Initial Hemostasis Research Articles

Clinical Outcomes of Patients with Bleeding Peptic Ulcer; Tertiary Center Experience

Background: Bleeding peptic ulcer remains an important cause of morbidity and mortality. Bleeding peptic ulcer (PUB) remains one of the most emergent and potentially fatal medical situations. However, the incidence of bleeding peptic ulcers not associated with H. pylori (Hp) infection or NSAID use varies considerably, and recent suggestions that patients with non-H. pylori–non-NSAID idiopathic bleeding peptic ulcers have a significantly higher mortality rate than patients with NSAID or H. pylori ulcers. Objective: The objective of this study was to demonstrate the epidemiological, clinical and endoscopic characteristics of peptic ulcer bleeding (PUB). Methods: This was a prospective study of patients who were admitted for peptic ulcers at Khulna Medical College Hospital Khulna, Bangladesh, from January 2021 to December 2021. Data were collected using a pretested and coded questionnaire and analyzed using SPSS computer software. Ethical approval to conduct the study was obtained from relevant authorities before the commencement of the study. Results: In this study, a total of 24 patients were included and analyzed. Regarding the age distribution of the study population, 11(45.83%) patients were <65 years of age, 9(37.50%) patients were from the age group 65-80 years and 4(16.67%) patients were aged >80 years. Also, 62.5 percent of patients were female and 37.5 percent were male. Among the study subjects, 14(58.33%) patients were treated by endoscopic therapy and 13(54.17%) patients had initial hemostasis. Initial hemostasis had some types also; 9(37.50%) patients had Epinephrine, 8(33.33%) patients had Epinephrine+endoclips, 5(20.83%) patients had endoclips. Conclusion: Three decades after the discovery of Hp, the etiologies of bleeding peptic ulcers are changing. However, diagnosis of Hp infection is still the priority in these patients. Invasive RUT is most frequently used, but this methodology is hampered by a high rate of false-negative results, especially in patients with UGI bleeding. Mediscope 2024;11(2): 77-81

Over-the-scope clips for Nonvariceal upper gastrointestinal bleeding: a systematic review and meta-analysis of randomized studies.

Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common and potentially life-threatening condition. Over-the-scope clips (OTSCs) have emerged as a promising endoscopic treatment option for NVUGIB. We aimed to analyze the efficacy and safety of OTSCs compared to standard endoscopic treatments (ST) in patients with NVUGIB. We conducted a comprehensive search of PubMed, Embase, Scopus, and Cochrane Library databases from inception to June 2024 for randomized controlled trials (RCTs) comparing OTSCs with ST for NVUGIB. The primary outcomes were initial hemostasis and persistent bleeding. Secondary outcomes included rebleeding rates, mortality, hospital stays and others. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random/fixed-effects models. Six RCTs involving 621 patients were included in the meta-analysis. OTSCs demonstrated significantly higher initial hemostasis (OR 4.80, 95% CI 1.78-12.96; P = 0.002) and lower persistent bleeding rates (OR 0.17, 95% CI 0.05-0.56; P = 0.003) compared to ST group. The rebleeding rate was significantly lower in the OTSC group 7-days re-bleeding (OR 0.27, 95% CI 0.14-0.53; P = 0.001); 30-days rebleeding (OR 0.40, 95%CI 0.22, 0.70; P = 0.002). No significant differences were observed in mortality (OR 0.65, 95% CI 0.31-1.33; P = 0.38) and hospital stay (mean difference 0.79days 95%CI -0.57, 2.15) between the two groups. OTSCs are more effective than ST for achieving hemostasis and preventing rebleeding in patients with NVUGIB, without increasing mortality. Key message What is Already Known Previous studies have shown that nonvariceal upper gastrointestinal bleeding (NVUGIB) is a serious medical condition that needs effective endoscopic interventions. The success rates of standard treatments for achieving hemostasis and preventing rebleeding are not consistent. What This Study Adds According to this study, over-the-scope clips (OTSCs) have the same mortality rate as standard endoscopic treatments, but they significantly improve initial hemostasis and lower rebleeding rates. Impact on Research, Practice, or Policy The findings support the use of OTSCs as a preferred intervention for NVUGIB, which could affect clinical guidelines and encourage additional research focused on improving endoscopic techniques and patient outcomes in the management of gastrointestinal bleeding.

