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Kang, Ka-Won, Yumin Choi, Hyung-Jun Lim, Kunye Kwak, Yoon Seok Choi, Yong Park, Byung Soo Kim, Kwang-Sig Lee, and Ki Hoon Ahn. "Impact of Platelet Transfusion and Bleeding Risk Stratification in Patients with Immune Thrombocytopenia before Procedures: A Nationwide Population-Based Cohort Study." Blood 144, Supplement 1 (November 5, 2024): 3942. https://doi.org/10.1182/blood-2024-194107.
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Background: The main treatment goal for immune thrombocytopenia (ITP) is to reduce bleeding risk, requiring extra precautions during procedures. Adjusting platelet thresholds with ITP treatments is usually recommended, but platelet transfusions are commonly used despite their controversial benefits. This study aims to evaluate the effectiveness of platelet transfusion in reducing post-procedure bleeding risk and to identify predictive indicators of post-procedure bleeding. Methods: This study used a nationally representative database to develop a model to predict the risk of post-procedure bleeding in patients with ITP. Machine learning analyses, including random forest feature importance and Shapley additive explanations (SHAP) values, were employed. This contained a total of 34 post-procedural bleeding risk factors, including the amount of platelet transfusion. Results: The random forest model had an area under the receiver-operating characteristic curve of 93.6%. The analysis identified the following variables as most important: amount of platelet transfusion, high-risk procedure, use of anticoagulant drugs, no use of antiplatelet or anticoagulant drugs, anemia, age, low-risk procedure, moderate-risk procedure, ITP treatment, and newly diagnosed ITP. Amount of platelet transfusion, high-risk procedures, use of anticoagulant drugs, anemia, ITP treatment, and newly diagnosed ITP positively correlated with post-procedure bleeding risk. In contrast, no use of antiplatelet or anticoagulant drugs and moderate- or low-risk procedures were negatively associated with post-procedure bleeding risk. In the SHAP dependence plot, the amount of platelet transfusion was associated with high-risk procedures. Additionally, among patients undergoing high-risk procedures, the likelihood of post-procedure bleeding increased with age. Conclusions: Platelet transfusion does not significantly reduce the risk of post-procedural bleeding in patients with ITP. The risk of post-procedural bleeding is more closely related to the bleeding risk of the procedure and the patient's medical condition. Minimizing inappropriate platelet transfusions and addressing factors that can increase bleeding risk before procedures are crucial. Keywords: Immune thrombocytopenia, Procedure, Platelet transfusion, Bleeding risk, Machine learning analysis
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Inoue, Takuya, Hideki Iijima, Takuya Yamada, Yuji Okuyama, Kanae Takahashi, Tsutomu Nishida, Ryu Ishihara, et al. "A prospective multicenter observational study evaluating the risk of periendoscopic events in patients using anticoagulants: the Osaka GIANT Study." Endoscopy International Open 07, no. 02 (January 17, 2019): E104—E114. http://dx.doi.org/10.1055/a-0754-1997.
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Abstract Background and study aims An increasing number of patients have been using anticoagulants including anti-vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs); however, in patients using anticoagulants, limited data are available with regard to the risks of gastrointestinal bleeding and thromboembolic events during the peri-endoscopic period. We aimed to evaluate the peri-endoscopic bleeding and thrombotic risks in patients administered VKAs or DOACs. Patients and methods Consecutive patients using anticoagulants who underwent endoscopic biopsy, mucosal resection, or submucosal dissection were prospectively enrolled across 11 hospitals. The primary outcome assessed was difference in incidence of post-procedural gastrointestinal bleeding in patients using VKAs and DOACs. Duration of hospitalization and peri-procedural thromboembolic events were also compared. Results We enrolled 174 patients using VKAs and 37 using DOACs. In total, 16 patients using VKA were excluded from the analysis because of cancellation of endoscopic procedures and contraindications to the use of DOACs; 128 (81 %) patients using VKAs and 17 (46 %) using DOACs received heparin-bridging therapy (HB). The rate of post-procedural gastrointestinal bleeding in DOAC users was similar to that in VKA users (16.2 % vs. 16.4 %, P = 1.000). Duration of hospitalization was significantly longer in patients using VKAs than in those using DOACs (median 15 vs. 7 days, P < 0.0001). Myocardial infarction occurred during pre-endoscopic HB in one patient using VKAs. Conclusion DOAC administration showed similar post-procedural gastrointestinal bleeding risk to VKA administration in patients undergoing endoscopic procedures, but it shortened the hospital stay.
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Trivedi, Bhushan, T. R. V. Wilkinson, and Murtaza Akhtar. "Day care management of grade I and II bleeding hemorrhoids." International Surgery Journal 6, no. 8 (July 25, 2019): 2916. http://dx.doi.org/10.18203/2349-2902.isj20193342.
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Background: Hemorrhoids occur in up to 80% of the population, involving any age and affecting males and females equally1 First and second-degree hemorrhoids can be treated conveniently on an out-patient basis by sclerotherapy and rubber band ligation 2. This study aims at comparing outcomes of these modalities for the treatment of grade I and II bleeding hemorrhoids.Methods: In NKP Salve institute of Medical Sciences and Research Centre hospital based nonrandomized comparative study, patients clinically diagnosed as Grade I and II bleeding hemorrhoids were included. Subjects were divided in into two groups i.e Barron’s banding and Injection of Sclerosant. The post procedural complications for the first 24 hrs were recorded, follow up was taken at regular intervals and any complications were recorded.Results: A total of 50 patients were enrolled with mean age 42.01 years and a male preponderance, with 31 males and 19 females. Barron’s banding was carried out in 25 subjects and the 25 subjects were subjected to Injection of sclerosant the mean duration taken for Injection of sclerosant was 13.6 min and in Barron’s banding 16.4 min. In the first 24hrs post procedural bleeding was observed in 40% subjects in the Barron’s banding group and 52% in the injection of sclerosant group. For post procedural pain the mean VAS score in the Barron’s group was 1.84 and 0.96 in injection of sclerosant group, follow up at 3rd month showed 16% recurrence of bleeding and 32% in injection of sclerosant group.Conclusions: Injection of sclerosant is better than Barron’s banding procedure in terms of post procedural pain.
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Nandivada, Prathima, Lorenzo Anez-Bustillos, Alison A. O'Loughlin, Paul D. Mitchell, Meredith A. Baker, Duy T. Dao, Gillian L. Fell, et al. "Risk of post-procedural bleeding in children on intravenous fish oil." American Journal of Surgery 214, no. 4 (October 2017): 733–37. http://dx.doi.org/10.1016/j.amjsurg.2016.10.026.
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Mou, An-Na, and Yu-Ting Wang. "Endoscopic polidocanol foam sclerobanding for treatment of internal hemorrhoids: A novel outpatient procedure." World Journal of Gastroenterology 30, no. 42 (November 14, 2024): 4583–86. http://dx.doi.org/10.3748/wjg.v30.i42.4583.
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In the study, we comment on the article by Qu et al . Internal hemorrhoids are the most common anorectal disorders worldwide with bleeding, prolapse, and difficulty in defecation. Endoscopic rubber band ligation (ERBL) is a safe, convenient, quick, and economical outpatient procedure. The main goal of ERBL is to alleviate prolapse, but the high incidence of recurrence and post-procedural pain are of clinical concern. Polidocanol foam as a local hemostatic and anesthetic agent could reduce the rates of post-procedural pain and bleeding. Endoscopic polidocanol foam sclerobanding (EFSB) is a novel approach that could lift the mucosa for easy ligation and promote increased scarring in the submucosal tissue which translates into long-term relief from prolapse recurrence and reduced 24-h post-procedural pain. The study by Qu et al is a novel multi-center prospective randomized study to compare ERBL and EFSB in patients with grades II and III internal hemorrhoids with one-year follow-up. Results showed that EFSB is a novel therapy for internal hemorrhoids, but future studies with a larger sample, multiple treatment sessions, and long-term follow-up are required to confirm these findings.
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Torigoe, Kenta, Ayuko Yamashita, Shinichi Abe, Kumiko Muta, Hiroshi Mukae, and Tomoya Nishino. "Effect of Hemocoagulase on the Prevention of Bleeding after Percutaneous Renal Biopsy." Toxins 14, no. 3 (March 18, 2022): 223. http://dx.doi.org/10.3390/toxins14030223.
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A percutaneous renal biopsy is an essential tool for the diagnosis of various renal diseases; however, post-biopsy bleeding is a major complication. Hemocoagulase is a detoxified and purified snake venom enzyme that is widely used to prevent post-procedural bleeding. In this study, we retrospectively analyzed the effect of hemocoagulase on post-renal biopsy bleeding. We included 221 patients who underwent percutaneous renal biopsy between April 2017 and December 2020 and analyzed post-renal biopsy hemoglobin (Hb) decline in patients who were administered a periprocedural hemocoagulase injection. After the renal biopsy, the mean Hb decrease in the entire patient cohort was 0.33 ± 0.84 g/dL. Periprocedural hemocoagulase injection lowered the Hb decline post-renal biopsy (0.50 ± 0.87 vs. 0.23 ± 0.80 g/dL, p = 0.0204). The propensity-matched cohort was also adjusted for factors influencing postprocedural bleeding; periprocedural hemocoagulase injection reduced the Hb decline post-renal biopsy (0.56 ± 0.89 vs. 0.17 ± 0.74 g/dL, p = 0.006). There were no adverse events (e.g., thrombosis and anaphylactic shock) due to hemocoagulase. Our study demonstrated the beneficial effect of hemocoagulase on post-renal biopsy Hb decline, suggesting its clinical value in preventing post-renal biopsy bleeding.
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Jiang, Tian’an, Alexis Kelekis, Qiyu Zhao, Argyro Mazioti, Jia Liu, Nikolaos Kelekis, Guo Tian, and Dimitrios Filippiadis. "Safety and efficacy of percutaneous microwave ablation for post-procedural haemostasis: a bi-central retrospective study focusing on safety and efficacy." British Journal of Radiology 93, no. 1106 (February 1, 2020): 20190615. http://dx.doi.org/10.1259/bjr.20190615.
