Active Bleeding Research Articles

A fusion model of manually extracted visual features and deep learning features for rebleeding risk stratification in peptic ulcers.

We propose a multi-feature fusion model based on manually extracted features and deep learning features from endoscopic images for grading rebleeding risk of peptic ulcers. Based on the endoscopic appearance of peptic ulcers, color features were extracted to distinguish active bleeding (Forrest I) from non-bleeding ulcers (Forrest II and III). The edge and texture features were used to describe the morphology and appearance of the ulcers in different grades. By integrating deep features extracted from a deep learning network with manually extracted visual features, a multi-feature representation of endoscopic images was created to predict the risk of rebleeding of peptic ulcers. In a dataset consisting of 3573 images from 708 patients with Forrest classification, the proposed multi-feature fusion model achieved an accuracy of 74.94% in the 6-level rebleeding risk classification task, outperforming the experienced physicians who had a classification accuracy of 59.9% (P<0.05). The F1 scores of the model for identifying Forrest Ib, IIa, and III ulcers were 90.16%, 75.44%, and 77.13%, respectively, demonstrating particularly good performance of the model for Forrest Ib ulcers. Compared with the first model for peptic ulcer rebleeding classification, the proposed model had improved F1 scores by 5.8%. In the simplified 3-level risk (high-risk, low-risk, and non-endoscopic treatment) classification task, the model achieved F1 scores of 93.74%, 81.30%, and 73.59%, respectively. The proposed multi-feature fusion model integrating deep features from CNNs with manually extracted visual features effectively improves the accuracy of rebleeding risk classification for peptic ulcers, thus providing an efficient diagnostic tool for clinical assessment of rebleeding risks of peptic ulcers.

Hyperbaric oxygen therapy in the treatment of severe gastric laceration with active bleeding: A case report

BACKGROUND Endoscopic therapy is the primary approach for treating Mallory-Weiss syndrome, particularly under conditions of mucosal protection and gastric acid suppression. However, for a subset of patients who cannot undergo endoscopic intervention or for whom such treatment proves ineffective, alternative measures like arterial embolization or surgical intervention may be required. While hyperbaric oxygen therapy (HBOT) has been applied across a range of medical conditions, its application in managing hemorrhage due to gastric tears remains undocumented. CASE SUMMARY A 52-year-old patient was admitted with symptoms of hematemesis and melena, and an endoscopy revealed a gastric fundus tear approximately 4 cm × 5 cm in size. The lesion was considered unsuitable for endoscopic repair by the attending endoscopist. Despite conservative measures, including fasting and acid suppression, the patient experienced persistent bleeding and a substantial decrease in hemoglobin levels relative to admission values. Following a multidisciplinary consultation, HBOT was initiated, resulting in the cessation of bleeding and rapid wound healing. CONCLUSION For patients with gastric tears presenting with active hemorrhage, HBOT might offer an effective alternative when conventional endoscopic therapies are not viable or have been unsuccessful.

Comparison of management options for spontaneous bleeding into soft tissues in patients with COVID-19

Spontaneous bleeding into soft tissues was a common complication of anticoagulant therapy among critically ill patients during the COVID-19 pandemic. This study sought to evaluate the impact of different treatment methods on survival among COVID-19 patients with active or self-resolved spontaneous bleeding into soft tissues. Methods used to treat CT-confirmed spontaneous hematomas in COVID-19 patients included nonoperative management (NOM), angiography (AG) with transarterial embolization (TAE) and open surgery (OS). A total of 227 participants with spontaneous hematomas into soft tissues were enrolled in this retrospective single-center study at a COVID-19-hospital between March 3, 2020 and March 3, 2022. NOM was used in 144 patients, including 51 patients with extravasation on CT; 60 patients with extravasation on CT were subjected to AG, which was followed by TAE in 41 patients. Open surgery was performed on 23 patients. The choice of treatment strategy did not have any effect on 30-day mortality among patients with extravasation. Mortality did not differ between the OS, NOM and AG/AG+TAE groups (p = 0.094). In the multivariate logistic regression model, OS and NOM did not increase the risk of death, in comparison with AG, respectively (OR 1.53 [95% CI: 0.35-7.37]; p = 0.579 and OR 1.39 [95% CI: 0.53–3.72]; p = 0.501).

