, although no good comparative studies exist. Seventy one patients with overt rectal bleeding had prospectively flexible sigmoidoscopy, double contrast barium enema and colonoscopy completed independently. Against the gold standard, the sensitivity and specificity of colonoscopy were 0.69 and 0.78 respectively for a spectrum of colonic lesions, while for combined flexible sigmoidoscopy and double contrast barium enema these values were 0.80 and 0.56, respectively. When assessing adenoma or carcinoma, colonoscopy was more sensitive at 0.82 v 0.73, while flexible sigmoidoscopy plus double contrast barium enema was superior for detecting diverticular disease. The positive predictive value for colonoscopy was 0.87 against 0.81 for flexible sigmoidoscopy and double contrast barium enema. This study confirms that colonoscopy should be a first line investigation in subjects likely to require biopsy or therapeutic intervention.

Barium Sulfate↗
PubMed1999

An evidence-based guideline for the management of heavy menstrual bleeding. Working Party for Guidelines for the Management of Heavy Menstrual Bleeding.

AIMS: The objective of this guideline is to provide evidence-based recommendations for the management of regular heavy menstrual bleeding in women with no detectable pathology. METHODS: A multidisciplinary working party was formed which met on four occasions over a 12 month period. The evidence from randomised controlled trials was summarised into evidence tables and guidelines were developed. A draft report was circulated in November 1997 prior to the final report which was published in July 1998. RESULTS: A diagnostic and treatment algorithm was produced (Figure 1) as well as a full text report. The cost of implementing the guideline was considered and overall net savings of $6 million were likely. CONCLUSIONS: An explicit evidence-based guideline on the management of heavy menstrual bleeding was produced. Both the Royal New Zealand College of Obstetricians and Gynaecologists and the Royal New Zealand College of General Practitioners endorsed this guideline.

Adult↗
PubMed1999

Abnormal vaginal bleeding in adolescence as the presenting symptom of a bleeding diathesis.

Menorrhagia in adolescents may be the presenting sign of a systemic hemostatic disorder. The evaluation of adolescents with menorrhagia should include an assessment of the pelvic organs to exclude anatomic pathology, and if none is found the possibility of primary hematological abnormality should be considered. Initially, a thorough personal and family history of a bleeding tendency should be obtained. Thereafter, we suggest a number of basic "screening" clotting assays be performed. These should include a platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen level and bleeding time. Abnormalities of any of these tests should then be further investigated using more specific clotting assays. The most common disorders reported to cause menorrhagia in adolescents are von Willebrand's disease, factor XI deficiency, and Glanzmann's thrombasthenia. General and specific therapeutic measures for treating these disorders are discussed.

Adolescent↗
PubMed1993

Acquired bleeding disorders: bleeding in obstetrics and surgery.

Hemorrhage continues to be the leading cause of maternal mortality and morbidity throughout the world. In England and Wales from 1970-87 hemorrhage, including ectopic pregnancy, was a major factor in over 40 maternal deaths. In the majority of deaths the care was substandard. In 70% of obstetric deaths from hemorrhage defective hemostasis contributes to the bleeding. Inappropriate correction of hypovolemia, failure to recognise and treat coagulation failure, and failure to control traumatic bleeding are the main causes of preventable death. In developing countries, cross matched blood and blood products may not be readily available. Surgical intervention should be preceded or accompanied by correction of the hemostatic defect with fresh frozen plasma and if necessary platelet concentrates. Teamwork with experienced staff is the essence of successful management of severe hemorrhage in obstetrics and surgery. A protocol should be agreed between medical nursing and laboratory staff for dealing with massive blood loss.

Blood Coagulation Disorders↗
PubMed1997

A method for measuring capillary bleeding time in non-anaesthetized dogs: prolongation of the bleeding time by acetylsalicylic acid.

A reproducible standardized method for measuring capillary bleeding time (CBT) in dogs is presented. The skin was punctured at the toe from a forelimb of non-anaesthetized dogs parallel to the edge of the horny skin of the pad. Before the procedure, a cuff of a sphygmometer was placed above the antibrachium and a hyperaemie agent was applied to the shaved area. The normal CBT in non-anaesthetized dogs was 2.25 +/- 0.76 min (x +/- SD). After injection of acetylsalicylic acid (ASA) (20 mg/kg body weight), CBT was prolonged up to 25 min. Platelet aggregation in response to 10 micrograms collagen/ml was decreased in parallel after treatment with ASA.

Animals↗
PubMed2002

Anticoagulants: to bleed or not to bleed, that is the question.

Thromboembolic vascular diseases remain the main cause of death in Western industrialized societies. Anticoagulants retard the formation, growth, and embolization of thrombi and are effective agents in the prevention and treatment of thromboembolic disease. Anticoagulants in venous thromboembolism have been investigated extensively with rigorous randomized, controlled trials, while the roles for anticoagulants in arterial thromboembolism generally have evolved through natural history studies and empirical practice. Thus, many current guidelines for anticoagulant use in arterial disease are based on successful established routines and rational therapy. To effectively balance the efficacy and risks of anticoagulation, the vascular surgeon needs a thorough understanding of anticoagulant drugs, their mechanisms of action, and their proven and unproven indications. Since the first use of heparin in arterial surgery, a variety of new and different anticoagulants have become available, including low-molecular-weight heparins, heparin-like drugs, hirudins, and thrombin inhibitors. Despite their diverse actions, they all inhibit some portion of the plasma coagulation cascade, thus distinguishing them from platelet inhibitors or fibrinolytics. Every interference with the coagulation cascade carries a risk of minor, major, or fatal hemorrhage. To date, no drug or therapeutic strategy has succeeded fully in dissociating its antithrombotic effects from its risks of bleeding.

Anticoagulants↗
PubMed1977

Division and repair of the sphincteric mechanism at the gastric outlet in emergency operations for bleeding peptic ulcer. A new technique for use in combination with suture ligation of the bleeding point and highly selective vagotomy.

In three of 26 patients who were treated by highly selective vagotomy (HSV) plus suture of the bleeding point for massive hemorrhage from peptic ulceration, access to the ulcer could not be obtained by means of a duodenotomy or gastrotomy which spared the pylorus. Instead, a wide gastroduodenotomy was performed, the artery in the base of the ulcer underrun and HSV performed. The gastroduodenotomy incision was closed longitudinally, rather than as a pyloroplasty. In this way, the integrity of the antral mill and of the pyloric sphincter was restored. The patients were followed up for six months, one year and three years respectively, and were found to be in good health, without clinical or radiological evidence of gastric retention or of recurrent ulceration. Thus the sphincteric mechanism at the exit of the stomach can, like the anal sphincter, be divided and subsequently repaired with good restoration of function.

Aged↗
PubMed1992

[Bleeding tendency and periodontal diagnosis. Evaluation of the prognostic significance of bleeding tendency for periodontal diagnosis].

Since differences in susceptibility to periodontal breakdown do exist, it is essential to predict future breakdown on the basis of a prognostic indicator. The experimental gingivitis model was chosen to investigate the clinical differences related to the degree of susceptibility to periodontal breakdown. Both bleeding upon probing and the amount of plaque seems to depend on the history of inflammatory periodontal disease. It is concluded that the bleeding/plaque ratio may act as a prognostic indicator to predict periodontal breakdown.

Dental Plaque↗