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Objective: To review safety and efficacy of percutaneous microwave ablation (MWA) for post-procedural haemostasis. Methods: Institutional databases retrospective research identified 10 cases of iatrogenic bleeding who underwent percutaneous MWA for post-procedural haemostasis. Ultrasound examination with Doppler and contrast enhancement identified a source of active bleeding prior to ablation; additionally they were used as guiding modality for antenna insertion whilst, post-ablation, assessed the lack of active extravasation. Target locations included liver intercostal space spleen and thyroid gland. Technical success was defined as positioning of the antenna on the desired location. Treatment end point was considered the disappearance of active extravasation in both Doppler imaging and contrast-enhanced ultrasound. Results: Technical success (i.e. positioning of the antenna on the desired location) was achieved in all cases. No complications were noted. All patients post MWA remained haemodynamically stable with no need for transfusion and were discharged from the hospital the next morning. Imaging and clinical follow-up in all patients before exiting the hospital did not depict any sign of active extravasation or bleeding. Conclusion: Our limited experience reports preliminary data showing that MWA could be added in the armamentarium of percutaneous therapies for iatrogenic bleeding. More prospective studies with larger patient samples are necessary for verification of this technique as well as for drawing broader conclusions in order to evaluate the place of percutaneous ablation in the treatment algorithm of haemorrhage. Advances in knowledge: Percutaneous ablation might have a role in haemostasis in well-selected cases
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Altawil, Zaid, Bryan J. Gendron, and Elissa M. Schechter-Perkins. "Topical use of tranexamic acid for the management of post-procedural rectal bleeding." American Journal of Emergency Medicine 37, no. 1 (January 2019): 173.e3–173.e4. http://dx.doi.org/10.1016/j.ajem.2018.09.037.
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Alasbali, Tariq. "Bleeding Post Chalazion Surgery Managed by Cauterization: A case report." Majmaah Journal of Health Sciences 11, no. 3 (2023): 105. http://dx.doi.org/10.5455/mjhs.2023.03.011.
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Chalazion is an eye lid lesion caused by the blockage and swelling of Meibomian glands and are very common in occurrence. Incision and curettage of chalazion is a minor procedure and is recommended for the ones resisting conservative medical treatment. Here an atypical case report of surgical management of post procedural haemorrhage of an upper left eye chalazion in a hypertensive patient is presented. The patient reported with haemorrhage soon after an uneventful chalazion incision procedure. The site of incision was successfully cauterized to manage the bleeding as it did not respond to pressure applications to stop the bleeding. Cauterization is a minimally invasive approach which is effective and safe method to manage post-operative bleeding complications from a chalazion incision.
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Pradyumna, Agasthi, and Sai Harika Pujari. "Peri- and Post-procedural Anticoagulation with Left Atrial Appendage Occlusion Devices." Heart International 17, no. 1 (2023): 54. http://dx.doi.org/10.17925/hi.2023.17.1.54.
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In patients with atrial fibrillation and high stroke risk, anticoagulation with direct oral anticoagulants or vitamin K antagonists is the standard of care for stroke prevention. The benefit of anticoagulation is driven by attenuating the risk of thrombus formation in the left atrial appendage. Percutaneous left atrial appendage occlusion offers an alternative therapeutic strategy for stroke prevention in patients with high bleeding risk or contraindications for long-term anticoagulation. This review of the current literature delineates the standard protocols of peri- and post-procedural anticoagulation/antithrombotic therapy after left atrial appendage occlusion, the complications of the procedure, and the risk of device-related thrombosis and of incomplete occlusion of the appendage. Finally,the limitations and gaps in the literature are identified.
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Ge, Heng, Chi Zhang, Zhi-Qing Qiao, Zi-Yong Hao, Zheng Li, Zhi-Chun Gu, Li-Sheng Jiang, Ben He, and Jun Pu. "Risk of device-related thrombosis following short-term oral anticoagulation with low-dose dabigatran versus warfarin after Watchman left atrial appendage occlusion." Science Progress 105, no. 3 (July 2022): 003685042211131. http://dx.doi.org/10.1177/00368504221113194.
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Background: Percutaneous left atrial appendage occlusion (LAAO) provides an alternative for poor candidates for long-term oral anticoagulation (OAC). To prevent device-related thrombosis (DRT), OAC should be continued for the first 45 days to allow complete endothelialization post-LAAO implantation. Whereas, evidence is limited on the feasibility and safety of direct oral anticoagulants (DOACs) used after LAAO. Methods: This was a retrospective observational single-center study of AF patients undergoing LAAO with a Watchman device and receiving either low-dose dabigatran (110mg twice daily) or warfarin in the peri- and post-procedural period for 45 days. Transesophageal echocardiography was scheduled to perform at 6 weeks, 6 months, and 12 months after the procedure to assess the stability of the device and to detect DRT. Incidence of thromboembolic and bleeding events were also evaluated during the follow-up period. Results: There were a total of 84 patients who successfully underwent Watchman implantation, with 38 patients (45.2%) receiving low-dose dabigatran and 46 patients (54.8%) using warfarin post-LAAO. Peri-procedural complications occurred in 10 patients, with 3 patients in the dabigatran group and 7 patients in the warfarin group (7.9% vs. 15.2%, p = 0.30). During the 12-month follow-up, 1 patient experienced major bleeding and 16 patients suffered minor bleeding in the warfarin group, while 5 patients treated with dabigatran had minor bleeding (34.8% vs. 13.2%, p = 0.02). Besides, 6 DRT (15.8%) were detected in dabigatran groups, and the incidence was higher than in the warfarin group (15.8% vs. 2.2%, p = 0.03). No DRT-related ischemic events were found. Conclusions: This study suggested that short-term low-dose dabigatran (110 mg twice daily) could significantly decrease the risk of bleeding compared with warfarin at the expense of increased risk of DRT post-LAAO. Therefore, low-dose dabigatran should be used with caution for post-implant anticoagulation of LAAO. Further studies are urgently needed on the feasibility and safety of DOACs post-LAAO.
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Branzoli, Stefano, Fabrizio Guarracini, Massimiliano Marini, Giovanni D’Onghia, Domenico Catanzariti, Elettra Merola, Luciano Annicchiarico, et al. "Heart Team for Left Appendage Occlusion without the Use of Antithrombotic Therapy: The Epicardial Perspective." Journal of Clinical Medicine 11, no. 21 (November 1, 2022): 6492. http://dx.doi.org/10.3390/jcm11216492.
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Background: Left atrial appendage occlusion is an increasingly proposed treatment for patients with atrial fibrillation and poor tolerance to anticoagulants. All endovascular devices require antithrombotic therapy. Anatomical and clinical variables predisposing to device-related thrombosis, as well as post-procedural peri-device leaks, could mandate the continuation or reintroduction of aggressive antithrombotic treatment. Because of the absence of foreign material inside the heart, epicardial appendage closure possibly does not necessitate antithrombotic therapy, but data of large series are missing. Methods: Multidisciplinary team evaluation for standalone totally thoracoscopic epicardial appendage closure was done in 180 consecutive patients with atrial fibrillation and poor tolerance to antithrombotic therapy. One hundred and fifty-two patients consented (male 66.1%, mean age 76.1 ± 7.4, CHA2DS2VASc mean 5.3 ± 1.6, HASBLED mean 3.8 ± 1.1). Indications were cerebral hemorrhage (48%), gastro-intestinal bleeding (33.3%), and other bleeding (20.7%). No antithrombotic therapy was prescribed from the day of surgery to the latest follow up. Results: Procedural success was 98.7%. At a mean follow up of 38.2 ± 18.8 months, cardioembolic and bleeding events were 1.3% and 0.6%, respectively. Among patients with a history of blood transfusions (41.1%), none needed further transfusions or treatment post procedure. Conclusion: Epicardial appendage occlusion without any antithrombotic therapy appears to be safe and effective. This strategy could be advised when minimization of bleeding risk concomitant to stroke prevention is needed.
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Ranadive, Isha, Anoop Ninan Koshy, Gennaro Giustino, Samantha Sartori, Nitin Barman, George D. Dangas, Joseph Michael Sweeny, Annapoorna Subhash Kini, Roxana Mehran, and Samin K. Sharma. "INCIDENCE, PREDICTORS AND IMPACT OF POST-PROCEDURAL BLEEDING FOLLOWING IMPELLA-ASSISTED HIGH-RISK PCI." Journal of the American College of Cardiology 79, no. 9 (March 2022): 852. http://dx.doi.org/10.1016/s0735-1097(22)01843-5.
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., Priyanka, and Samir Kumar. "Dental Care for Patients with Bleeding Disorders, Including Hemophilia." International Journal of Medical and Biomedical Studies 9, no. 1 (February 27, 2025): 171–78. https://doi.org/10.32553/ijmbs.v9i1.3018.
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Background: Bleeding disorders, such as hemophilia and von Willebrand disease, pose significant challenges in dental management due to the increased risk of excessive bleeding. Proper pre-treatment evaluation, hemostatic measures, and postoperative care are essential to minimize complications. However, there is a lack of standardized guidelines and awareness among dental professionals, leading to variations in treatment approaches. Aim: This study aimed to evaluate the dental management strategies for patients with bleeding disorders, focusing on treatment protocols, pre-treatment interventions, and post-procedural complications. The findings provide insights into optimizing dental care for this high-risk population. Methods: A cross-sectional study was conducted at Sadar Hospital, Hajipur, Vaishali, Bihar, from May 2023 to October 2024. A total of 50 patients diagnosed with bleeding disorders underwent various dental procedures, including tooth extractions, scaling, restorations, and root canal treatments. Pre-treatment interventions, intraoperative management, and post-treatment complications were recorded. Statistical analysis was performed using SPSS version 23.0, with chi-square and independent t-tests applied for comparative analysis. Results: The majority of participants were male (70%) and aged 18-40 years. Hemophilia A was the most prevalent bleeding disorder (50%), followed by von Willebrand disease (30%) and Hemophilia B (20%). Tooth extractions were the most commonly performed dental procedure (40%). Pre-treatment interventions included Factor VIII replacement (50%), desmopressin (30%), and tranexamic acid (20%). Post-treatment complications occurred in 20% of cases, with prolonged bleeding (12%) being the most frequent. A statistically significant association (p=0.03) was found between procedure type and complications, with extractions posing the highest risk. Conclusion: The study highlights the importance of individualized treatment planning and pre-procedural interventions to minimize complications in dental management for patients with bleeding disorders. The use of factor replacement therapy and antifibrinolytics significantly improved patient outcomes, reducing bleeding-related risks. Recommendations: Standardized guidelines should be established for dental management of patients with bleeding disorders, emphasizing pre-treatment risk assessment and interdisciplinary collaboration with hematologists. Dental practitioners should receive training on appropriate hemostatic measures and emergency protocols to enhance patient safety. Further research is needed to evaluate newer hemostatic agents and minimally invasive dental techniques for this patient population. Keywords: Bleeding disorders, hemophilia, von Willebrand disease, dental management, hemostatic measures
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Manolakis, Anastasios, Kyriaki Tsagkidou, and Konstantinos Eleftherios Koumarelas. "Endoscopic ultrasound-guided therapies in the treatment of gastric varices: An in-depth examination of associated adverse events." World Journal of Gastrointestinal Endoscopy 16, no. 12 (December 16, 2024): 640–46. https://doi.org/10.4253/wjge.v16.i12.640.