Diagnosis and Treatment Options for Cirrhosis With Unexplained Upper Gastrointestinal Bleeding: An Observational Study Based on Endoscopic Ultrasonography.

To investigate the role of endoscopic ultrasonography (EUS) in the diagnosis and treatment of upper gastrointestinal bleeding of unknown origin in liver cirrhosis, focusing on patients with recurrent treatment of esophageal and gastric varices who failed to identify the bleeding site under direct endoscopy. Esophagogastric variceal bleeding is one of the severe complications of decompensated liver cirrhosis, and serial endoscopic therapy can improve the long-term quality of life of patients. Most acute bleeding can be detected under direct endoscopy with thrombus or active bleeding, but there are still some patients with recurrent bleeding after repeated treatments, and it is difficult to find the bleeding site, especially in gastric variceal bleeding. Therefore, it is of great significance to identify the bleeding site. A total of 88 patients with liver cirrhosis bleeding diagnosed and treated under EUS were collected in this study, including 26 patients who failed to identify the bleeding site under direct endoscopy. EUS was used to scan the bleeding site, and EUS-guided treatment was performed. The characteristics of the bleeding site under direct endoscopy and EUS and the follow-up results after surgery were analyzed. Among the 26 patients, 16 patients (16/26, 61.5%) showed red color signs of gastric fundus mucosa under direct endoscopy, 5 patients (5/26, 19.2%) showed punctate erosion, and the remaining 5 patients (5/26, 19.2%) showed no abnormal mucosal manifestations. All patients could find anechoic blood vessels under EUS, and blood flow signals could be detected within. Among them, 23 patients (23/26, 88.5%) chose EUS-guided treatment, and no rebleeding occurred after surgery. Another 3 patients (3/26, 11.5%) were given endoscopic variceal ligation due to small esophageal and gastric varices and inability to perform intravascular injection. The median follow-up time was 86 days. Adverse reactions included 5 cases of retrosternal pain (5/23, 21.7%), and 1 case of fever (1/23, 4.3%). EUS can detect submucosal varices in the gastric mucosa, and these bleeding sites may present as red color signs or punctate erosion under direct endoscopy.

Spectrum of Atypical Vascular Pathologies Mimicking Duodenal Submucosal Tumor and Directly Bleeding into Duodenal Lumen: A Case Series Study with Management by Interventional Radiology

AbstractGastrointestinal (GI) bleeding is a life-threatening medical condition and requires a multidisciplinary approach for proper diagnosis and management. Various vascular pathologies in and around the duodenum can lead to bleeding into the duodenum either directly or through the bile duct or pancreatic duct, and the patients present with melena or hematemesis. Sometimes, these lesions present as a submucosal tumor with active bleeding or present like a bleeding duodenal ulcer. These cases must be investigated thoroughly before any endoscopic interventions; otherwise, patient may land up in life-threatening situations. Radiology plays an important role in both diagnosing and treating these vascular lesions. Here, we have presented a few cases where the vascular pathologies mimicking duodenal submucosal tumors caused direct bleeding into the duodenum.

Clinical Outcomes of Total or Partial Renal Artery Embolization in Patients with Spontaneous Renal Bleeding.