Tamponing in severe liver injuries (two clinical cases)

Favorable outcomes of surgical treatment of two patients with blunt liver damage of IV degree according to E. Moore as part of polytrauma are presented. In conditions of unstable hemodynamics and extremely severe state of the patient, the authors used a method of liver damage tamponing with a single tampon material (cotton surgical sheet) as an initial hemostasis. The applied method of liver damage tamponing helps to achieve a stable initial hemostasis, it does not require a highly-qualified surgical team and can be used in second- and third-level trauma centers.

Evaluating the Efficacy of a Novel Hemostatic Powder Compared to Traditional Treatments in Non-Variceal Upper Gastrointestinal Bleeding: A Multicenter, Randomized Non-inferiority Study

Hemostatic powders have been rapidly developed and used to treat gastrointestinal bleeding. We aimed to investigate the non-inferiority of the newly developed hemostatic powder (CEGP-003) compared to conventional endoscopic treatments for non-variceal upper gastrointestinal bleeding (NVUGIB). This prospective, multicenter, randomized, open-label, controlled trial was conducted at four referral institutions. We enrolled consecutive patients who underwent emergency endoscopy for NVUGIB. The patients were randomly assigned to either the CEGP-003 or the conventional treatment group. In the CEGP-003 group, the hemostatic powder was applied as a spray. Conventional endoscopic treatments included electrical coagulation and hemoclipping. Between November 2019 and June 2022, 218 patients were enrolled (CEGP-003, 108; conventional, 110). Initial hemostasis was achieved in 104 of 108 patients (96.3%) in the CEGP-003 group and 101 of 110 patients (91.8%) in the conventional treatment group. The CEGP-003 group exhibited a significantly higher re-bleeding rate than the conventional treatment group. Multivariate analysis that age, duodenum and middle 1/3 of stomach, and CEGP-003 use as the initial hemostatic treatment were independent risk factors for re-bleeding. No adverse events were associated with CEGP-003. CEGP-003 demonstrates promise as an initial endoscopic therapy for NVUGIB, however close monitoring is warranted due to the risk of re-bleeding (Cris.nih.go.kr, number: KCT0004655).

UI-EWD hemostatic powder in the management of refractory lower gastrointestinal bleeding: a multicenter study

Introduction Lower gastrointestinal bleeding (LGIB) is a common cause of emergency hospitalization and may require readmission for re-bleeding. A novel adhesive endoscopic hemostatic powder (UI-EWD/NexpowderTM, Nextbiomedical, Incheon, South Korea) has been developed and recently utilized for LGIB hemostasis. The aim of the current study was to assess the efficacy and safety of UI-EWD as a rescue therapy for the treatment of refractory LGIB. Methods In this study, a total of 59 consecutive patients with LGIB who experienced initial hemostasis failure with conventional endoscopic therapy were enrolled into this multicenter single-arm study. These patients subsequently underwent UI-EWD application for the refractory LGIB hemostasis. We evaluated the success rate of hemostasis, re-bleeding rate within 30 d, and adverse events related to UI-EWD. Results UI-EWD was successfully administered to the bleeding sites in all enrolled refractory bleeding patients. Hemostasis was achieved in the entirety of the 59 patients (100%). The cumulative re-bleeding rate within 30 d was 8.5% (5/59). There were no UI-EWD-related adverse events, such as perforation nor embolism. Conclusion Based on our results, the utilization of UI-EWD demonstrated a remarkable success rate in achieving hemostasis for refractory LGIB, while also exhibiting promising outcomes in reducing the re-bleeding rate within a 30-day period. Particularly, UI-EWD exhibits a favorable safety profile across all segments of the colon in cases of refractory LGIB.

Endoscopic Glue Injection Versus Endoscopic Human Thrombin Injection for Bleeding Gastric Varices-A Randomized Controlled Trial.