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The Baveno VII consensus, released in 2023, recommends that the endoscopic treatment of choice for managing bleeding gastric varices (GV) is endoscopic ultrasound (EUS)-guided treatment, specifically EUS-guided cyanoacrylate (CYA) glue injection. This approach has been endorsed due to its efficacy in controlling bleeding while reducing rebleeding rates, compared to other endoscopic techniques. Despite its efficacy, CYA injection for GV has been linked to rare but serious adverse events, such as glue embolization leading to pulmonary embolism, infection/bacteremia, splenic infarction, intra-procedural and post-procedural complications. The technique for endoscopic obliteration of GV was subsequently refined using EUS guidance, aiming to more accurately direct the injection into the varix, reduce the volume of injected glue, target the perforating vein when possible, and confirm obliteration of GV via Doppler examination.
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Dietrich, Laurent, Marion Kibler, Kensuke Matsushita, Benjamin Marchandot, Antonin Trimaille, Antje Reydel, Bamba Diop, et al. "Impact of Primary Hemostasis Disorders on Late Major Bleeding Events among Anticoagulated Atrial Fibrillation Patients Treated by TAVR." Journal of Clinical Medicine 11, no. 1 (December 31, 2021): 212. http://dx.doi.org/10.3390/jcm11010212.
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Background: Bleeding events are among the striking complications following transcatheter aortic valve replacement (TAVR), and bleeding prediction models are crucially warranted. Several studies have highlighted that primary hemostasis disorders secondary to persistent loss of high-molecular-weight (HMW) multimers of the von Willebrand factor (vWF) and assessed by adenosine diphosphate closure time (CT-ADP) may be a strong predictor of late major/life-threatening bleeding complications (MLBCs). Pre-existing atrial fibrillation (AF) is a frequent comorbidity in TAVR patients and potentially associated with increased bleeding events after the procedure. Objectives: This study evaluated the impact of ongoing primary hemostasis disorders, as assessed by post-procedural CT-ADP > 180 s, on clinical events after TAVR among anticoagulated AF patients. Methods: An ongoing primary hemostasis disorder was defined by post-procedure CT-ADP > 180 s. Bleeding complications were assessed according to the Valve Academic Research Consortium-2 (VARC-2) criteria. The primary endpoint was the occurrence of late MLBCs at one-year follow-up. The secondary endpoint was a composite of mortality, stroke, myocardial infarction, and rehospitalization for heart failure. Results: In total, 384 TAVR patients were included in the analysis. Of these patients, 57 patients (14.8%) had a prolongated CT-ADP > 180 s. Increased MLBCs were observed in patients with CT-ADP > 180 s (35.1% versus 1.2%; p < 0.0001). Conversely, the occurrence of the composite endpoint did not differ between the groups. Multivariate analysis identified CT-ADP > 180 s (HR 28.93; 95% CI 9.74–85.95; p < 0.0001), bleeding history, paradoxical aortic stenosis (AS), and major vascular complications following TAVR as independent predictors of late MLBCs. Conclusion: Among patients with anticoagulated AF, a post-procedural CT-ADP > 180 s was identified as a strong independent predictor of late MLBCs. These findings suggest that persistent primary hemostasis disorders contribute to a higher risk of late bleeding events and should be considered for a tailored, risk-adjusted antithrombotic therapy after TAVR.
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Yoshii, Shunsuke, Takuya Yamada, Shinjiro Yamaguchi, Yoshito Hayashi, Masanori Nakahara, Narihiro Shibukawa, Masashi Yamamoto, et al. "Efficacy of vonoprazan for the prevention of bleeding after gastric endoscopic submucosal dissection with continuous use of antiplatelet agents." Endoscopy International Open 08, no. 04 (March 23, 2020): E481—E487. http://dx.doi.org/10.1055/a-1067-4380.
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Abstract Background Post-procedural bleeding, after gastric endoscopic submucosal dissection (ESD) for high risk thromboembolic cases that require continuous antiplatelet therapy, is challenging. Its incidence rate is > 20 % among those using conventional antacids. We evaluated the efficacy of perioperative management with vonoprazan to prevent post-ESD bleeding. Materials and methods This was a multicenter prospective interventional trial conducted at 10 Japanese referral centers. Patients who regularly used antiplatelet agents (aspirin or thienopyridine derivatives, etc.) and who required continuous antithrombotic medication due to high thromboembolic risk were enrolled. They underwent gastric ESD with continuous aspirin therapy. Oral administration of vonoprazan (20 mg daily) was started from the day of ESD and continued for 28 days. The primary end point was the incidence of post-ESD bleeding. The sample size was 50 patients, and vonoprazan was considered to be effective when the upper threshold of the 95 % confidence interval (CI) for post-ESD bleeding did not exceed 20 %. Results Although 50 patients were enrolled, one patient withdrew consent. Therefore, 49 patients were included in the analysis. One patient who used aspirin and clopidogrel experienced bleeding 11 days after ESD. The overall post-ESD bleeding rate was 2.0 % (1/49; 95 %CI 0.4–10.7 %). Thromboembolic events were not observed. One case of ESD-associated adverse events (perforation) and one case of drug-associated adverse events (drug eruption, possibly due to vonoprazan) were observed. Conclusions Vonoprazan may be efficacious for preventing post-ESD bleeding in patients using continuous antiplatelet therapy, warranting further comparative study to definitively test the effectiveness of the drug.
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Islam, AHM Waliul, AQM Reza, Sham Munwar, and Shahabuddin Talukder. "High Bleeding Risk (HBR) patients Percutaneous Coronary Intervention-a Challenge to Deal with." Bangladesh Heart Journal 36, no. 2 (October 31, 2021): 133–38. http://dx.doi.org/10.3329/bhj.v36i2.56039.
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Coronary artery disease (CAD) is one of the leading causes of death in our patient population. In the era of cardiovascular intervention, Percutaneous coronary intervention (PCI) is one of the most important modalities in treating these group of patients. Several CAD risks factors and co-morbid conditions are key responsible factor of procedural success. High bleeding risk (HBR) patients undergoing PCI is not an uncommon phenomenon. Incidences and prevalence of HBR patients with CAD and their management by PCI is not well addressed in our literature. PCI in HBR patients carries potential risk of intracranial hemorrhage (ICH) and lifethreatening bleeding. Therefore, careful pre-PCI assessment of possible risk or threats of post-PCI complications in patients with HBR are deem necessitate to understand. We recommend forming multicenter common consensus and to form a guideline in treating HBR patient by PCI. Thus, to reduce post procedural complication and subsequent improvement of mortality and morbidity in HBR patients undergoing PCI in both ST segment elevated myocardial infarction (STEMI) and as well as non-STEMI. Bangladesh Heart Journal 2021; 36(2): 133-138
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Vetrovec, George W., Amir Kaki, Jason Wollmuth, and Thom G. Dahle. "Strategies for Reducing Vascular and Bleeding Risk for Percutaneous Left Ventricular Assist Device-supported High-risk Percutaneous Coronary Intervention." Heart International 16, no. 2 (2022): 105. http://dx.doi.org/10.17925/hi.2022.16.2.105.
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In patients at high risk for haemodynamic instability during percutaneous coronary intervention (PCI), practitioners are increasingly opting for prophylactic mechanical circulatory support, such as the Impella® heart pump (Abiomed, Danvers, MA, USA). Though Impellasupported high-risk PCI (HRPCI) ensures haemodynamic stability during the PCI procedure, access-related complication rates have varied significantly in published studies. Reported variability in complication rates relates to many factors, including anticoagulation practices, access and closure strategy, post-procedure care and variations in event definitions. This article aims to outline optimal strategies to minimize vascular and bleeding complications during Impella-supported HRPCI based on previously identified clinical, procedural and postprocedural risk factors. Practices to reduce complications include femoral skills training, standardized protocols to optimize access, closure, anticoagulation management and post-procedural care, as well as the application of techniques and technological advances. Protocols integrating these strategies to mitigate access-related bleeding and vascular complications for Impella-supported procedures can markedly limit vascular access risk as a barrier to appropriate large-bore mechanical circulatory support use in HRPCI.
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Elliott, Timothy, Zacharias Tsiamoulos, Siwan Thomas-Gibson, Noriko Suzuki, Leonidas Bourikas, Ailsa Hart, Paul Bassett, and Brian Saunders. "Factors associated with delayed bleeding after resection of large nonpedunculated colorectal polyps." Endoscopy 50, no. 08 (April 6, 2018): 790–99. http://dx.doi.org/10.1055/a-0577-3206.
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Abstract Background Delayed bleeding is the most common significant complication after piecemeal endoscopic mucosal resection (p-EMR) of large nonpedunculated colorectal polyps (NPCPs). Risk factors for delayed bleeding are incompletely defined. We aimed to determine risk factors for delayed bleeding following p-EMR. Methods Data were analyzed from a prospective tertiary center audit of patients with NPCPs ≥ 20 mm who underwent p-EMR between 2010 and 2012. Patient, polyp, and procedure-related data were collected. Four post p-EMR defect factors were evaluated for interobserver agreement and included in analysis. Delayed bleeding severity was reported in accordance with guidelines. Predictors of bleeding were identified. Results Delayed bleeding requiring hospitalization occurred after 22 of 330 procedures (6.7 %). A total of 11 patients required blood transfusion; of these, 4 underwent urgent colonoscopy, 1 underwent radiological embolization, and 1 required surgery. Interobserver agreement for identification of the four post p-EMR defect factors was moderate (kappa range 0.52 – 0.57). Factors associated with delayed bleeding were visible muscle fibers (P = 0.03) and the presence of a “cherry red spot” (P = 0.05) in the post p-EMR defect. Factors not associated with delayed bleeding were American Association of Anesthesiologists class, aspirin use, polyp size, site, and use of argon plasma coagulation. Conclusions Visible muscle fibers and the presence of a “cherry red spot” in the resection defect were associated with delayed bleeding after p-EMR. These findings suggest evaluation and photodocumentation of the post p-EMR defect is important and, when considered alongside other patient and procedural factors, may help to reduce the incidence and severity of delayed bleeding.