The aim of this study was to evaluate renal artery embolization in patients with spontaneous renal artery bleeding based on detailed angiographic findings and a comprehensive analysis of its efficacy and clinical outcomes. This retrospective study evaluated the outcomes of renal artery embolization in 18 cases among 15 patients (11 men and 4 women; mean age: 57.9 years) treated for spontaneous renal bleeding at our institution between March 2017 and October 2023. Data derived from abdominal computed tomography (CT) and arteriography were analyzed to assess the effectiveness of embolization. Most patients had end-stage renal disease or renal atrophy, with common findings on CT scans, including signs of active bleeding in 66.7% (10/15) and hematoma extending to the retroperitoneal space in 53.3% (8/15). Microcoils were commonly used for embolization (n = 10), with a technical success rate of 100% and primary and final clinical success rates of 80% and 100%, respectively. No major complications were reported during the follow-up, and clinical improvement was observed in all patients who underwent total embolization, with few instances of reduced hematoma size and renal atrophy. Transarterial embolization is safe and effective for controlling spontaneous renal hemorrhage.

Visualization of bleeding site on 24-hour imaging in lower gastrointestinal bleeding with 99mTc-nanocolloid: A case report

Gastrointestinal bleeding can be diagnosed by history taking, physical examination, and diagnostic examinations. However, localization of gastrointestinal bleeding via a nuclear medicine examination can indicate an accurate examination to detect the location of bleeding. Radiopharmaceuticals can be selected according to a patient’s condition. Good image results are needed so that the results are conclusive and lead to further examination and management. A 2-years-old girl patient was hospitalized in a paediatric ward due to a large number of loose stools mixed with fresh blood for months after experiencing diarrhoea. The patient was active, absence any decreased appetite, pain, activity disturbances, or significant weight loss . Her parents took her for treatment to several hospitals but no improvement. The patient was referred to the Nuclear Medicine Department to undergo localization of gastrointestinal bleeding study. 99mTc-nanocolloid was injected as radiopharmaceuticals, followed by a dynamic and serial static imaging after 30 minutes. No focus of radioactivity extravasation was found. Examination was continued at 1, 2, and 24 hours. Diffuse radioactivity extravasation was found in the descending colon 24 hours after injection of the radiopharmaceutical, and she was confirmed by colonoscopy and biopsy a week later. 99mTc-labeled colloid had not been used after a few studies showed that 99mTc-red blood cell (RBC) in vitro was better at localizing gastrointestinal bleeding. Usually, 99mTc-labeled colloid remains in circulation for only 30 minutes due to rapid distribution to the reticuloendothelial system. The visualization of the bleeding site on 24-hour imaging was unusual. However, these findings suggest that 99mTc-labeled colloid can still be used with due regard to the patient's clinical active bleeding and imaging techniques.

Placenta Previa: Case Report

Placenta previa is a significant obstetric complication that occurs during pregnancy, characterized by abnormal implantation of the placenta in the lower uterine segment. Risk factors for having had a previous caesarean section, multiple pregnancies, advanced maternal age, or having a history of uterine surgery at higher risk, a history of previous uterine curettage, may increase the likelihood of placenta previa. woman aged 29 years G3P2A0 38 weeks pregnant came with complaints of fresh blood coming out of the birth canal since 3 hours before entering the hospital about half of the pads. Previous history to an obstetrician with malpositioned ultrasound results and a history of 2 previous deliveries by cesarean section. Physical examination, blood pressure 110/70, pulse 78 times/minute, respiration 18 times/minute, temperature 360C, there was no clinical anemia, obstetric examination of the height of the uterine fundus (TFU) 33 cm with an estimated fetal weight (TBJ) 3100 gr, FHR 152 times/minute regularly, positive His 1-2 times/10 minutes 10-15 seconds each. From vaginal positive spots, no active bleeding, vaginal touch was not done. Ultrasound of the fetus in cephalic presentation, positive FHB, EFW 3100 gr, placenta corpus posterior closing OUI grade 3 SDP 6 cm PAI score 2 positive hypoechoic zone, negative lacuna, KTG category 1. From investigations, Hb was 10.2 gr/dl. Ht 30%, leukocytes 12,950 uL, platelets 322,000 uL, bleeding time and clotting time within normal limits. management carried out strict vital signs monitoring, planned sectio caesaria cito and given premedication injection of ceftriaxone 2gr and 250cc PRC blood supply. Placenta previa is a complex obstetric condition that requires careful diagnosis, monitoring and management. Prompt recognition of the condition, close monitoring of maternal and fetal safety, and timely intervention, such as cesarean section when indicated, are critical to reducing the risks associated with placenta previa.