Acute gastric variceal bleeding (AGVB) is a potentially fatal consequence of portal hypertension, accounting for 10% to 30% of all variceal bleeding. Although endoscopic cyanoacrylate glue injection is a common treatment for acute hemostasis, it has been linked to significant side effects. In the treatment of AGVB, there is limited evidence of the efficacy and relative safety of endoscopic human thrombin injection over glue injection. A total of 52 AGVB patients were randomized to receive either thrombin injection (25 patients) or glue injection (27 patients). The primary outcome was the incidence of any glue or thrombin injection-related post-therapy complications. Initial hemostasis, rebleeding, and mortality were all secondary end goals. Both groups had comparable baseline data. Hemostasis of active bleeding at endoscopy was 100.0% (10/10) in the thrombin group and 87.5% (7/8) in the glue group ( P =0.44). Treatment failure after 5 days occurred in 2 patients (6.1%) in the glue group compared with none in the thrombin group ( P =0.165). Between 6 and 42 days after index bleeding, rebleeding occurred in 4 patients in the thrombin group compared with 6 patients in the glue group ( P =0.728). In the thrombin group, none of the patients had post-treatment ulcers on gastric varices compared with 14.81% (4/27) that occurred in the glue group ( P =0.045), a statistically significant observation. Overall, complications occurred in 4 (20%) and 11 (40.7%) patients in the thrombin and glue groups, respectively ( P =0.105). Two patients in the glue group died. To achieve successful AGVB hemostasis, endoscopic thrombin injection has been proven efficacious. However, glue injection may be linked to a higher rate of rebleeding and post-therapy gastric variceal ulceration compared with thrombin.

Clinical outcomes of endoscopic detachable snare ligation for colonic diverticular hemorrhage: Multicenter cohort study.

The hemostatic mechanism of endoscopic detachable snare ligation (EDSL) for colonic diverticular hemorrhage (CDH) is similar to that of endoscopic band ligation, which is effective and safe. However, because reports on EDSL are scarce, we conducted a two-center cohort study to evaluate its effectiveness. This study analyzed 283 patients with CDH treated with EDSL at two Japanese hospitals between July 2015 and November 2021. Patient characteristics and clinical outcomes were retrospectively evaluated. A Kaplan-Meier analysis was performed to evaluate the cumulative probability of rebleeding after EDSL. A Cox proportional hazards regression analysis was performed to compare the effects of complete and incomplete ligation on rebleeding. The initial hemostasis success and early rebleeding rates were 97.9% and 11.0%, respectively. The time to hemostasis after identification of the bleeding site and total procedure time were 9 min and 44 min, respectively. Red blood cell transfusion was required for 32.9% of patients. The median hospital length of stay after EDSL was 5 days. The complete ligation rate of the early rebleeding group was significantly lower than that of the group without early rebleeding (P < 0.01). The 1-year cumulative rebleeding rate with EDSL was 28.2%. Complete ligation was associated with decreased cumulative rebleeding after EDSL (P < 0.01). One patient experienced colonic diverticulitis; however, colonic perforation was not observed. Complete ligation is associated with reduced short-term and long-term rebleeding. EDSL could be valuable for CDH because of its low rebleeding rate and the absence of serious adverse events.

Haemostatic spray in the management of acute nonvariceal upper gastrointestinal bleeding in children: A single-centre experience in Singapore.

Haemostatic spray (HS; Hemospray) is a powder agent for endoscopic haemostasis in patients with acute upper gastrointestinal bleeding (UGIB). It has been shown to be effective and easy to administer. However, published data on efficacy and safety in children remain scarce. Our aim was to describe our experience with the use of HS in the management of UGIB. A retrospective review was conducted of patients aged 0-18 receiving HS for endoscopic haemostasis from January 2017 to December 2021. Information was obtained on demographics, clinical presentation and comorbidities. Outcomes were successful initial haemostasis and rates of re-bleeding. A total of 25 applications of HS occurred in 23 patients. The median patient age was 8 years (range: 4 months to 16 years). HS was used in 17/25 (68%) applications as monotherapy. Other treatments employed were clip application and adrenaline injection. One hundred per cent initial haemostasis was achieved with three (13.0%) patients who experienced re-bleeding. All patients tolerated HS applications with no adverse events. Our finding supports the use of HS in the management of UGIB in children. HS, either as monotherapy or in combination with other conventional therapy, could potentially be the treatment of choice in children with UGIB with its excellent feasibility and good safety profile.

A Noninferiority Trial Comparing 2 Days vs 5 Days of Terlipressin and Ceftriaxone in Terms of 5-Day Rebleeding for Patients With Acute Gastroesophageal Variceal Hemorrhage.