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Hong, Gi-Woong, Jovian Wan, Song-Eun Yoon, Sky Wong, and Kyu-Ho Yi. "Pre- and Post-Procedural Considerations and Thread Types for Thread Lifting." Life 15, no. 1 (January 12, 2025): 85. https://doi.org/10.3390/life15010085.
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Facial thread lifting has emerged as a minimally invasive alternative to traditional face-lifting procedures, with particular emphasis on U-shaped and I-shaped barbed threads. This review analyzes the anatomical considerations, procedural techniques, and clinical outcomes of different thread types for facial rejuvenation. The study examines the mechanical principles and lifting mechanisms of U-shaped “suspension type” threads versus I-shaped threads, highlighting their distinct characteristics and applications. The results indicate that U-shaped threads provide strong lifting effects, with success rates reported at 85–90% in achieving visible tissue elevation when anchored in the temporal area. However, these threads carry higher risks of complications, including bleeding (15–20%), dimpling (12–18%), and tissue damage at exit points (5–10%). In contrast, I-shaped threads demonstrate advantages in minimizing tissue trauma and patient discomfort, with complication rates below 5%, though they may provide less dramatic lifting effects. The study concludes that optimal outcomes are achieved through careful patient selection and customized combination approaches rather than reliance on a single thread type. Future directions point toward the development of hybrid techniques that combine the strengths of both thread types to maximize efficacy while minimizing complications.
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Kikkert, Wouter J., Sophie H. van Nes, Krystien V. V. Lieve, George D. Dangas, Jan van Straalen, Marije M. Vis, Jan Baan, et al. "Prognostic value of post-procedural aPTT in patients with ST-elevation myocardial infarction treated with primary PCI." Thrombosis and Haemostasis 109, no. 05 (2013): 961–70. http://dx.doi.org/10.1160/th12-10-0726.
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SummaryUnfractionated heparin is the most commonly used anticoagulant in ST-elevation myocardial infarction (STEMI) and its effect can be monitored with activated partial thromboplastin time (aPTT). However, the optimal aPTT range during heparin therapy after primary percutaneous coronary intervention (PCI) is yet to be defined. A mean aPTT was calculated of all aPTT measurements in the first 24 hours after pPCI in a total of 1,876 STEMI patients. Mean aPTT measurements were stratified into four categories; < 1.5 times the upper limit of normal (ULN), 1.5 – 2.0 times ULN (the therapeutic group), 2.01 – 3.99 times ULN, and ≥ 4 times ULN. Compared to patients with a therapeutic aPTT, patients with aPTTs < 1.5 times ULN had no increase in recurrent ischaemic events and had similar rates of bleeding complications. Patients with a mean aPTT ≥ 4 times ULN had higher rates recurrent ischaemic and haemorrhagic complications. After multivariable analyses, aPTT ratios ≥ 4 times ULN were no longer associated with recurrent ischaemic events, but remained a strong predictor of severe and moderate bleeding (hazard ratio [HR] 4.64, p = 0.016 and HR 2.27, p = 0.052). In conclusion, in 1,876 STEMI patients treated with pPCI, low aPTTs in the first 24 hours after PCI were not associated with an increase in ischaemic events, whereas high aPTT values were associated with more frequent bleeding complications. These results indicate no clear benefit as well as a safety concern with heparin treatment after primary PCI.
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Grommes, J., KT von Trotha, MA de Wolf, H. Jalaie, and CHA Wittens. "Catheter-directed thrombolysis in deep vein thrombosis: Which procedural measurement predicts outcome?" Phlebology: The Journal of Venous Disease 29, no. 1_suppl (May 2014): 135–39. http://dx.doi.org/10.1177/0268355514529394.
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The post-thrombotic syndrome (PTS) as a long-term consequence of deep vein thrombosis (DVT) is caused by a venous obstruction and/or chronic insufficiency of the deep venous system. New endovascular therapies enable early recanalization of the deep veins aiming reduced incidence and severity of PTS. Extended CDT is associated with an increased risk of bleeding and stenting of residual venous obstruction is indispensable to avoid early rethrombosis. Therefore, this article focuses on measurements during or after thrombolysis indicating post procedural outcome.
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Salama, HusamEddin Z., Yousef A. Alnajjar, Tarek A. Owais, Afnan W. M. Jobran, Ruaa Safi, Mohammad Bahar, and Hazem Al-Ashhab. "Endoscopic retrograde cholangiopancreatography utilisation and outcomes in the first advanced endoscopy centre in Palestine at Al-Ahli Hospital: a retrospective cohort study." BMJ Open 13, no. 12 (December 2023): e077806. http://dx.doi.org/10.1136/bmjopen-2023-077806.
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ObjectiveTo evaluate the utilisation and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures, success rates, incidence and risk factors for procedural-related complications in a single centre-based study.Study designRetrospective cohort study.SettingFirst advanced tertiary endoscopy centre in Palestine.ParticipantsA total of 1909 procedures on 1303 patients were included in the analysis: females were 57.9% of the cases (n=755), 1225 patients (94%) were from West Bank and Jerusalem and 78 (6%) were from Gaza Strip. All patients who underwent ERCP throughout the period from December 2017 to September 2022 were selected to participate in the study.Primary and secondary outcome measuresThe primary outcomes of interest in our analysis were success rates, procedural outcomes and post- procedural complications including pancreatitis, bleeding and others. Two multivariate logistic regression models were performed to calculate the risk of post-ERCP complications and post-ERCP pancreatitis (PEP) in patients with certain risk factors like demographic factors, procedural techniques' variation, pancreatic duct manipulations and others. We also discussed the management of the failed procedures.ResultsThe overall complication rate was 5%, including PEP (n=43, 2.3%), infection/cholangitis (n=20, 1%), bleeding (n=9, 0.5%) and perforation (n=7, 0.4%). The mortality rate was 0.6% (n=11). Risk factors for adverse events included pancreatic duct cannulation and PEP (p<0.001, OR=3.64). Additionally, younger patients (≤45) were found to carry a higher risk for PEP when compared with older patients (≥65) (p=0.023, OR=2.84). In comparison with sphincterotomy, the double-wire technique was associated with a higher risk of complications (p=0.033, OR=2.29).ConclusionsWe summarised the utilisation and outcomes of ERCP among the Palestinian population in the first advanced centre in Palestine. Cannulation success rates are similar to the established standards and are acceptable compared with other centres worldwide. Perioperative complication rates of ERCP remain infrequent, and death is quite unusual and thus considered a safe procedure.
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Yoshida, Manami, Ryosuke Tateishi, Shinzo Hiroi, Yoshie Hongo, Masakazu Fujiwara, Yoshitake Kitanishi, Kosuke Iwasaki, Tomomi Takeshima, and Ataru Igarashi. "Effects of Lusutrombopag on Post-invasive Procedural Bleeding in Thrombocytopenic Patients with Chronic Liver Disease." Advances in Therapy 39, no. 1 (November 8, 2021): 379–90. http://dx.doi.org/10.1007/s12325-021-01965-7.
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Movahed, Mohammad Reza. "Higher post procedural bleeding in patients with advanced chronic kidney disease undergoing percutaneous coronary intervention." American Journal of Blood Research 14, no. 1 (2024): 1–5. http://dx.doi.org/10.62347/iqus3924.
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Barkun, A. N., C. Barkun, M. Martel, and P. INVESTIGATORS. "A94 PERI-PROCEDURAL MANAGEMENT OF PATIENTS RECEIVING A DIRECT ORAL ANTICOAGULANT UNDERGOING A DIGESTIVE ENDOSCOPY." Journal of the Canadian Association of Gastroenterology 5, Supplement_1 (February 21, 2022): 109–10. http://dx.doi.org/10.1093/jcag/gwab049.093.
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Abstract Background The peri-procedural management of patients on a direct oral anticoagulant (DOAC) requiring an elective digestive (GI) endoscopic procedure remains uncertain. Aims To investigate the safety of a standardized peri-procedural DOAC management strategy. Methods The Perioperative Anticoagulation Use for Surgery Evaluation (PAUSE) cohort study was conducted at 23 clinical centers in North America and Europe. Participants (n=3007) all had atrial fibrillation (AF), were >18 years old, long-term users of Apixaban, Rivaroxaban, or Dabigatran, and scheduled for an elective procedure or surgery; all could adhere to the DOAC interruption protocol. This analysis focuses on the 579 patients undergoing a digestive endoscopic procedure. The DOAC interruption (1–2 days pre-endoscopy) and resumption (1–3 days post-endoscopy) strategy is based on the DOAC molecule, patient renal function, with most GI procedures considered at low-risk for bleeding. Follow-up occurred at 30 days. Outcomes included GI bleeding and thromboembolic events (ischemic stroke, transient ischemic attack, myocardial infarction, systemic embolism, deep vein thrombosis, and pulmonary embolism) and mortality. Results Of the 556 patients (72.5 +8.6 yrs; 37.4 % female), 38.9%) were on Apixaban, 36.9% on Rivaroxaban, and 24.3% on Dabigatran; 10.1% were on anti-platelet therapy. The overall CHADS score was 1.7 +1.0. Overall, 525 patients were categorized as having a low risk for bleeding, and 31 were at high-risk. DOAC were stopped 2.0 +0.5 days pre-procedure and restarted 1.9 +1.5 days post-procedure. Overall rates were: all bleeding 4.4% (2.9–6.4), GI bleeding 2.5% (1.4–4.2%), while 0.7% (0.3–1.8%) experienced a thromboembolic event. Additional results are listed in Table 1. Conclusions Patients with AF undergoing a standardized DOAC therapy interruption management protocol for elective digestive endoscopy experienced low rates of major bleeding and arterial thromboembolism. All results reported as % and 95% CI * outcomes were missing for 4 patients that had the procedure Funding Agencies None
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Kim, Jae Gyu, Jae Yong Park, Beom Jin Kim, and Mi-Sook Kim. "The influence of procedural volume on the outcome of endoscopic submucosal dissection for gastric neoplasm: A nationwide population-based study." Journal of Clinical Oncology 41, no. 4_suppl (February 1, 2023): 285. http://dx.doi.org/10.1200/jco.2023.41.4_suppl.285.