Evaluating the cost-utility of ferric derisomaltose versus ferric carboxymaltose in patients with inflammatory bowel disease and iron deficiency anaemia in Norway

AIMS Iron deficiency anemia (IDA) is among the most common extraintestinal sequelae of inflammatory bowel disease (IBD). Intravenous iron is often the preferred treatment in patients with active inflammation with or without active bleeding, iron malabsorption, or intolerance to oral iron. The aim of the present study was to evaluate the cost-utility of ferric derisomaltose (FDI) versus ferric carboyxymaltose (FCM) in patients with IBD and IDA in Norway. MATERIALS AND METHODS A published patient-level simulation model was used to evaluate the cost-utility of FDI versus FCM in patients with IBD and IDA from a Norwegian national payer perspective. Iron need was modelled based on bivariate distributions of hemoglobin and bodyweight combined with simplified tables of iron need from the FDI and FCM summaries of product characteristics. Patient characteristics and disease-related quality of life data were obtained from the PHOSPHARE-IBD trial. Cost-utility was evaluated in Norwegian Kroner (NOK) over a five-year time horizon. RESULTS Patients required 1.64 fewer infusions of FDI than FCM over five years (5.62 versus 7.26), corresponding to 0.41 fewer infusions per treatment course. The reduction in the number of infusions resulted in cost savings of NOK 7,720 (NOK 35,830 with FDI versus NOK 43,550 with FCM). The need for phosphate testing in patients treated with FCM resulted in further cost savings with FDI (no costs with FDI versus NOK 4,470 with FCM). Total cost savings with FDI were therefore NOK 12,190. FDI also increased quality-adjusted life expectancy by 0.071 quality-adjusted life years (QALYs) driven by reduced incidence of hypophosphatemia and fewer interactions with the healthcare system. CONCLUSIONS FDI resulted in cost savings and improved quality-adjusted life expectancy versus FCM in patients with IDA and IBD in Norway. FDI therefore represents the economically preferable iron formulation in Norwegian patients with IBD and IDA in whom it is indicated.

Clinical outcomes after emergency transarterial renal embolization: a retrospective study

BackgroundStudies on emergency transarterial embolization (TAE) of renal arterial injuries are rare. The aim of this retrospective study was to evaluate clinical outcomes after emergency transarterial renal embolization.Material and methodsBetween January 1st, 2013 and January 1st, 2024, all consecutive patients treated for renal arterial injuries by TAE in emergency settings were retrospectively reviewed. Demographic, biological and angiographic data were recorded. The inclusion criteria were all patients ≥ 18-years-old treated by emergency TAE for renal vascular injury. Clinical success was defined as the resolution of bleeding signs without the need for repeat TAE, surgery, death related to massive blood loss during this period, without functional impairment (> 50% of parenchyma volume or onset of chronic kidney disease) following TAE.ResultsDuring the inclusion period, 79 procedures were performed. The median age was 60[39–73] years old. On preoperative CT, ≥ 1 pseudoaneurysm was detected in 36(45.6%) patients, and active bleeding in 47(65.8%) patients. The preoperative median haemoglobin rate was 8.9[7.6–11] g/dl, and 37(46.8%) patients required red blood cell transfusions. The main aetiologies of arterial injury were blunt trauma (n = 19) and renal biopsy (n = 17). No severe adverse events were reported. Clinical success was reported in 74(93.7%) of the procedures. Three (3.8%) repeat embolizations were required, and were clinically successful. During the median follow-up of 7[1.5–35.5] months, 9(11.4%) patients died, of which 5(6.3%) occurred within 30 days.ConclusionThe present study reports high clinical success, low complications and low rebleeding rates of emergency renal TAE.

