Digestive Tract Bleeding Research Articles

Effect of comfortable nursing on quality of life of patients with upper gastrointestinal bleeding

Objective To explore the effect of comfortable nursing on quality of life of patients with upper gastrointestinal bleeding. Methods From October 2010 in our hospital to October 2009,63 cases of patients with acute upper digestive tract hemorrhage were selected into the treatment group,63 cases were selected at admission into the control group. Patients of two groups were given conventional hemostatic symptomatic care. Patients in treatment group were given comfortable nursing intervention based uplink. Anxiety score during hospitalization, quality of life, satisfaction score, bleeding volume were compared between the two groups. Results There were significant differences in psychological, social, physical discomfort, anxiety, satisfaction degree between the treatment and control groups (P 0.05). Conclusions Comfortable nursing for patients with hemorrhage of upper digestive tract could relieve the patient's psychological pressure, improve the quality of life, promote nurse-patient relationship. Key words: Comfortable nursing; Upper gastrointestinal bleeding; Anxiety; Satisfaction; Quality of life

Application value of the predictive nursing care in the patients with hemorrhage of upper digestive tract

Objective To observe the application value of the predictive nursing care in the patients with hemorrhage of upper digestive tract. Methods 114 cases with hemorrhage of upper digestive tract were selected and divided into 2 groups randomly, the control group (114 cases)and the observation group(61 cases). The patients in the control group were given conventional care,and the patients in the observation group were given predictive nursing care. The treatment condition, psychologic status and nursing satisfaction were compared between the 2 groups. Results The preoperative preparation time and hemostatic treatment completion time of the patients in the observation group were shorter significantly than the control group. The successful rescue rate was higher significantly than that of the control group. And the frequency of bleeding and the complication rate was lower obviously than the control group. After treatment and nursing of the patients in the 2 groups, the psychological status before discharge improved significantly compared with the admission, in which the control group improved more obviously. The nursing satisfaction of the observation group was superior to the control group. There was statistically significant difference between the 2 groups(P<0.05). Conclusion The predictive nursing care has important significance on the rescue and treatment of the patients with hemorrhage of upper digestive tract. Key words: Hemorrhage of upper digestive tract; Care; Predictive

Analysis of Patients' Irregular Antibody Screening and Identification Results before Blood Transfusion

To analyze the results of irregular antibody screening and identification among patients before blood transfusion, and to investigate the specific distribution of irregular antibodies and the distribution regularity in different diseases. Choosing the patients intended to be transfused in our hospital from January 1, 2009 to December 31, 2013 years, micro-column gel technique was used to screen the irregular antibodies of those receptors and to identify the antibody specificity of the positive specimens. Among 44194 patients, 137 patients were with irregular antibody positive and their positive rate was 0.31%, among them 33 cases were male and accounted for 0.18% in the studied males; the 104 cases were females and accounted for 0.40% in all the studied females. The difference of sex distribution was statistically significant (X2=15.38, P<0.05). In the irregular antibody screening positive patients, patients with transfusion or pregnancy history were 129 cases, and the patients without transfusion or pregnancy history were 8 cases. In the irregular antibody screening positive patients, the main antibody of 54 cases belongs to Rh blood type system, accounting for 39.42%; The main antibody of 37 cases belongs to MNS blood type system, accounting for 27.01%; while the 30 cases belong to Lewis blood type system, accounting for 21.90%. According to the classification of diseases, the irregular antibody screening-positive patients with tumors were ranked in the highest rate at 5.96‰, the secondary hemorrhage of digestive tract and chronic renal failure were ranked at the rate of 3.28‰ and 3.19‰. The difference of positive rates between diseases was statistically significant (χ2=19.33, P<0.05). Irregular antibody screening before blood transfusion is necessary, which can discover the irregular antibodies of clinical significance, especially for patients with tumors and the other patients with the history of frequent blood transfusions or multiple pregnancies. Antibody screening is a useful warning signal, as it ensures the safety of blood transfusions.