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285 Background: Endoscopic submucosal dissection (ESD) is a well-established treatment modality for gastric neoplasms. The aim of this study was to investigate the effect of procedural volume on the outcome of endoscopic submucosal dissection (ESD) for gastric cancer or adenoma. Methods: Patients who underwent ESD for gastric cancer or adenoma from November 2011 to December 2017 were identified using the Korean National Health Insurance Service database. Operational definitions to identify target population and post-procedural complications were created by combining the diagnosis and procedure codes, and validated using individual hospital medical record data. The outcomes were the occurrence of post-procedural complications (bleeding, perforation, pneumonia, and 30-day mortality) and additional resection within 180 days after the initial ESD procedure. Hospital volume was categorized into four groups based on the mean annual number of procedures: very high-, high-, low-, very low-volume hospitals (VHVH, HVH, LVH, VLVH). The outcome of ESD was compared in relation to hospital volume. Results: There were 95,411 procedures in 89,780 patients during the study period. There were 5,607 composite events, which included 5,098 bleeding, 601 perforation, and 712 pneumonia cases, respectively. Additional resection within 180days occurred in 7,900 cases. There were significant differences in ESD-related adverse outcomes among the four hospital volume categories. Multiple logistic regression revealed that VHVH, HVH, and LVH were associated with significantly lower relative risk of composite outcome, when compared to VLVH. Similar tendencies were also shown in terms of bleeding, perforation, and pneumonia. This volume-outcome association was not evident in additional resection. Conclusions: Hospital volume was closely associated with adverse clinical outcome in patients with ESD for gastric cancer or adenoma. The outcomes of gastric ESD should be closely and systemically monitored to ensure the safety of patients. [Table: see text]
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Ahsan, Syed Ali, Ahmed Shafiqul Hossain, Md Hafizur Rahman, Monjur Mahmud, Md Abu Siddique, and Muhmmad Mobarock Hossain. "First Case of Transulnar Approach for Angiogram (Coronary and Peripheral) in BSMMU." University Heart Journal 8, no. 1 (August 26, 2012): 65–68. http://dx.doi.org/10.3329/uhj.v8i1.11672.
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Transfemoral approach is mostly used for coronary and peripheral angiography and intervention. Transradial coronary angiography and intervention has become a popular technique due to reduced local and bleeding complications, easier post-procedural care and patient preference. In certain patients, transradial access may not be possible due to various anatomical reasons and usually, the transfemoral route is used for these patients. In a minority of patients, such as those with significant peripheral arterial disease or obesity, the transfemoral approach is challenging and is associated with an increased risk of local complications or bleeding. Transulnar arterial access, however, has recently been shown to be feasible and safe for both coronary angiography and intervention. The procedural success, advantages and complication rates for this procedure appear similar to those for the transradial approach. This is a case of transulnar artery percutaneous coronary and peripheral intervention in a patient of chronic stable angina and peripheral vascular disease. DOI: http://dx.doi.org/10.3329/uhj.v8i1.11672 University Heart Journal Vol. 8, No. 1, January 2012
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Woo, Ji Hun, Junyeol Kim, Jin Ho Choi, Joongyu Kang, Woo Hyun Paik, Ji Kon Ryu, Yong-Tae Kim, and Sang Hyub Lee. "Two Cases of Life-Threatening Hemobilia Following Removal of Biliary Stents Treated with Covered Self-Expandable Metal Stents." Korean Journal of Pancreas and Biliary Tract 28, no. 3 (July 31, 2023): 81–88. http://dx.doi.org/10.15279/kpba.2023.28.3.81.
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Biliary stent removal can cause hemobilia due to injury to the adjacent vessel, but it is rarely reported. If significant hemobilia occurs during stent removal, samesession covered self-expandable metal stent (CSEMS) insertion may be useful as a rescue or bridge therapy before angiography. Here, we report two cases of lifethreatening hemobilia following stent removal successfully treated by CSEMS. The first case was a Klatskin tumor bismuth type IV patient who required biliary stenting for resolving malignant biliary obstruction. The second case was a hepatocellular carcinoma patient who had undergone multiple transarterial chemoembolization and required biliary stents for liver abscess. In this situation, inserting a CSEMS at a higher level than the expected bleeding site and recognizing stenting as a temporary therapy with its limitations are important. Also, it is crucial to consider pre-procedural imaging in high-risk patients, and perform post-procedural imaging to evaluate for ongoing bleeding or vascular abnormalities.
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Mohanprasad, Virukalpatti Goparathinam, Praveen Patil, Madhura Prasad, and Gokul Kruba Shanker. "Role of cyanoacrylate glue therapy in enteral SEMS bleeding - A nightmare." Journal of Digestive Endoscopy 04, no. 03 (July 2013): 084–86. http://dx.doi.org/10.4103/0976-5042.129978.
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AbstractOver the past century, the use of stents has evolved to a point where they are now used extensively throughout the gastrointestinal tract. Endoscopic stenting has become widely used for treatment of gastrointestinal and hepatobiliary strictures. Metallic stents are deployed in malignant strictures as a palliative procedure. Adverse events of stenting include perforation, migration, bleeding, occlusion, and pain. Finally, the use of multidisciplinary teams which include endoscopists, interventional radiologists, and surgeons allows for the exchange of ideas and procedural planning necessary for successful innovation. We present a case of successful cessation of bleeding by using cyanoacrylate glue therapy in post-enteral self-expandable metallic stent bleeding. In conclusion, glue therapy may also be considered as a mode of treatment other than conservative approach and angiographic coil embolization.
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Pawlak, K., K. Khalaf, S. Gupta, D. Tham, J. Mosko, G. May, and N. Calo. "A140 DELAYED BLEEDING POST-ENDOSCOPIC AMPULLECTOMY FOR AMPULLARY ADENOMAS: INCIDENCE, RISK FACTORS AND MANAGEMENT OF DELAYED BLEEDING." Journal of the Canadian Association of Gastroenterology 7, Supplement_1 (February 14, 2024): 107–8. http://dx.doi.org/10.1093/jcag/gwad061.140.
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Abstract Background The duodenal tumors of major papilla account 10% of all peri-ampullary lesions, and the majority represent adenomas, carrying malignant potential through the well-known adenoma–carcinoma sequence ([i]). Historically, surgical resection was the standard of care, but it is associated with significant risk of complications (44.7%) ([ii]). Hence, endoscopic ampullectomy became the treatment modality for selected cases. Despite the significantly lower rate of adverse events, pancreatitis and bleeding occurs in up to 25% of patients ([iii]). The rate of bleeding may be even higher, depending on periampullary lesion size and type. Factors related to delayed bleeding are poorly understood. Aims The aim of our study was to determine predicting factors for delayed post-ampullectomy bleeding. Methods We conducted a single-center retrospective study over 13 years (2010-2023). All patients who underwent an endoscopic ampullectomy were analyzed. The primary endpoint was the incidence of delayed bleeding, which was defined as a post-procedural bleeding that necessitated either a blood transfusion, ICU admission or re-intervention. Secondary outcomes included risk factors for delayed bleeding, management, and other adverse events. Results 113 patients underwent endoscopic papillectomy [mean age 66.2 ± 12.2 years; male gender 51 (45.1%)]. Mean lesion size was 27.0 ± 14.3 mm and mean procedure duration was 62.8 ± 35.6 minutes. There were 24 cases of delayed bleeding (21.2%). Of these, 6 (25%) required repeat endoscopic intervention. The average length of hospital was longer in those experiencing a delayed bleed (8.6 ± 4.9 vs 4.8 ± 2.4 days, Pampersand:003C0.001). By univariable logistic regression, the odds of delayed bleeding were greater in those with hypertension (OR 3.8, 95%CI 1.4-10.3, P=0.008) or an INR ≥ 1.2 (OR 13.3, 95%CI 3.0-58.3, P=0.001). A multivariable logistic regression analysis revealed that INR≥ 1.2 predicted delayed bleeding, with an OR of 16.1 (95%CI 3.0-85.4, P=0.001). Other adverse events included perforation (n=7, 6.3%) and pancreatitis (n=19, 16.8%). There were no deaths. Conclusions Post-ampullectomy bleeding is a common adverse event in patients undergoing ampullectomy leading to more prolonged hospital stay. History of hypertension and elevated INR above 1.2 might be related to delayed post-ampullectomy bleeding. Additional strategies to reduce post-ampullectomy bleeding should be explored. Funding Agencies None
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Madan, Shikha, Sonia Dahiya, Mahak Singaal, Pushpa Dahiya, and Smriti Anand. "Comparative study of medical vs surgical abortion in the first trimester- which one is better choice?" Indian Journal of Obstetrics and Gynecology Research 11, no. 4 (November 15, 2024): 577–81. http://dx.doi.org/10.18231/j.ijogr.2024.103.
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Abortion is defined as the spontaneous and induced termination of a pregnancy before foetal viability. Abortions accounted for one-third of all pregnancies, and nearly half of the pregnancies were unintended. An effective way to prevent the burden of unsafe abortion could be access to safe abortion services. Both surgical and medical methods are available for abortion or the termination of a pregnancy. Thus, we compare the two methods of medical and surgical abortions in this study. The study was conducted on women attending obstetrics and gynaecology OPD for seeking treatment for abortion in the first trimester. 100 women were allocated to Group A, who opted for medical treatment, and Group B, for surgical abortion. Two groups were compared in terms of clinical parameters like blood loss, aftereffects, post-procedure visits, and efficacy. In group A, 14% of women had minimal bleeding, 70% had moderate bleeding, and 6% had heavy bleeding. In group B, 72% had minimal bleeding, 28% had moderate bleeding, and no one had heavy bleeding. The combined complication rate in surgical abortion was significantly lower as compared to medical abortion, but the difference in clinical efficacy is not significant. The medical method is a good alternative to surgical abortion. The medical termination was associated with more bleeding and more post-procedural aftereffects, although both procedures were comparable in clinical efficacy.
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Tarantino, Michael D., Kristin Ansteatt, and Jessica Mistretta. "Prophylaxis and Treatment of Bleeding or Thrombosis with Fibrinogen Concentrate (Fibryga) in Patients with Congenital Hypofibrinogenemia or Dysfibrinogenemia." Blood 142, Supplement 1 (November 28, 2023): 5483. http://dx.doi.org/10.1182/blood-2023-181045.