Safety and Efficacy of Novel Cost-Effective EUS Coiling and Glue Technique for the Management of Large Gastric Varices: A Long-Term Follow-up Study

Abstract Aims and Objective Mortality by gastric variceal bleeding can reach up to 30%. Gastric varices can be treated by either direct endoscopic glue or endoscopic ultrasound (EUS) coiling + glue injection. Now, enough data show that EUS coil + glue is an effective option for large varices. However, it is a costlier option than direct endoscopic glue injection. In our study, after putting the coil under EUS guidance, direct endoscopic glue injection is done with a 21G sclerotherapy needle. Since the EUS needle was not used for the glue injection, it can be reused for up to three cases for deployment of the EUS coil, hence reducing the cost of the whole procedure. In short, our study aims to find the safety and efficacy of a cost-effective method of EUS coiling + glue injection in a cohort of the Indian population. Material and Methods Retrospective review of prospectively collected data on EUS coiling + direct endoscopic glue injection over a period spanning from July 2017 to December 2023 from a tertiary care center in North India. Results A total of 103 patients (gastroesophageal varices type 2, GOV2 [n = 82] and isolated gastric varices type 1, IGV1 [n = 21]) were taken up for the study. Among the 103 patients, 74 patients were males and 29 were females. The mean follow-up duration of the study population was 34.2 ± 21 months. The average size of the varix was 2.3 cm. The average number of coils was 3.3 and the volume of injected glue was 3.1 mL. In our study, 4 out of 103 patients had rebleeding, but the cause of rebleeding turned out to be nonvariceal. Regarding the intraprocedural and postprocedural adverse events, 1 out of 103 patients in our study experienced abdominal pain and fever, which responded to oral analgesics and antipyretics. There was no active bleeding from the puncture site or evidence of systemic embolization. Technical success was 100% in our study. Reuse of needles was not associated with any increment in risk of infection. Conclusion EUS coiling + direct endoscopic glue injection is a safe and effective endoscopic therapy for large gastric varices with sustainable long-term beneficial effects with a negligible amount of rebleeding. Direct endoscopic injection of glue following EUS coiling with a 21G sclerotherapy needle can significantly reduce the cost of the procedure without any risk of infection.

Plasma transfusion in the intensive care unit.

Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines. This was a sub-study of an international, prospective, observational cohort. Primary outcomes were in-ICU occurrence rate of plasma transfusion, proportion of plasma events of total blood products events, and number of plasma units per event. Secondary outcomes included transfusion indications, INR/PT, and proportion of events for non-bleeding indications. Of 3643 patients included, 356 patients (10%) experienced 547 plasma transfusion events, accounting for 18% of total transfusion events. A median of 2 (IQR 1, 2) units was given per event excluding massive transfusion protocol (MTP) and 3 (IQR 2, 6) when MTP was activated. MTP accounted for 39 (7%) of events. Indications of non-MTP events included active bleeding (54%), prophylactic (25%), and pre-procedure (12%). Target INR/PT was stated for 43% of transfusion events; pre-transfusion INR/PT or visco-elastic hemostatic assays (VHA) were reported for 73%. Thirty-seven percent of events were administered for non-bleeding indications, 54% with a pre-transfusion INR < 3.0 and 30% with an INR < 1.5. Plasma transfusions occurred in 10% of ICU patients. Over a third were given for non-bleeding indications and might have been avoidable. Target INR/PT was not stated in more than half of transfusions, and pre-transfusion INR/PT or VHA was not reported for 27%. Further research and education is needed to optimize guideline implementation and to identify appropriate indications for plasma transfusion.