Esclerosis hepatoportal como causa de hipertensión portal no cirrótica en un paciente colombiano infectado con VIH

Antecedentes: la esclerosis hepatoportal se manifiesta como hipertensión portal no cirrótica. Su etiología parece estar relacionada con alteraciones idiopáticas en la microvasculatura hepática. Las manifestaciones de la esclerosis hepatoportal incluyen sangrado de vías digestivas altas, pancitopenia, esplenomegalia e hipertensión portal no cirrótica. Presentamos el primer caso reportado en Colombia de esclerosis hepato- portal en un paciente con serología positiva para el virus de la inmunodeficiencia humana (VIH). Métodos: paciente masculino de 60 años de edad, VIH-positivo, quien ingresa a nuestra institución por hemorragia de vías digestivas alta (várices esofágicas y fúndicas) y ascitis, cuyo manejo requirió la toma de biopsia hepática. Resultados: se realizó biopsia Trucut de hígado que evidenció la presencia de 6 a 8 espacios porta con parénquima arquitectónico conservado que demostró fibrosis perivenular y dilatación sinusoidal pericentral severa. Conclusión: la esclerosis hepatoportal es una causa de morbilidad en pacientes VIH-positivos. Debe considerarse en cada paciente que manifiesta hipertensión portal no cirrótica asociada con hemorragia de la vía digestiva alta. Sin embargo, una investigación adicional es imprescindible con el fin de describir la relación entre el desarrollo de alteraciones intrahepáticas (microtrombosis), la patogénesis del VIH y el uso de terapia antirretroviral, particularmente el uso de didanosina.

Gastroesophageal varices (bleeding) and splenomegaly: the initial manifestations of some pancreatic body and tail carcinoma.

Gastroesophageal varices (bleeding) and splenomegaly: the initial manifestations of some pancreatic body and tail carcinoma.

Somatostatin analogs in the medical management of occult bleeding of the lower digestive tract.

The management of occult bleeding from the lower digestive tract can be very challenging. In cases of identified angiodysplasia, the first line management options can be limited by a number of clinical or anatomical factors and an alternative approach might be required, including the use of medications. Somatostatin analogs have been considered as an effective and well-tolerated alternative management option in a number of cases where the endoscopic therapeutic approach is not practical or is unsuccessful, in patients with coagulopathies or who need concomitant anticoagulation or antiplatelet treatment. Despite the lack of double-blinded randomized placebo-control trials and despite the limitations of the available evidence in the literature, including small sample size, variable dosing, and administration routes, there is a consistent agreement in the literature that somatostatin analogs are a safe, well-tolerated, and effective therapeutic option for managing refractory or occult bleeding from the lower digestive tract, with particular reference to patients with angiodysplasia, where endoscopic or surgical management is either not feasible or unsuccessful and other pharmacological options are not preferred.

Clinical pathway management in liver cirrhosis complicated with upper digestive tract hemorrhage

Clinical pathway management in liver cirrhosis complicated with upper digestive tract hemorrhage

Clinical Study of Allo-HSCT with Conditioning Regimen Containing Decitabine in the Treatment of advanced Acute Myloid Leukemia and Myelodysplastic Syndrom