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Congenital fibrinogen disorders (CFDs) are rare and make up approximately 0.6% of all inherited bleeding disorders. Two subtypes include a quantitative deficiency of fibrinogen, congenital afibrinogenemia (CA), congenital hypofibrinogenemia (CH), and qualitative defect of the fibrinogen molecule, congenital dysfibrinogenemia (CD). Patients with CD may have a thrombotic as well as a hemorrhagic disease phenotype. In the past, fresh frozen plasma or cryoprecipitate were the only options available for treatment and prevention of bleeding in patients with CFD. Today in the US, human plasma-derived concentrates (FIBRYGA, Octapharma, Lachlen, Switzerland, and RiaSTAP, CSL, Melbourne, Australia) are available and considered safe and effective treatment options for CD and CH. Guidelines for the treatment and prevention of bleeding is not established for CFDs, and especially for CD. We present eight clinical cases of patients with hypo- or dysfibrinogenemia that were effectively treated with a pooled, plasma-derived fibrinogen concentrate (FIBRYGA) either prophylactically for elective or urgent surgery, or post-traumatic injury. The mean age of patients treated was 34 years (min-max 8-70 years). Three patients were male and five, female. Four patients had CH and four, CD. FIBRYGA was used to prophylactically treat a total of ten surgical procedures and two post-traumatic events in these patients. Dosing of FIBRYGA was based on the goal peak plasma fibrinogen concentration and the manufacturer's prescribing information, but modified to align with local laboratory reference ranges for the functional fibrinogen test. No acute or delayed infusion reactions (nausea, fever, rigors, headache) and no hypersensitivity reactions were noted. One patient developed two adverse events, one thrombotic and one hemorrhagic. This patient underwent left, above the knee amputation (AKA) and had a complicated postoperative period due to her multiple comorbidities including type 2 diabetes, hypertension, and long standing, poorly-controlled, severe peripheral arterial disease. She presented nineteen days after receiving FIBRGYA with a PE and multiple DVTs. Fifty-nine days later she presented with wound dehiscence and underwent an extensive excisional debridement with postoperative bleeding deemed to be secondary to her strap sliding during surgery and acting as a tourniquet for venous blood flow. For the majority (86%) of our patients described here with CH and CD, FIBRYGA was well tolerated and effective in preventing post procedural or post traumatic bleeding complications. The post procedural bleeding noted in one patient may have been due to inadequate fibrinogen concentration or other comorbid conditions. Further clinical studies are needed to determine the role of FIBRGYA and other HFC in the treatment of patients with CFD, especially those with CD.
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Giannopoulos, Spyridon, Bhavani Pokala, and Dimitrios Stefanidis. "Management of gastrointestinal bleeding following bariatric surgery." Mini-invasive Surgery 6, no. 4 (2022): 22. http://dx.doi.org/10.20517/2574-1225.2021.135.
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Gastrointestinal bleeding following bariatric surgery is a relatively rare adverse event but constitutes a significant cause of morbidity. It requires a high index of suspicion, early diagnosis, and prompt management, as it can lead to rapid deterioration and potential mortality. In most cases, GI bleeding is self-limited and does not necessitate emergent reoperation. For some patients, however, control of postoperative hemorrhage may require various procedural-based interventions via surgical, endoscopic, or radiologic approaches. Recent studies suggest that endoscopic therapies to manage intraluminal bleeding post-bariatric surgery are becoming increasingly popular given their high efficacy rate and favorable safety profile. Currently, there is no consensus on the management of early or late GI hemorrhage after metabolic surgery. Therefore, the aim of this review is to summarize the effectiveness of several treatment options and outline management algorithms for this subset of bariatric patients based on the established literature.
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Abuqayyas, Sami, Shine Raju, John R. Bartholomew, Roulan Abu Hweij, and Atul C. Mehta. "Management of antithrombotic agents in patients undergoing flexible bronchoscopy." European Respiratory Review 26, no. 145 (July 19, 2017): 170001. http://dx.doi.org/10.1183/16000617.0001-2017.
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Bleeding is one of the most feared complications of flexible bronchoscopy. Although infrequent, it can be catastrophic and result in fatal outcomes. Compared to other endoscopic procedures, the risk of morbidity and mortality from the bleeding is increased, as even a small amount of blood can fill the tracheobronchial tree and lead to respiratory failure. Patients using antithrombotic agents (ATAs) have higher bleeding risk. A thorough understanding of the different ATAs is critical to manage patients during the peri-procedural period. A decision to stop an ATA before bronchoscopy should take into account a variety of factors, including indication for its use and the type of procedure. This article serves as a detailed review on the different ATAs, their pharmacokinetics and the pre- and post-bronchoscopy management of patients receiving these medications.
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Gauto, Estefania, Juan Del Cid Fratti, Miguel Salazar, Hugo Macchi, Shristi Upadhyay Upadhyay Banskota, Binav Baral, Catherine Weir, Kriti Ahuja, and Juan Adolfo Cattoni. "In-hospital outcomes of percutaneous coronary intervention with drug-eluting stent in patients with localized and metastatic cancer." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e18631-e18631. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e18631.
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e18631 Background: Patients with localized and advanced malignancy are usually excluded from randomized clinical trials of drug-eluting stents and anti-platelet therapy. We aimed to evaluate short term outcomes of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with localized and metastatic malignancy. Methods: Analysis from the Nationwide inpatient sample January 2016 to December 2018 of patients with localized and advanced malignancy admitted for a percutaneous coronary intervention with drug-eluting stents. Primary outcome was in-hospital mortality. Secondary outcomes were post-procedural complications and healthcare-utilization. Multivariate regression analysis was performed to adjust for confounders. Results: During 2016 – 2018 a total of weighted 1, 244, 550 PCI with DES were performed. 97.9 % in patients without cancer, 1.6% (n=21,125) patients with localized cancer and 0.3 % (n=4,765) with metastatic cancer. During hospitalization patient with cancer were more likely to develop respiratory failure, need for mechanical ventilation, AKI, and to receive blood products. After multivariate regression analysis patients with localized malignancy did not have any difference in-hospital mortality, total charges, cost, cardiac arrest or post procedural bleeding but had less LOS, respiratory failure, AKI requiring HD, post-procedural CVA and higher post-procedural blood transfusion when compared with patients without cancer. Conclusions: Patients with metastatic malignancy have higher in-hospital mortality when compared to patients without cancer. Patients with localized or advanced malignancy do not have higher in hospital complications. Blood transfusion is higher in patients with malignancy but is not related to procedure.[Table: see text]
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Santamaria, Amparo, Paolo Colonna, Christian von Heymann, Manish Saxena, Thomas Vanassche, James Jin, Robert Wilkins, Cathy Chen, and Martin Unverdorben. "Periprocedural Interruption of Edoxaban in Real World Setting: Results from the Emit AF/VTE Study." Blood 136, Supplement 1 (November 5, 2020): 13–14. http://dx.doi.org/10.1182/blood-2020-137569.
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Background: The optimal interruption schedule for NOACs in patients undergoing invasive procedures has not been determined. This analysis describes periprocedural interruption of edoxaban in real world EMIT AF/VTE study. Methods: EMIT AF/VTE was a prospective, non-interventional study conducted in 7 European countries that collected detailed information on periprocedural management of edoxaban from 5 days before to 30 days after procedure in patients with AF or VTE. Results: Among 1155 patients, pre-procedural interruption occurred in 781 (68%) patients (median 2 days, IQR 1.0-2.0) and post-procedural interruption in 308 (27%) patients (median 3 days, IQR 1.0-8.0); 279 (24.2%) patients had both pre- and post-procedural interruption. Edoxaban interruption in some patients differed from 2018 EHRA Recommendations for NOAC use in AF. Of 294 patients receiving minor risk procedures, for whom no interruption is recommended, 173 (58.8%) had preprocedural interruption (median 1 day). Of 581 patients with low bleeding risk procedures, for whom ≥24h preprocedural interruption is recommended, 188 (32.4%) had no interruption. Of 280 patients receiving high bleeding risk procedures, for whom ≥48h interruption is recommended, 46 (16.4%) had no interruption. Clinical events are shown in Table. Conclusion: Edoxaban interruption schedules in routine practice were not always consistent with EHRA guidelines; nevertheless, rates of clinically significant bleeding or acute thromboembolic events or coronary syndromes were low in the EMIT study. Table Disclosures Colonna: Boehringer Ingelheim: Honoraria; Daiichi Sankyo: Honoraria; BayerAG: Honoraria; Italian Cardiology Association: Other: Non-financial support; European Society of Cardiology: Other: Non-financial support; Pfizer/BMS: Honoraria. von Heymann:Daiichi Sankyo: Honoraria, Research Funding; Boehringer Ingelheim: Honoraria; Bayer AG: Honoraria; Pfizer GmBH: Honoraria; CSL Behring: Honoraria; NovoNordisk Pharma: Honoraria; EACTA and EACTS: Other; DGGG: Other; Mitsubishi Pharma: Honoraria; Ferring GmbH: Honoraria; Biotest GmbH: Honoraria; Leo Pharma GmBH: Honoraria; German Society of Anaesthesiology and Intensive Care Medicine: Other. Saxena:Daiichi Sankyo: Honoraria, Research Funding. Vanassche:Boehringer Ingelheim: Honoraria; 367 Leo Pharma: Honoraria; Bayer: Honoraria; Daiichi Sankyo: Honoraria, Research Funding. Jin:Daiichi Sankyo: Current Employment. Wilkins:Daiichi Sankyo: Honoraria. Chen:Daiichi Sankyo: Current Employment. Unverdorben:Daiichi Sankyo: Current Employment.
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Piraka, Cyrus, Ahmed Saeed, Akbar Waljee, Ajish Pillai, Ryan Stidham, and B. Elmunzer. "Cold snare polypectomy for non-pedunculated colon polyps greater than 1 cm." Endoscopy International Open 05, no. 03 (March 2017): E184—E189. http://dx.doi.org/10.1055/s-0043-101696.
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Abstract Background and study aims Colonic polyps > 1 cm in size are commonly managed using hot polypectomy techniques. The most frequent adverse events (delayed bleeding, post-polypectomy syndrome, and perforation) are related to electrocautery-induced injury. We hypothesized that cold resection of large polyps may have similar efficacy and improved safety compared to hot polypectomy. Our aims were to evaluate efficacy and safety of piecemeal cold snare resection of colonic polyps > 1 cm. Patients and methods Patients undergoing lift and piecemeal cold snare polypectomy of non-pedunculated colon polyps > 1 cm from October 2013 to September 2015 were identified retrospectively. Efficacy was defined by the absence of residual adenomatous tissue at endoscopic follow-up. Adverse events (AEs), including post-procedural bleeding, bowel perforation, or post-procedural pain requiring hospitalization were assessed by chart review and telephone follow-up. Results Seventy-three patients underwent piecemeal cold snare polypectomy for 94 colon polyps > 1 cm with 56 of 73 patients completing follow-up on 72 polyps. Residual or recurrent adenoma was found in 7 cases (9.7 %). Median polyp size was significantly greater in those with residual/recurrent adenoma (37.1 vs. 19.1 mm, P < .0001). There were no AEs among all 73 patients enrolled. Conclusions Piecemeal cold snare resection of colon polyps > 1 cm is feasible, safe and efficacious when compared to published hot polypectomy data. Additional observational and randomized comparative effectiveness studies are necessary to demonstrate comparable adenoma eradication and improved safety advantage over existing hot snare polypectomy techniques.