Trends of trauma team physicians toward patients with bleeding in Saudi Arabia: a cross-sectional study

ABSTRACT Objectives Trauma poses a significant health burden in Saudi Arabia, with high rates of morbidity and mortality rates. We evaluated the trends among trauma team (TT) physicians in Saudi Arabia regarding their awareness and referral practices for percutaneous endovascular arterial embolization (EAE) in bleeding patients. Methods A 13-question survey developed by consultants from various specialties assessed the knowledge of TT physicians regarding decision-making and appropriate approaches for managing traumatic bleeding. The surveys were administered in person to 135 TT physicians. Results Among them, 38.52% had five or more years of independent practice, and 87.41% routinely encountered patients with bleeding patients. Physicians who routinely treated patients with bleeding patients exhibited higher median scores, in line with current management standards (p = 0.634). Tertiary care physicians and academic- and military-affiliated physicians exhibited higher median scores (p = <0.001 and p < 0.006, respectively). Amongst TT physicians, 47.41% preferred EAE for unstable pelvic ring fractures with active bleeding, while 68.15% favored splenectomy for unstable patients with grade V splenic injuries. For traumatic aortic injuries, 67.42% considered TEVAR/EVAR safer options. Notably, 84.44% viewed an INR > 3 as a contraindication for EAE in hemodynamically stable patients. General surgeons scored the highest in management decision-making, followed by neurosurgeons (p = 0.001). Orthopedics, emergency medicine, intensive care (ICU), and anesthesia specialists exhibited similarly high median scores for appropriate management approaches (p = 0.003). Overall, general surgeons, orthopedic surgeons, and ICU specialists exhibited the highest median correct responses, adhering to the current standard of practice (p = 0.001). Conclusions To address the potentially life-threatening condition of traumatic bleeding, raising awareness of the appropriate management and referral patterns for EAE is crucial.

Predictors of active and recurrent bleeding in upper gastrointestinal angiodysplasia: Results from 10-year esophagogastroduodenoscopy of a tertiary center in Taiwan.

Upper gastrointestinal angiodysplasia (UGIA) is a unique mucosal vascular lesion that causes acute or recurrent gastrointestinal bleeding. Despite the increasing incidence of UGIA, the risk factors for bleeding in this condition remain unclear. We investigated the predictors of active and recurrent bleeding among patients with UGIA. We conducted a retrospective cohort study of 104,086 patients who underwent esophagogastroduodenoscopy (EGD) at the Tri-Service General Hospital in Taiwan between October 2011 and September 2021. UGIA was diagnosed in 112 patients, and the data from these patients were comprehensively analyzed. EGD documented UGIA in 112 patients, which corresponded with an overall diagnostic yield of 1.1%. Active bleeding was documented in 28 (25%) patients. Patients in the active bleeding group were older than the patients in the asymptomatic group (71.6 ± 11.7-years vs 61.3 ± 18.5-years). Most of the UGIA lesions were singular and measured 2 to 5 mm. Nearly 1-quarter of the patients (24.1%) underwent endoscopic hemostasis, and rebleeding occurred in 6 (21.4%) patients during the follow-up period. Multivariate analysis identified diabetes mellitus (DM), chronic kidney disease (CKD), and lesions in the duodenum as significant risk factors for active bleeding (P = .019; P = .006; P = .004). Our cohort study provided real-world data on the clinical and endoscopic features of UGIA. DM, CKD, and lesions in the duodenum were independent predictors of active bleeding.

Management of internal bleeding : Guidelines of the American Association for the Surgery of Trauma (AAST) and World Society of Emergency Surgery (WSES)