▪Background: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only curative treatment options to hematologic malignancies. However, majority of patients with refractory or resistant hematologic malignancies can not achieve remission before transplantation. And the relapse rate of these patients after transplantation remains high obviously. Therefore, it is necessary to design a safe and effective conditioning regimen to improve the remission rate of these patients and disease-free survival (DFS), but to reduce transplantation related mortality (TRM). The optimal conditioning regimen not only can reduce tumor burden and eradicate minimal residual disease but also can make immunosuppressive state to ensure engraftment. As well as, it does not increase the TRM. One of the promising drugs of epigenetics is decitabine (DAC), which has a significant effect on a variety of hematologic malignancies. It is widely used in myelodysplastic syndromes(MDS) even for relapsed and refractory acute myelocytic leukaemia (AML). Because decitabine can not only up-modulate the tumor-associated antigen express on surface of leukemia cells to increase graft-versus-leukemia (GVL) effect but also can reduce the incidence of graft-versus-host disease (GVHD) by increase the number of regulatory T Cells（Tregs）.Aims: This clinical study will investigate the security and efficacy of conditioning regimen containing decitabine. Further to explore the role in advanced malignant hematologic disease.Methods: We retrospectively studied 20 cases of patients with hematologic malignancies, who underwent allo-HSCT with decitabine combined with conditioning regimens in the Department of Hematology, the First Affiliated Hospital of Soochow University during May 1, 2012 to April 30, 2014.Results: 19 patients achieved complete remission and hematopoietic reconstitution after transplantation. Only 1 NR case died on day +27 post transplant. The median time of neutrophil and platelet reconstitution were 12 (10-22) and 14.5 (12-35) days respectively. The median time of archiving full donor chimerism [short tandem repeat (STR)STR>95%] was 18(13-62) days. The median follow-up post transplant was 246 (19-582) days. 3 cases relapsed. 2 cases were dead due to relapse.1 case achieved complete remission again after donor lymphocyte infusion (DLI). 1 CR case was dead due to hemorrhage of digestive tract. The other 15 CR cases were survival with continued remission. The estimated 2-year overall survival (2yr-OS) rate was 78%.The 2 year disease-free survival (2yr-DFS) rate was 62.6%. The cumulative relapse rate was 26.7%. The transplantation-related mortality (TRM) rate was 0. Furthermore, the estimated 2-yr OS and DFS of patients with DNMT3A mutations or abnormalities of chromosome 7 and complex chromosomal karyotype were 72.9% and 60.6% respectively. Concerning about transplant related toxicity, except one case has grade III gastrointestinal toxicity, all the other toxicities were mild (grade I-II). The cumulative rate of aGVHD and cGVHD were 20.5% and 48.3%.And the cumulative rate of aGVHD for grade I-II and grade II-IV were 15% and 10.5%.Conclusions1.Allo-HSCT is an effective treatment for refractory and relapsed AML and high- risk MDS. It is feasible to use conditioning regimen containing decitabine before allo-HSCT. The treatment were well tolerated.2.92.3% of the patiants achieved CR, and were well engraftment. Because of decitabine can promote megakaryocytic maturation and accelerate the release of platelet, so hematopoietic was reconstructed rapidly, especially for the megakaryocyte. The 2yr-DFS rate was 62.6%, the cumulative relapse rate was 26.7%. The conditioning regimen containing decitabine before allo-HSCT seems to reduce the incidence of aGVHD.The prognosis and survival of the patients with complex chromosomal karyotype or chromosome 7 abnormalities or DNMT3A mutation may be improved by treating with decitabine containing conditioning regimen. DisclosuresNo relevant conflicts of interest to declare.

Logistic regression analysis of prognostic factors in 106 acute-on-chronic liver failure patients with hepatic encephalopathy

Objective To analyze the prognostic factors in acute-on-chronic liver failure ( ACLF) patients with hepatic encephalopathy ( HE) and to explore the risk factors for prognosis. Methods A retrospective analysis was performed on106 ACLF patients with HE who were hospitalized in our hospital from January 2010 to July 2013. The patients were divided into improved group and deteriorated group. The univariate indicators including age, sex, laboratory indicators [total bilirubin ( TBil) , albumin ( Alb) , alanine aminotransferase ( ALT) , aspartate amino-transferase ( AST) , and prothrombin time activity ( PTA) ], the stage of HE, complications [persistent hyponatremia, digestive tract bleeding, hepatorenal syndrome ( HRS) , ascites, infection, and spontaneous bacterial peritonitis ( SBP) ], and plasma exchange were analyzed by chi-square test or t-test. Indicators with statistical significance were subsequently analyzed by binary logistic regression. Results Univariate analysis showed that ALT ( P = 0. 009) , PTA ( P = 0. 043) , the stage of HE ( P = 0. 000) , and HRS ( P = 0. 003) were significantly different between the two groups, whereas differences in age, sex, TBil, Alb, AST, persistent hyponatremia, digestive tract bleeding, ascites, infection, SBP, and plasma exchange were not statistically significant ( P >0. 05) . Binary logistic regression demonstrated that PTA ( b =-0. 097, P =0. 025, OR =0. 908) , HRS ( b =2. 279, P =0. 007, OR =9. 764) , and the stage of HE ( b = 1. 873, P = 0. 000, OR = 6. 510) were prognostic factors in ACLF patients with HE. Conclusion The stage of HE, HRS, and PTA are independent influential factors for the prognosis in ACLF patients with HE. Reduced PTA, advanced HE stage, and the presence of HRS indicate worse prognosis.

Clinical, radiologic, and endoscopic characteristics upon diagnosis of patients with prehepatic portal hypertension at the Instituto Nacional de Pediatría from 2001 to 2011.

