Evaluation Of Bleeding Risk Research Articles

Evaluation of bleeding risk and measurement methods in dental patients

The present study explores bleeding manifestations in routine dental surgical procedures, evaluates the influence of antithrombotic drugs upon bleeding risk, and validates the efficiency of a clinical method for the measurement of bleeding. A prospective observational study was made involving a cohort of 99 patients in the setting of normal clinical practice, with the added conduction of prior hematological tests including baseline hemostasis and platelet function, based on a new method (Multiplate System®). For evaluation of the bleeding manifestations, a clinical method was selected that evaluates bleeding on the basis of its duration and the hemostatic measures needed to resolve the problem. Almost one-third of the patients (27.3%) were receiving treatment with oral antiplatelet drugs, while 19.2% received oral anticoagulants and 9% received combined therapy with acetylsalicylic acid plus clopidogrel. In turn, an 8% incidence of moderate bleeding episodes was detected correlated to the ASPI platelet function test and to advanced patient age. The incorporation of platelet function tests increases the safety of oral surgery in elderly patients subjected to antiplatelet treatment, particularly with acetylsalicylic acid and clopidogrel.

Diagnostic value of portal duplex ultrasound in liver cirrhosis

In a prospective study we investigated if the endoscopical evaluation of the bleeding risk of esophageal varices in cirrhotics could be improved by additional duplex sonography of the portal vein. The trial involved 41 patients with endoscopically diagnosed esophageal varices (27 male, 14 female) who were followed up over a period of 30 months (mean of 13 +/- 3). According to the Child-Pugh-Turcotte -classification, 14 patients were classified as grade A, another 14 as grade B, and 13 as grade C. The cause of the cirrhosis included virus infection (n = 14), alcohol (n = 17) and miscellaneous disorders (n = 9, primary biliary = 3, autoimmune = 2, idiopathic = 4). During the observation time, 17 patients who developed an acute esophageal variceal hemorrhage were put in the bleeding group (mean portal flow velocity Vm = 9.29 +/- 3.31 cm/s, mean flow volume Fm = 371 +/- 173 ml/min), while the remaining 24 patients formed the non-bleeding group (Vm = 13.29 +/- 5.12 cm/s, FV = 500 +/- 200 ml/min). The bleeding group had significantly lower mean portal flow velocities (p < 0.017) and mean flow volumes (p < 0.05) than the non-bleeding group. By adopting cut-off values of 12 cm/s for Vm and 420 ml/min for FV we obtained a diagnostic sensitivity for predicting esophageal variceal hemorrhage of 0.88 and 0.65 respectively. Portal duplex sonography may improve the evaluation of bleeding risk in patients wit endoscopically diagnosed esophageal varices and could influence the decision for prophylactic treatment.

An evaluation of bleeding risk after EUS-guided FNA in patients taking aspirin or NSAIDs

An evaluation of bleeding risk after EUS-guided FNA in patients taking aspirin or NSAIDs

An evaluation of bleeding risk after EUS-guided FNA in patients taking aspirin or NSAIDs

An evaluation of bleeding risk after EUS-guided FNA in patients taking aspirin or NSAIDs

Preoperative evaluation of hemorrhagic risk

Evaluation of bleeding risk before surgery requires both precise knowledge of epidemiological data relating to haemostasis disorders and a true clinical approach to help guide the diagnosis. The patient's individual and familial history is recovered during both the interview with the anaesthesiologist and the clinical examination. Preoperative haemorrhage risk prevalence is 1/40,000 patients in patients with asymptomatic congenital haemostasis disorders with low bleeding and 1/2,000 patients for acquired asymptomatic haemostasis disorders. Deficits in haemostasis factors, i.e., congenital disorders with haemorrhage potential, have an overall prevalence of 1/6,500 patients. Whatever the clinical case, haemorrhage disorders will arise in patients with either congenital or acquired bleeding abnormalities without symptoms. To work in close collaboration with haemobiologists and to request appropriate biological screening tests, it is therefore important to take into account prevalence data according to the surgical environment from which the patient will benefit.

Portal duplex sonography in liver cirrhosis. A useful supplement to endoscopic evaluation of bleeding risk of esophageal varices?

In a prospective study we investigated whether the endoscopic assessment of the bleeding risk of esophageal varices could be supported by portal duplex sonography. Over the time span of 2.5 years (range, 13 +/- 5 months) we observed 41 patients with liver cirrhosis. During that time 17 patients had acute esophageal variceal hemorrhage and constituted the bleeding group, and the remaining 24 patients without a hemorrhage constituted the non-bleeding group. Within the bleeding group the mean portal blood flow velocity (Vm) was 0.093 +/- 0.033 m/sec, and the mean flow volume (Fm) was 0.371 +/- 0.173 l/min. Both results were significantly lower than the corresponding results of the nonbleeding group (p < 0.017; p < 0.05). By assuming cut-offs for Vm of 0.12 m/sec and for Fm of 0.420 l/min, we obtained a diagnostic sensitivity for hemorrhage of 0.88 and 0.65. Our results show that portal duplex sonography may improve the evaluation of endoscopically ascertained bleeding risk of esophageal varices.

The value of preoperative haemostatic screening.

The value of preoperative haemostatic screening tests in prediction of surgical bleeding was examined in 101 patients, mainly with abdominal and thyroid lesions. The study demonstrated complete lack of correlation between the preoperative evaluation of bleeding risk and the observed surgical bleeding (phi2 test P approximately 0.85).