Internal bleeding is a common and serious complication in trauma patients. The American Association for the Surgery of Trauma (AAST) and the World Society of Emergency Surgery (WSES) have developed comprehensive guidelines to standardize and optimize the care of these patients. In Germany, abdominal injuries are involved in around 20% of all polytraumas, often caused by falls or road traffic accidents. The liver and spleen are most frequently affected. Correct diagnosis and timely management are crucial for patient survival. Computed tomography (CT) is gold standard to assess organ injuries, while ultrasound (fokussiertes Assessment mit Sonographie für Trauma, FAST) provides a readily available, non-invasive diagnostic tool. Magnetic resonance imaging (MRI) is used for detailed soft tissue injuries. The AAST has developed a scoring system (Organ Injury Scale, OIS) to classify the severity of organ injuries. The WSES classifies the hemodynamic condition of the patient. Spleen: Treatment decisions are based on hemodynamic stability. Unstable patients often require emergency surgery, while stable patients can be treated conservatively. In the presence of active bleeding, embolization is a treatment option. Liver: Stable patients with a positive blush (leakage of contrast medium) are treated angiographically. Unstable patients should undergo surgery with perihepatic packing and Pringle maneuver. Kidney: Conservative treatment for stable patients. Embolization is used for active bleeding. Unstable patients require surgical treatment. Gastrointestinal tract: Duodenal hematomas can be treated conservatively. Pancreatic injuries require conservative or surgical intervention depending on the severity and stability of the patient. These guidelines aim to improve the survival and outcome of trauma patients with internal bleeding.

Safety monitoring and countermeasures of anticoagulant drugs for pulmonary thromboembolism

The safe use of anticoagulant drugs is a major challenge in the clinical management of pulmonary thromboembolism (PTE). This paper presents a comprehensive review of the recent literature, summarizing and evaluating the classification and historical development of anticoagulants, monitoring strategies for their administration, selection and safety considerations for special patient populations (such as those with malignant tumors, pregnant women or obese patients) and specific disease states (including platelet disorders, severe renal insufficiency, active bleeding and pulmonary hypertension). It also discusses current research into countermeasures for anticoagulant-related bleeding. Based on personal experience and expertise in this field, we propose an approach to managing the safety of anticoagulant therapy.

Cancer-related thrombosis: impact of biological sex on the risk of rethrombosis and bleeding.

Patients with cancer present a higher risk of rethrombosis and bleeding secondary to anticoagulant treatment than individuals without cancer. Given the lack of specific clinical trials, the decision regarding the optimal duration of treatment must consider multiple factors, including sex. The current study used data from the international, prospective TESEO Registry that includes consecutive patients diagnosed with cancer-associated thrombosis (CAT). Between July 2018 and December 2022, 2,823 patients were included in the TESEO Registry, 1,351 (48%) of whom were female. The most common venous thromboembolic event (VTE) in both sexes was pulmonary embolism (PE), with an incidence of 58.0% among men and 54.3% in women (p=0.045). After a median follow-up of 6.9 months (IQR, 1.9-14.4), the rethrombosis rate at the end of follow up was 10.0% in males and 15.0% in females (p=0.14). The location of the primary tumor in the gastrointestinal tract was associated with a greater risk of rethrombosis, whereas sex had no significant impact. Men presented twice as many major bleeds. Additional risk factors for major bleeding included situations of risk due to tumor site or thrombocytopenia, as well as the presence of active tumor bleeding at the time of VTE diagnosis. Overall survival was higher among women. Given the higher incidence of major bleeding among men, sex should be deemed a relevant factor when deciding on the duration of anticoagulant treatment in cancer patients.

Hypertension Among Patients Presenting with Epistaxis in a Tertiary Care Center: A Descriptive Cross-sectional Study

Introduction: Epistaxis is one of the most common emergency conditions. Hypertension has been considered to be a major cause of spontaneous epistaxis for a long time. The objective of this study is to determine the prevalence of hypertension among patients presenting with epistaxis in a tertiary care hospital. Materials and Methods: A descriptive cross-sectional study was conducted in the patients visiting Kathmandu Medical College and Teaching Hospital with active nose bleeding from January 2023 to December 2023. Patients visiting the Emergency Department with active nose bleeding were included in the study by convenience sampling method. The blood pressure (BP)was measured in the Emergency Department at the time of presentation and patients with BP of &gt;140/90 mmHg were considered to be hypertensive. Data was collected and statistical analysis was done in Statistical Packages for Social Services version 22. Results: A total of 250 patients were included in this study. The prevalence of hypertension in patients with epistaxis in the present study is 28.8 %. Hypertension was more common in males and elderly patients above 60 years. Conclusions: Our study showed that hypertension was more common in male and elderly patients Regular blood pressure monitoring should be advised for elderly patients. Other causes of epistaxis could be explored in future studies.