Prehepatic portal hypertension in children can be asymptomatic for many years. Once diagnosed, the therapeutic measures (pharmacologic, endoscopic, and surgical) are conditioned by the specific characteristics of each patient. In Mexico, there are no recorded data on the incidence of the disease and patient characteristics. To determine the main clinical, radiologic, and endoscopic characteristics upon diagnosis of these patients at the Instituto Nacional de Pediatría within the time frame of January 2001 and December 2011. A cross-sectional, retrolective, descriptive, and observational study was conducted in which all the medical records of the patients with portal hypertension diagnosis were reviewed. There was a greater prevalence of prehepatic etiology (32/52) (61.5%) in the portal hypertension cases reviewed. Males (62.5%) predominated and 11 of the 32 patients were under 4 years of age. The primary reason for medical consultation was upper digestive tract bleeding with anemia (71.9%) and the main pathology was cavernomatous degeneration of the portal vein (65.6%). Splenoportography was carried out on 17 of the 32 patients. A total of 65.5% of the patients received the combination therapy of propranolol and a proton pump inhibitor. Initial endoscopy revealed esophageal varices in 96.9% of the patients, 12 of whom presented with gastroesophageal varices. Congestive gastropathy was found in 75% of the patients. The varices were ligated in 8 cases, sclerotherapy for esophageal varices was carried out in 5 cases (15.6%), and sclerotherapy for gastric varices was performed in 2 patients. Seventeen patients (53.1%) underwent portosystemic diversion: 10 of the procedures employed a mesocaval shunt and 7 a splenorenal shunt. Nine patients (28.1%) underwent total splenectomy. The primary cause of the disease was cavernomatous degeneration of the portal vein; it was predominant in males and the first symptom was variceal bleeding.

Clinical, radiologic, and endoscopic characteristics upon diagnosis of patients with prehepatic portal hypertension at the Instituto Nacional de Pediatría from 2001 to 2011

BackgroundPrehepatic portal hypertension in children can be asymptomatic for many years. Once diagnosed, the therapeutic measures (pharmacologic, endoscopic, and surgical) are conditioned by the specific characteristics of each patient. In Mexico, there are no recorded data on the incidence of the disease and patient characteristics. AimsTo determine the main clinical, radiologic, and endoscopic characteristics upon diagnosis of these patients at the Instituto Nacional de Pediatría within the time frame of January 2001 and December 2011. MethodsA cross-sectional, retrolective, descriptive, and observational study was conducted in which all the medical records of the patients with portal hypertension diagnosis were reviewed. ResultsThere was a greater prevalence of prehepatic etiology (32/52) (61.5%) in the portal hypertension cases reviewed. Males (62.5%) predominated and 11 of the 32 patients were under 4years of age. The primary reason for medical consultation was upper digestive tract bleeding with anemia (71.9%) and the main pathology was cavernomatous degeneration of the portal vein (65.6%). Splenoportography was carried out on 17 of the 32 patients. A total of 65.5% of the patients received the combination therapy of propranolol and a proton pump inhibitor. Initial endoscopy revealed esophageal varices in 96.9% of the patients, 12 of whom presented with gastroesophageal varices. Congestive gastropathy was found in 75% of the patients. The varices were ligated in 8 cases, sclerotherapy for esophageal varices was carried out in 5 cases (15.6%), and sclerotherapy for gastric varices was performed in 2 patients. Seventeen patients (53.1%) underwent portosystemic diversion: 10 of the procedures employed a mesocaval shunt and 7 a splenorenal shunt. Nine patients (28.1%) underwent total splenectomy. ConclusionsThe primary cause of the disease was cavernomatous degeneration of the portal vein; it was predominant in males and the first symptom was variceal bleeding.

Role of Double Balloon Enteroscopy in the Diagnosis of Obscure Gastrointestinal Bleeding

Obscure gastrointestinal bleeding (OGIB) is bleeding in the digestive tract which persist or recur and with unclear aetiology. OGIB is one of the important problems in the gastrointestinal field due to difficulty in diagnosing the aetiology and determining the source of digestive tract bleeding in patients. In diagnosing the cause of OGIB, clinical approach through history taking and physical examination still have important roles. Most of the sources of bleeding in OGIB is from the small intestine, which cannot be reached by esophagogastroduodenoscopy (EGD) or colonoscopy. Therefore, role of diagnostic tool which is able to perform total enteroscopy becomes important in diagnosing the cause of OGIB.Double balloon enteroscopy (DBE) technique is a safe endoscopy procedure which may use oral or even rectal approach. In finding the cause of OGIB, where most of the lesions is found in the proximal region of the small intestine, oral approach is more beneficial. When bleeding is not found after conventional endoscopy is performed, it needs to be suspected that the source might come from the small intestine. Currently, the two main modalities which can be used in the evaluation are video capsule endoscopy (VCE) and DBE. However, based on cost effectiveness DBE without prior VCE has benefit because it can also administer therapy in the abnormalities being found. Keywords: obscure gastrointestinal bleeding, endoscopy, diagnosis, double balloon enteroscopy