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Lei, Haoyu, Hieu Minh Vo, and Matthew Hyatt. "Repeat uterine artery embolization for uterine leiomyomas: Indications, strategies, and outcomes – A case report." American Journal of Interventional Radiology 8 (September 9, 2024): 13. http://dx.doi.org/10.25259/ajir_30_2024.
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Uterine leiomyoma is a frequent cause of abnormal uterine bleeding, especially among African Americans. It is also associated with dysmenorrhea, pelvic pain, infertility, and complicated pregnancies. While hysterectomy and myomectomy are more common forms of treatment for uterine leiomyoma in the United States, uterine artery embolization (UAE) offers a uterus-preserving alternative, with lower rates of major complications, although with an increased risk of reintervention. This case study presents a 45-year-old African American female with persistent abnormal uterine bleeding post-initial UAE, underscoring the importance of strategic techniques during repeat embolization to ensure efficacy. The patient underwent a successful repeat UAE procedure, demonstrating its safety and effectiveness in treating abnormal uterine bleeding while preserving fertility. In this case, the presence of collateral vessels may have contributed to the previous treatment failure. Specific procedural techniques are discussed, and long-term monitoring is recommended for optimal outcomes.
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Gragnano, Felice, Antonio Capolongo, Antonio Micari, Francesco Costa, Victoria Garcia-Ruiz, Vincenzo De Sio, Fabrizia Terracciano, et al. "Antithrombotic Therapy Optimization in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention." Journal of Clinical Medicine 13, no. 1 (December 23, 2023): 98. http://dx.doi.org/10.3390/jcm13010098.
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The antithrombotic management of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) poses numerous challenges. Triple antithrombotic therapy (TAT), which combines dual antiplatelet therapy (DAPT) with oral anticoagulation (OAC), provides anti-ischemic protection but increases the risk of bleeding. Therefore, TAT is generally limited to a short phase (1 week) after PCI, followed by aspirin withdrawal and continuation of 6–12 months of dual antithrombotic therapy (DAT), comprising OAC plus clopidogrel, followed by OAC alone. This pharmacological approach has been shown to mitigate bleeding risk while preserving adequate anti-ischemic efficacy. However, the decision-making process remains complex in elderly patients and those with co-morbidities, significantly influencing ischemic and bleeding risk. In this review, we discuss the available evidence in this area from randomized clinical trials and meta-analyses for post-procedural antithrombotic therapies in patients with non-valvular AF undergoing PCI.
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Maselli, Roberta, Marco Spadaccini, Paul J. Belletrutti, Piera Alessia Galtieri, Simona Attardo, Silvia Carrara, Andrea Anderloni, et al. "Endoscopic submucosal dissection for colorectal neoplasia: outcomes and predictors of recurrence." Endoscopy International Open 10, no. 01 (January 2022): E127—E134. http://dx.doi.org/10.1055/a-1551-3058.
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Abstract Background and study aims The role of endoscopic submucosal dissection (ESD) for colorectal lesions in Western communities is unclear and its adoption is still limited. The aim of this study is to assess the long-term outcomes of a large cohort of patients treated with colorectal ESD in a tertiary Western center. Patients and methods A retrospective analysis was conducted on patients treated by ESD for superficial colorectal lesions between February 2011 and November 2019. The primary outcome was the recurrence rate. Secondary outcomes were en-bloc and R0 resection rates, procedural time, adverse events (AEs), and need for surgery. The curative resection rate was assessed for submucosal invasive lesions. Results A total of 327 consecutive patients, median age 69 years (IQR 60–76); 201 men (61.5 %) were included in the analysis. Of the lesions, 90.8 % were resected in an en-bloc fashion. The rate of R0 resection was 83.1 % (217/261) and 44.0 % (29/66) for standard and hybrid ESD techniques, respectively. Submucosal invasion and piecemeal resection independently predicted R1 resections. A total of 18(5.5 %) intra-procedural AEs (perforation:11, bleeding:7) and 12(3.7 %) post-procedural AEs occurred (perforation:2, bleeding: 10). Eighteen adenoma recurrences per 1,000 person-years (15cases, 5.6 %) were detected after a median follow-up time of 36 months. All recurrences were detected within 12 months. No carcinoma recurrences were observed. R1 resection status and intra-procedural AEs independently predicted recurrences with seven vs 150 recurrences per 1,000 person-years in the R0 vs R1 group, respectively. Conclusions Colorectal ESD is a safe and effective option for managing superficial colorectal neoplasia in a Western setting, with short and long-terms outcomes comparable to Eastern studies. En-bloc R0 resection and absence of intra-procedural AEs are associated with reduced risk of recurrence.
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Wang, Shi-Shi, and Wang-Hao Liu. "Impact of frailty on outcomes of elderly patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis." World Journal of Clinical Cases 12, no. 1 (January 6, 2024): 107–18. http://dx.doi.org/10.12998/wjcc.v12.i1.107.
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BACKGROUND Frailty is a common condition in elderly patients who receive percutaneous coronary intervention (PCI). However, how frailty affects clinical outcomes in this group is unclear. AIM To assess the link between frailty and the outcomes, such as in-hospital complications, post-procedural complications, and mortality, in elderly patients post-PCI. METHODS The PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science databases were screened for publications up to August 2023. The primary outcomes assessed were in-hospital and all-cause mortality, major adverse cardiovascular events (MACEs), and major bleeding. The Newcastle-Ottawa Scale was used for quality assessment. RESULTS Twenty-one studies with 739693 elderly patients undergoing PCI were included. Frailty was consistently associated with adverse outcomes. Frail patients had significantly higher risks of in-hospital mortality [risk ratio: 3.45, 95% confidence interval (95%CI): 1.90-6.25], all-cause mortality [hazard ratio (HR): 2.08, 95%CI: 1.78-2.43], MACEs (HR: 2.92, 95%CI: 1.85-4.60), and major bleeding (HR: 4.60, 95%CI: 2.89-7.32) compared to non-frail patients. CONCLUSION Frailty is a pivotal determinant in the prediction of risk of mortality, development of MACEs, and major bleeding in elderly individuals undergoing percutaneous coronary intervention.
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Howard, Ato, Jill Germinaro, Joseph Squire, Saurabh Sanon, George Jabbour, Madhurmeet Singh, Andrew Voigt, Suresh Mulukutla, Samir Saba, and Sandeep Jain. "Abstract 12967: Early Gastrointestinal Bleeding is Most Common Hemorrhagic Complication After Watchman Implantation." Circulation 146, Suppl_1 (November 8, 2022). http://dx.doi.org/10.1161/circ.146.suppl_1.12967.
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Introduction: Left atrial appendage occlusion (LAAO) with the Watchman device is increasingly used for patients with an indication for anticoagulation for atrial fibrillation (AF) and a contraindication to long term anticoagulation. Real world early outcomes in this high-risk patient population are scarce. Methods: We retrospectively evaluated a healthcare system registry of 1200 patients who underwent LAAO with Watchman 2.5 or FLX between 10/2018 and 8/2021 and included 849 patients with 6-month follow-up. We classified complications in 3 distinct categories (immediate procedural, 6-week post-procedural and 6-month post-procedural) and tracked all thromboembolism, hemorrhage and mortality that occurred after the immediate procedural complications. Results: Mean age was 77.6 ± 8.3 years old, 49% were female, 68% had paroxysmal AF, mean CHA 2 DS 2 -VASc was 5.0 ± 1.4, and mean HAS-BLED was 2.9 ± 1.0. Immediate procedural complication rate was 2.4% (access site n=16; tamponade n=2; esophageal injury n=2). 6-week post-procedural complication rate was 4.2% whereas 6-month post-procedural complication rate was 2.0% (% per 100 patient-months). Overall post-procedural complication rate after 6.2 ± 1.1 months was 2.6% of which 0.3% were thromboembolic, 1.2% were hemorrhagic and 1.1% were mortality events (% per 100 patient-months). Gastrointestinal bleeding (GIB) made up 39% and 83% of post-procedural and hemorrhagic complications respectively. Time-indexed post-procedural GIB rate was higher during 6-week period compared to 6-month period (1.9% vs. 0.7%, p=0.00003). Patients with most common indication for LAAO (high risk for bleeding or history of major bleeding, 82.0%) had higher odds of post-procedural GIB than those without bleeding indication (7.0% vs. 2.6%, OR=2.8, p=0.02). GIB was not significantly associated with mortality. Conclusions: Post-LAAO complication rate was low and decreased over time when comparing 6-week and 6-month periods in a high-risk patient population. Early GIB was the most common hemorrhagic complication and patients with bleeding indication for LAAO had a higher risk of GIB within the first 6 months after procedure. Further studies targeting ideal antithrombotic regimen after Watchman implantation are needed.
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Ramamoorthy, Sivaranjani, and Kathleen Shurpin. "Abstract 205: Minimizing Post Procedural Bleeding Complications - A Quality Improvement Initiative." Circulation: Cardiovascular Quality and Outcomes 9, suppl_2 (March 2016). http://dx.doi.org/10.1161/circoutcomes.9.suppl_2.205.
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Objectives: The primary purpose of this study is to implement the National Cardiovascular Data Registry (NCDR) CathPCI bleeding risk score pre-procedurally, in order to identify the patients who are at high risk for bleeding complications and secondly, to examine accurate documentation to decrease hemorrhagic complications among adult patients undergoing percutaneous coronary intervention (PCI). Background: Bleeding is one of the most common complications of PCI. The NCDR CathPCI bleeding risk score can predict patient risk for bleeding complications pre-procedurally. This tool is recognized as an assessment tool that can modify bleeding risk among adult patients undergoing PCI. This validated, individualized bleeding risk score (BRS) is useful in clinical decision making to promote quality of care, patient safety, and patient satisfaction and PCI outcomes. Specific outcomes evaluated in this project include number of blood transfusion and length of stay (LOS). Currently, this BRS tool is under utilized in the clinical setting. Methods: A cross sectional study design was implemented for this quality improvement project in a major medical center in the Northeast. Retrospective clinical data review was conducted for adult patients who underwent PCI prior to initiation of the NCDR CathPCI assessment tool. A data collection form was implemented to obtain this retrospective data related to bleeding complications. The NCDR CathPCI bleeding score tool was then implemented for adult patients who underwent PCI. Prospective data collection after implementing NCDR cathPCI bleeding risk tool is in progress. Results: The preliminary findings of the retrospective data review prior to implementation of the NCDR CathPCI bleeding score suggests that, 34.4% of the patients who received blood transfusions had documented bleeding complications (hematoma 15.6% (10 of 64); retro-peritoneal bleeding 9.4% (6 of 64); gastrointestinal bleeding 9.4% (6 of 64). Only 14.1% (9 of 64) of these patients had a drop in hemoglobin of 3grams from the baseline prior to transfusion. There was also a lack of documentation of hematoma size. Chronically anemic patients who received blood transfusion without bleeding complications accounted for 65.6% (42 of 64) of the patients reviewed in the retrospective data review. Average LOS of patients who required blood transfusion was an average of 1.34 days when compared with patients who did not develop bleeding complications. Final results of the prospective data analysis post implementation of the NCDR CathPCI assessment tool are pending. Conclusion: Pending.