This trial was to shorten the duration of both vasoconstrictors and prophylactic antibiotics to only 2 days in the therapy of acute gastroesophageal variceal hemorrhage. After successful endoscopic hemostasis of gastroesophageal variceal hemorrhage, eligible patients were randomized to receive terlipressin infusion 1 mg per 6 hours and ceftriaxone 1 g daily for 5 days (group A) or a similar regimen for 2 days (group B). Primary end points were very early rebleeding at 5 days, and secondary end points included 48-hour hemostasis, 42-day rebleeding, and hospitalization days. Group A comprised 48 patients, and group B comprised 52 patients. Both groups were comparable in the severity of liver disease. Forty-eight-hour initial hemostasis was 95.8% in group A and 100% in group B ( P = 0.13). Very early rebleeding between 3 and 5 days occurred in 1 patient (2.1%) in group A and 2 patients (3.8%) in group B ( P = 0.60). The difference was 1.8% and the 95% confidence interval was -1.31% to 2.08%, which demonstrated noninferiority. Forty-two-day rebleeding occurred in 5 patients (10.4%) in group A and 4 patients (7.7%) in group B ( P = 0.63). The median hospitalization days were 8.5 ± 3.8 days in group A vs 5.6 ± 2.6 days in group B ( P < 0.001). After successful endoscopic hemostasis of acute variceal bleeding, combination of 2-day terlipressin infusion and ceftriaxone therapy was not inferior to the 5-day regimen in terms of very early rebleeding, with the advantage of shortening hospitalization stay.

Over-the-scope clip as first-line treatment of peptic ulcer bleeding: a multicenter randomized controlled trial (TOP Study).

First-line over-the-scope (OTS) clip treatment has shown higher efficacy than standard endoscopic therapy in acute nonvariceal upper gastrointestinal bleeding (NVUGIB) from different causes. We compared OTS clips with through-the-scope (TTS) clips as first-line mechanical treatment in the specific setting of peptic ulcer bleeding. We conducted an international, multicenter randomized controlled trial on consecutive patients with suspected NVUGIB. Patients with Forrest Ia-IIb gastroduodenal peptic ulcer were randomized 1:1 to OTS clip or TTS clip treatment. The primary outcome was the rate of 30-day rebleeding after successful initial hemostasis. Secondary outcomes included the rates of successful initial hemostasis and overall clinical success, defined as the composite of successful initial hemostasis and no evidence of 30-day rebleeding. 251 patients were screened and 112 patients were randomized to OTS (n = 61) or TTS (n = 51) clip treatment. The 30-day rebleeding rates were 1.6% (1/61) and 3.9% (2/51) in patients treated with OTS clips and TTS clips, respectively (Kaplan-Meier log-rank, P = 0.46). Successful initial hemostasis rates were 98.4% (60/61) in the OTS clip group and 78.4% (40/51) in the TTS clip group (P = 0.001). Overall clinical success rates were 96.7% (59/61) with OTS clips and 74.5% (38/51) with TTS clips (P = 0.001). Low rates of 30-day rebleeding were observed after first-line endoscopic treatment of acute peptic ulcer bleeding with either OTS or TTS clips. However, OTS clips showed higher efficacy than TTS clips in achieving successful initial hemostasis and overall clinical success.

Clinical, endoscopic and therapeutic features of bleeding Dieulafoy’s lesions: case series and literature review

ObjectiveDieulafoy’s lesions (DLs) are a rare but potentially life-threatening source of gastrointestinal (GI) haemorrhage. They are responsible for roughly 1%–6.5% of all cases of acute non-variceal GI bleeding.Here, we describe...

Characteristics of Bleeding Peptic Ulcers and the Outcome after Endoscopic Therapy at a Tertiary Care Centre of Pakistan