Long-term consequences of bile duct injury after cholecystectomy

Late complications arising after bile duct injury (BDI) include biliary strictures, hepatic atrophy, cholangitis and intra-hepatic lithiasis. Later, fibrosis or even secondary biliary cirrhosis and portal hypertension can develop, enhanced by prolonged biliary obstruction associated with recurrent cholangitis. Secondary biliary cirrhosis resulting in associated hepatic failure or digestive tract bleeding due to portal hypertension is a substantial risk factor for morbidity and mortality after bile duct repair. Parameters that determine the management of late complications of BDI include the type of biliary injury, associated vascular injury, hepatic atrophy, the presence of intra-hepatic strictures or lithiasis, repetitive infectious complications, the quality of underlying parenchyma (fibrosis, secondary biliary cirrhosis) and the presence of portal hypertension. Endoscopic drainage is indicated for patients with uncontrolled acute sepsis, patients at high operative risk, patients with cirrhosis who are not eligible for liver transplantation and patients who have previously undergone several attempts at repair. Roux-en-Y hepaticojejunostomy, whether de novo or as an iterative repair, is the technique of reference for post-cholecystectomy BDI. Hepatic resection is indicated in only rare instances, mainly in case of extended hilar stricture, multiple stone retention in one sector of the liver or in patients for whom the repair is deemed technically difficult. Liver transplantation is indicated only in exceptional circumstances, when secondary biliary cirrhosis is associated with liver failure and portal hypertension.

Early complications of intra-operative radiotherapy in locally advanced pancreatic cancer

To investigate the complications in intra-operative radiotherapy (IORT) for patients with local advanced pancreatic cancer. The clinical data, operation material, overall dose of IORT, postoperative therapy, complications, treatment and prognosis were retrospectively analyzed in all the in-hospital pancreatic cancer patients from Nov 2008 to Jan 2012. There were 115 patients with local advanced pancreatic cancer treated with IORT in this study. 81 cases had a tumor in the head of pancreas and 34 cases in the pancreatic body and tail. The operation method was IORT combined with internal drainage surgery. The intra-operative radiotherapy was performed using Mobetron mobile electron accelerator, with a total dose of 12-20 Gy. Bilioenteric anastomosis and/or gastrointestinal anastomosis were included in the internal drainage surgery. Gastroparesis syndrome (10.4%), hemorrhage (3.5%), abdominal infection (2.6%), pancreatic fistula (0.9%) and renal failure (1.7%) were the common postoperative complication of IORT. All patients were cured except one who died of digestive tract hemorrhage. Major complications of IORT are gastroparesis syndrome, abdominal infection and hemorrhage. The incidence of gastroparesis syndrome is at the top of the list. However, early complications have a relatively better prognosis, indicating that IORT is a safe and reliable therapy for patients with locally advanced pancreatic cancer.

Retrospective analysis of correlative factors between digestive system injury and anticoagulant or antiplatelet-agents