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Carabetta, Nicole, Sabato Sorrentino, Fabiola Boccuto, Antonio Bellantoni, Salvatore Giordano, Michele Antonio Cacia, Alberto Polimeni, et al. "809 Frequency and determinants of haemoglobin drop without overt bleeding in patients undergoing transcatheter aortic valve replacement." European Heart Journal Supplements 23, Supplement_G (December 1, 2021). http://dx.doi.org/10.1093/eurheartj/suab149.004.
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Abstract Aims Post-procedural bleedings have a significant impact on mortality in patients undergoing transcatheter aortic valve replacement (TAVR). Unfortunately, the source of these bleedings is often undetermined, causing difficulties in diagnosis and related treatment. Furthermore, the frequency and determinants of ‘non-overt’ bleeding are largely lacking in TAVR studies. Accordingly, in this analysis, we aimed to assess the frequency and determinants of haemoglobin drop without overt bleeding in patients undergoing TAVR. Methods Patients undergoing TAVR at Magna Graecia University in Catanzaro from September 2008 to November 2020 were included in this study. Post-procedural haemoglobin (Hb) drop was calculated subtracting the lowest value observed after the procedure to the one obtained at admission (Hb drop). The association between baseline clinical and procedural variables with Hb drop was investigated with a linear regression model. Results Out of 407 patients undergoing TAVR at our institution, 119 (29.2%) were excluded because experiencing overt bleeding, red blood cells transfusion, were treated with only balloon angioplasty, or for procedural unsuccess. Among the 288 patients included in the final analysis, 239 (83.0%) were older than 74 y.o., 148 (51.4%) were female, 94 (32.6%) were diabetics, and 69 (24.0%) had CKD. All the patients were deemed at intermediate/high operatory risk and treated using the transfemoral approach. After TAVR, Hb significantly decreased (12.6 ± 1.6 g/dL to 9.7 ± 1.3 g/dL, P < 0.001), with an absolute mean reduction of 2.9 ± 1.23 g/dL 126 patients (43.8%) had Hb drop ≥ 3 g/dL, while 11 (3.8%) had Hb drop ≥ 5 g/dL. The table below summarizes the determinants of Hb drop. Among them, the new generation of self-expandable and balloon-expandable devices were associated with a lower post-procedural Hb drop compared to the previous generation of self-expandable devices, alongside, higher body mass index and hypertension. Conclusions Post-procedural reduction of Hb without overt bleeding or RBC transfusion is frequent, involving almost half of the patients undergoing TAVR. The introduction in clinical practice of new-generation valve devices is significantly associated with a reduction of this adverse event. However, further and thorough investigation should be accomplished to reclassify this large part of patients into a well-defined category.
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Elmokadem, Ali H., Hassan Abdelsalam, Ahmed El-Morsy, and Ahmed Elsabbagh. "Trans-arterial embolization of malignant tumor-related gastrointestinal bleeding: technical and clinical efficacy." Egyptian Journal of Radiology and Nuclear Medicine 50, no. 1 (October 29, 2019). http://dx.doi.org/10.1186/s43055-019-0045-4.
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Abstract Background Gastrointestinal (GI) tract bleeding is a major cause of mortality among patients with GI malignancies. We aimed to assess the technical and clinical efficacy of trans-arterial embolization (TAE) as a symptomatic treatment of tumor-related GI bleeding. This study was conducted for patients with GI bleeding secondary to histopathologically proven different GI malignancies. Fourteen patients underwent trans-arterial embolization. Patients were followed up clinically for any complications or episodes of recurrent bleeding. Results Fourteen patients were included (9 males and 5 females) with mean age 55.5 years (range 42–69 years). All procedures were technically successful with post-procedural hemorrhage control and no immediate complication. The 30-day post-procedural clinical success rate was 78.4%. Three repeated clinically successful TAE sessions were done for recurrent bleeding. The median post-procedural follow-up duration was 241 days. The 30-day mortality rate was 7.1%, while the overall mortality rate was 35.7%. Conclusion Trans-arterial embolization of tumor-related GI bleeding controlled hemorrhage with acceptable clinical success rate and without complication in this small group of patients.
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Goudreau, Sally, Lars J. Grimm, Ashmitha Srinivasan, Jose Net, Roger Yang, Vandana Dialani, and Katerina Dodelzon. "Bleeding Complications After Breast Core-needle Biopsy—An Approach to Managing Patients on Antithrombotic Therapy." Journal of Breast Imaging, May 8, 2022. http://dx.doi.org/10.1093/jbi/wbac020.
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Abstract Image-guided core-needle breast and axillary biopsy (CNB) is the standard-of-care procedure for the diagnosis of breast cancer. Although the risks of CNB are low, the most common complications include bleeding and hematoma formation. Post-procedural bleeding is of particular concern in patients taking antithrombotic therapy, but there is currently no widely established standard protocol in the United States to guide antithrombotic therapy management. In the face of an increasing number of patients taking antithrombotic therapy and with the advent of novel classes of anticoagulants, the American College of Radiology guidelines recommend that radiologists consider cessation of antithrombotic therapy prior to CNB on a case-by-case basis. Lack of consensus results in disparate approaches to patients on antithrombotic therapy undergoing CNB. There is further heterogeneity in recommendations for cessation of antithrombotic therapy based on the modality used for image-guided biopsy, target location, number of simultaneous biopsies, and type of antithrombotic agent. A review of the available data demonstrates the safety of continuing antithrombotic therapy during CNB while highlighting additional procedural and target lesion factors that may increase the risk of bleeding. Risk stratification of patients undergoing breast interventional procedures is proposed to guide both pre-procedural decision-making and post-procedural management. Radiologists should be aware of antithrombotic agent pharmacokinetics and strategies to minimize post-procedural bleeding to safely manage patients.
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Reinhart, Kathryn, Parkpoom Phatharacharukul, and Eric Orman. "The risk of bleeding following therapeutic endoscopy is low in patients with cirrhosis." Proceedings of IMPRS 1, no. 1 (December 7, 2018). http://dx.doi.org/10.18060/22749.
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Background: Patients with cirrhosis may be at increased risk of bleeding after invasive procedures due to defects in coagulation; however the bleeding risk following therapeutic endoscopy remains poorly understood. We aimed to determine the incidence and risk factors for post-procedural bleeding for patients with cirrhosis undergoing therapeutic endoscopy.
Methods: We performed a retrospective cohort study of patients undergoing three common endoscopic procedures (colonoscopic polypectomy, endoscopic variceal ligation, and biliary sphincterotomy) at Indiana University Hospital between 2007 and 2014. Clinical and procedural data were collected, including complications in the 30 days following the proceduress.
Results: We identified 447 procedures: 128 polypectomies, 63 sphincterotomies, and 256 variceal ligations. The incidence of bleeding was 2% (4 polypectomies, 1 sphincterotomy, and 4 variceal ligations) after a median of 4.5 days. . Prophlactic platelet transfusions were provided to 11 patients and plasma was transfused in 17 patients. Of those who received prophylactic transfusions, only one bled (post-polypectomy despite prophylactic hemoclip placement). The patients that bled had a median INR of 1.48 which was slightly elevated compared to the overall median INR 1.26. Post-polypectomy bleeding occurred following removal of fairly large polyps (8, 9, 10, 25 mm) compared to the median overall polyp size of 5 mm.
Conclusion: The incidence of bleeding for patients with cirrhosis undergoing therapeutic endoscopy is low. More data on post-procedural bleeding are needed to determine risk factors and to inform appropriate prophylactic measures. These data may be used to guide clinicians in counseling patients prior to these procedures.
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DesRoche, Chloe, Jeannie Callum, Aiden Scholey, Omar I. Hajjaj, Jennifer Flemming, Ben Mussari, Emidio Tarulli, Amir Reza Nasirzadeh, and Alexandre Menard. "Platelet and INR Thresholds and Bleeding Risk in Ultrasound Guided Percutaneous Liver Biopsy: A Before-After Implementation of the 2019 Society of Interventional Radiology Guidelines Observational Quality Improvement Study." Canadian Association of Radiologists Journal, May 16, 2024. http://dx.doi.org/10.1177/08465371241252059.
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Purpose: To evaluate if implementation of the 2019 Society of Interventional Radiology (SIR) guidelines for periprocedural management of bleeding risk in patients undergoing percutaneous ultrasound guided liver biopsy is associated with increased haemorrhagic adverse events, change in pre-procedural blood product utilization, and evaluation of guideline compliance rate at a single academic institution. Methods: Ultrasound guided percutaneous liver biopsies from (January 2019-January 2023) were retrospectively reviewed (n = 504), comparing biopsies performed using the 2012 SIR pre-procedural coagulation guidelines (n = 266) to those after implementation of the 2019 SIR pre-procedural guidelines (n = 238). Demographic, preprocedural transfusion, laboratory, and clinical data were reviewed. Chart review was conducted to evaluate the incidence of major bleeding adverse events defined as those resulting in transfusion, embolization, surgery, or death. Results: Implementation of the 2019 SIR periprocedural guidelines resulted in reduced guideline non-compliance related to the administration of blood products, from 5.3% to 1.7% ( P = .01). The rate of pre-procedural transfusion remained the same pre and post guidelines at 0.8%. There was no statistically significant change in the incidence of bleeding adverse events, 0.8% pre guidelines versus 0.4% post ( P = 1.0). Conclusion: Implementation of the 2019 SIR guidelines for periprocedural management of bleeding risk in patients undergoing percutaneous ultrasound guided liver biopsy did not result in an increase in bleeding adverse events or pre-procedural transfusion rates. The guidelines can be safely implemented in clinical practice with no increase in major adverse events.