Approaches to management of HIT in complex scenarios, including cardiac surgery.

Although heparin-induced thrombocytopenia (HIT) presents management challenges for any population, it adds complexity to the management of certain patient populations, including those undergoing cardiac surgery and those with refractory HIT and/or acute bleeding. For each of these scenarios, we review alternative management strategies when standard therapies-heparin cessation and the initiation of a nonheparin anticoagulant-are either insufficient or not practicable. In patients with HIT undergoing cardiac surgery, we review the clinical experience for heparin reexposure using therapeutic plasma exchange (TPE) or antiplatelet therapy. In patients with refractory HIT despite adequate nonheparin anticoagulation, we address the use of intravenous immune globulin, TPE, and rituximab. Finally, in patients with active bleeding, we discuss bleeding management and the risks associated with platelet transfusion. Although they may facilitate a patient-centered approach, most of these strategies are supported by limited evidence.

Correlation between Phenotype and Coagulation Factor Activity Level in Rare Bleeding Disorders: A Systematic Review.

Rare bleeding disorders (RBDs) represent 3 to 5% of congenital bleeding disorders and are primarily inherited in an autosomal recessive manner, with increased prevalence in consanguineous populations. Clinically, RBDs can be accompanied by mild to severe bleeding episodes, often assessed using bleeding assessment tools (BATs) such as the International Society on Thrombosis and Hemostasis (ISTH)-BAT. However, the correlation between bleeding severity and coagulation factor activity levels remains inconsistent. This systematic review investigates this relationship to enhance understanding and improve management strategies for patients with RBD. This review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with the International Prospective Register for Systematic Reviews (PROSPERO) (CRD42024504537). Using the PICO (Population, Intervention, Comparator, and Outcomes) framework, the study focused on RBD patients to explore the correlation between coagulation factor activity levels and bleeding severity. A comprehensive search was conducted across PubMed, Scopus, and Web of Science until April 1, 2024, with data extracted on bleeding severity, phenotype, and coagulation factor activity levels. The analysis highlights complex and often inconsistent relationships between coagulation factor levels and the severity of bleeding. In cases of fibrinogen deficiency, three out of four studies (n = 73 of 111 cases, 66%) demonstrated a moderate to strong correlation between fibrinogen levels and bleeding severity. In prothrombin deficiency, one of two studies (n = 16 of 29 cases, 55%) found a strong correlation between FII levels and bleeding severity. Four of six studies (n = 106 of 139 cases, 76%) in FV deficiency found a weak or no correlation between factor activity and bleeding severity. In combined FV and FVIII deficiency, two of three studies (n = 26 of 60 cases, 43%) found a significant correlation between factor activity and bleeding severity. In FVII deficiency, four (of nine) studies with a study population of 325 patients (65%) found a weak correlation between factor activity and severity of bleeding. Almost all studies (five of six studies, n = 114 of 118 patients, 97%) in FX deficiency revealed a strong correlation between FX levels and bleeding severity. In FXI deficiency, most studies (five of seven studies, n = 254 patients, 93%) found a weak or no correlation between factor activity and bleeding severity or symptoms. For FXIII deficiency, there was a moderate to strong correlation between FXIII activity and bleeding severity in all three studies (n = 61 patients). In conclusion, despite current controversies, this review highlights a moderate or strong correlation between factor activity and bleeding severity in fibrinogen, FX, and FXIII deficiencies, but no correlation or weak correlation for FV, FVII, and FXI deficiencies. Further prospective studies with standardized BATs on a large number of patients are needed to better understand these relationships and optimize patient management.