To explore the correlative factors and clinical characteristics of digestive system injury during the treatment of anticoagulant and (or) antiplatelet-agents. A total of 1 443 hospitalized patients on anticoagulant and (or) antiplatelet-agents from January 2010 to December 2013 at Renmin Hospital of Wuhan University were analyzed retrospectively. Their length of hospital stay was from 5 to 27 days. Most of them were elderly males (n = 880, 61.0%) with an average age of (62 ± 6) years. 1 138 patients (78.9%) were farmers, workers or someone without a specific occupation. During the treatment of anticoagulant/antiplatelet-agents, statistical difference existed (P = 0.01) between positively and negatively previous digestive disease groups for actively newly occurring digestive system injury (16.0% (41/256) vs 15.9% (189/1 187)). After the dosing of anticoagulant and (or) antiplatelet-agents, 57 (66.3%, 57/86) patients were complicated by hemorrhage of digestive tract, taking 62.9% (61/97) of all positive result patients for Helicobacter pylori test. Comparing preventive PPI group with no PPI group, there was no marked statistical differences (P = 2.67) for digestive system complication (including hemorrhage of digestive tract) while receiving anticoagulant and (or) antiplatelet-agents (13.9% (74/533) vs 17.1% (156/910)). During anticoagulant and/or antiplatelet-agent therapy, 185 patients (12.8%) were complicated by peptic ulcer or peptic ulcer with bleeding, 40 patients (2.8%) had erosive gastritis and 5 (0.3%) developed acute gastric mucosal lesions. And 42 of 76 patients complicated by hemorrhage of digestive tract underwent endoscopic hemostasis while 2 patients were operated. Ninety-seven patients (6.7%) died, including 61 (62.9%, 61/97) from hemorrhage of digestive tract. The remainder became cured, improved and discharged. Moreover, no significant statistical differences existed (P = 2.29) among three combination group (aspirin, clopidogrel, warfarin), two combination group (aspirin, clopidogrel), exclusive aspirin group and exclusive warfarin group in short-term (<27 d) mortality. It is necessary to clearly dictate the details of medication to the patients not highly educated. Elder, male, history of digestive system disease and Helicobacter pylori infection are possibly highly risk correlative factors for digestive system complications during anticoagulant/antiplatelet-agent therapy. The short-term protective effect of routine dose of PPI is inconspicuous. No significant correlation exists between short-term mortality and the dosage (or type) of anticoagulant/antiplatelet-agents.

Prevention of portal venous system thrombosis after splenectomy and devasculation

Objective To investigate the causes and prevention measures for patients with portal hypertension hypersplenism undergone splenectomy plus pericardial devascularization and post-operative portal vein thrombosis (portal vein thrombogenesis,PVT).Methods 178 cases of splenectomy plus devascularization from July 2013 to May 1994 in Cangzhou Central Hospital of Hebei Province,including 102 cases of early postoperative application of low molecular heparin anticoagulant for the prevention group,76 cases without anticoagulant medicine as control group.33 cases with PVT found by B ultrasound or CT scan,were treated with urokinase body intravenous thrombolysis,hepatic artery catheterization thrombolysis,intestinal resection of + Fogarty catheter embolectomy vein stump treatment respectively.Results The total incidence of thrombosis was 18.5％ (33/178),prevention group was 8.8％ (9/102),including 7 cases in grade Ⅰ,Ⅲ,Ⅳ thrombus,in 1 cases,no intestine necrosis.The control group thrombosis rate was 31.6％ (24/76),including 7 cases in grade Ⅰ,Ⅲ,Ⅳ,thrombosis in 17 cases,5 cases of intestine necrosis,two groups of thrombosis rate were significantly differences (x2 =14.932,P =0.000).Thrombus disappeared completely in 7 cases,the thrombus grading decreased in 2 cases in the preventive group after thrombolysis,and thrombus disappeared completely in 6 cases,11 cases of thrombosis degraded in the control group after treatment of thrombolysis,1 case cured by TIPS with thrombolysis and thrombectomy,1 case died of sudden digestive tract bleeding,Among 5 cases of intestinal necrosis,4 cases died and 1 case undergone abdominal exploration being found with intestine & colon necrosis.Conclusions There are a variety of factors causing PVT after splenectomy and devascularization.Early anticoagulation can significantly reduce the incidence of PVT,early discovery and treatment can prevent severe outcome. Key words: Hypertension, portal vein; Splenectomy; Venous thrombosis ; Heparin

Triflusal and Aspirin in the Secondary Prevention of Atherothrombotic Ischemic Stroke: A Very Long-Term Follow-Up

Background: The mean follow-up in the clinical trials of antiplatelet drugs in the secondary prevention of ischemic atherothrombotic stroke ranges from 1 to 5.5 years. Thus, the safety and efficacy of these drugs in the very long term is not totally documented. We have assessed the safety and effectiveness of triflusal and aspirin for a very long-term period in the secondary prevention of patients with ischemic atherothrombotic stroke. Methods: Patients with atherothrombotic ischemic stroke, including TIA, who participated in randomized clinical trials of triflusal versus aspirin were included in the study. The period of recruitment was between 1983 and 1999. After finishing their participation in the clinical trials, patients were followed up in the Neurology Department of our hospital. All patients were treated with aspirin or triflusal during a mean period of 17.2 years. Groups were comparable with respect to sex, age, risk factor and etiology of the stroke. Adverse events and vascular events (including stroke recurrence, ischemic heart disease and vascular death) that appeared throughout the study were registered. Statistical analysis was performed using the statistical package SPSS 15.0 for Windows. Kaplan-Meier curves and the log-rank test were used to compare treatments. Results: A total of 441 patients (305 men) with a mean age (±SD) of 51.1 ± 12.4 years were included in the study; 288 patients (65.3%) were treated with triflusal and 153 with aspirin. There were no statistically significant differences between aspirin and triflusal concerning new vascular events (72.5 vs. 60.4%; p = 0.28), stroke recurrence (49.7 vs. 46.5%; p = 0.53), ischemic heart events (54.9 vs. 55.6%; p = 0.90), vascular death (25.5 vs. 24%; p = 0.73) and global mortality (42.5 vs. 42%; p = 0.92). The incidence of serious bleeding (upper digestive tract hemorrhage and cerebral hemorrhage) was 18.3% in aspirin-treated patients and 5.5% in triflusal-treated patients (p < 0.001). In reference to other adverse events, no significant differences were found between aspirin and triflusal. Conclusions: In the secondary prevention of ischemic stroke, very long-term treatment with triflusal or aspirin seems to have a similar efficacy, but triflusal is safer with a lower hemorrhagic risk. Triflusal may be an alternative therapy, particularly in patients who present aspirin resistance.

Combined use of GM1 with proton-pump inhibitors or H2-receptor antagonists for treatment of spontaneous intracerebral hemorrhage with upper digestive tract hemorrhage

Combined use of GM1 with proton-pump inhibitors or H2-receptor antagonists for treatment of spontaneous intracerebral hemorrhage with upper digestive tract hemorrhage

Prophylaxis for stress ulcer bleeding in the intensive care unit

BackgroundThe critically ill patient can develop gastric erosions and, on occasion, stress ulcers with severe gastrointestinal bleeding that can be fatal. AimsThe purpose of this review was to provide current information on the pathophysiology, risk factors, and prophylaxis of digestive tract bleeding from stress ulcers in the intensive care unit. MethodsWe identified articles through a PubMed search, covering the years 1970 to 2013. The most relevant articles were selected using the search phrases “stress ulcer”, “stress ulcer bleeding prophylaxis”, and “stress-related mucosal bleeding” in combination with “intensive care unit”. ResultsThe incidence of clinically significant bleeding has decreased dramatically since 1980. The most important risk factors are respiratory failure and coagulopathy. Proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs) are used in stress ulcer bleeding prophylaxis. Both drugs have been shown to be superior to placebo in reducing the risk for gastrointestinal bleeding and PPIs are at least as effective as H2RAs. Early enteral feeding has been shown to reduce the risk for stress ulcer bleeding, albeit in retrospective studies. ConclusionsAdmittance to the intensive care unit in itself does not justify prophylaxis. PPIs are at least as effective as H2RAs. We should individualize the treatment of each patient in the intensive care unit, determining risk and evaluating the need to begin prophylaxis.

Profilaxis para sangrado por ulceras de estrés en la unidad de cuidados intensivos

The critically ill patient can develop gastric erosions and, on occasion, stress ulcers with severe gastrointestinal bleeding that can be fatal.The purpose of this review was to provide current information on the pathophysiology, risk factors, and prophylaxis of digestive tract bleeding from stress ulcers in the intensive care unit.We identified articles through a PubMed search, covering the years 1970 to 2013. The most relevant articles were selected using the search phrases "stress ulcer", "stress ulcer bleeding prophylaxis", and "stress-related mucosal bleeding" in combination with "intensive care unit".The incidence of clinically significant bleeding has decreased dramatically since 1980. The most important risk factors are respiratory failure and coagulopathy. Proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs) are used in stress ulcer bleeding prophylaxis. Both drugs have been shown to be superior to placebo in reducing the risk for gastrointestinal bleeding and PPIs are at least as effective as H2RAs. Early enteral feeding has been shown to reduce the risk for stress ulcer bleeding, albeit in retrospective studies.Admittance to the intensive care unit in itself does not justify prophylaxis. PPIs are at least as effective as H2RAs. We should individualize the treatment of each patient in the intensive care unit, determining risk and evaluating the need to begin prophylaxis.