Peptic ulcers are a global health concern. Bleeding episodes, a common complication require urgent intervention. Endoscopic therapy for managing bleeding peptic ulcers offering both diagnostic and therapeutic benefits. Objective: To analyze the characteristics of bleeding peptic ulcers and assess the outcomes following endoscopic therapy. Methods: A descriptive case series was conducted at Lahore General Hospital (LGH) between June 2021 and January 2022. Patients aged 18-80 with upper GI bleeding due to peptic ulcers or undergoing endoscopy with bleeding peptic ulcers were included. An 80mg bolus of omeprazole was given, followed by infusion at 8mg per hour and an urgent endoscopy was planned. Patients were observed for re-bleeding for 72 hours post-endoscopy. Results: Out of total 100 patients with upper GI bleeding, 70% of patients were male and 30% were female. The most common diagnosis was duodenal ulcers (75%), with the anterior wall being the most common site (86.67%). Dual therapy was administered in all patients, with hemostatic clips being applied in 68% of patients and electrocoagulation heat therapy being used in 32% of patients. Initial hemostasis was successful in 88% of patients treated endoscopically. But, 12% of patients experienced heavy bleeding during endotherapy and out of these, 8 patients required urgent laparotomy. Patients needed a second look endoscopy, 4 patients requiring angiographic embolization and 6 being managed with endotherapy. Conclusion: Dual therapy, hemostatic clips and electrocoagulation heat therapy are effective in achieving initial hemostasis in most cases

Comparison of 2 Days versus 5 Days of Octreotide after Endoscopic Therapy in Preventing Early Esophageal Varices Rebleed: A Randomized Controlled Study

In esophageal varices bleeding, following the initial endoscopic hemostasis, it is recommended to administer vasoactive medications for a period of 2-5 days in order to avoid early rebleeding. Octreotide is the preferred vasoactive medication for treating variceal bleeding due to its favorable safety profile. This study aimed to assess the effectiveness of a 2-day octreotide infusion against a 5-day octreotide infusion following endoscopic intervention in avoiding early rebleeding of esophageal varices in individuals with cirrhosis. This study was a prospective, parallel, randomised controlled experiment conducted on a cohort of 184 subjects who were recruited from the endoscopy unit of the Tropical Medicine and Infectious Diseases Department at Tanta University Hospital in Egypt. The five days rate of rebleeding was 16.85% in the 2-days group against 15.91% in the 5- days group without significant difference (P= 0.865). In cirrhotic individuals with bleeding esophageal varices, a 2-day regimen of octreotide is equally efficacious as a 5-day regimen in avoiding rebleeding over a 5-day period, following successful control of bleeding with endoscopic intervention.

Intermittent tourniquet compared to throughout tourniquet use during Total Knee Arthroplasty in patients with Body Mass Index of 30 or more: A retrospective cohort study

BackgroundTourniquet use during total knee arthroplasty (TKA) reduces bleeding which optimises bone-cement interface for prosthesis stability and improves surgical field visualisation. However, prolonged usage can lead to complications and poorer outcomes. Some surgeons advocate for intermittent tourniquet application. Limited literature exists for patients with high body mass index (BMI). This study aims to compare the outcomes of intermittent tourniquet (IT) to throughout tourniquet (TT) use among obese patients undergoing primary TKA for knee osteoarthritis. MethodsThis was a retrospective cohort study. In the TT group, tourniquet was inflated from the beginning and released once the bone cement has hardened. In the IT group, tourniquet was inflated at the beginning, released after initial incision and haemostasis, then inflated again during cementation. Tourniquet was released once the bone cement had set. Categorical outcome measures were analysed using Chi-squared or Fisher's exact test. T-test or Kruskal-Wallis test were used for continuous data. ResultsWhen comparing IT to TT among patients with BMI≥30 (IT n = 48, TT n = 47), the mean duration of surgery was shorter in the TT group (p < 0.05). The difference in haemoglobin drop between the two groups was not statistically significant from post-operative day three onwards. There was no difference in transfusion rate (p > 0.05). ROM was greater in the IT group up to three weeks post-operatively (p < 0.05). When comparing patients with BMI <30 (n = 71) and BMI≥30 (n = 48) with IT use, there was no statistically significant difference in ROM and LOS. ConclusionPatients with BMI≥30 in the IT group had greater ROM in the initial post-operative period. Although operative time and blood loss were greater among the IT group, there was no difference in transfusion rate. Outcomes of TKA performed with IT were similar for patients with BMI≥30 and BMI <30. The authors recommend intermittent tourniquet use during TKA for patients with BMI≥30. Level of evidence3.

Turn over the new leaf of the treatment in peptic ulcer bleeding: a review of the literature.

Peptic ulcer bleeding is the most common cause of upper gastrointestinal bleeding, which has a high mortality risk. The standard therapy for acute peptic ulcer bleeding combines medication administration and endoscopic therapies. Both pharmacologic and endoscopic therapies have developed continuously in the past few decades. Proton pump inhibitors (PPIs) already reached a high efficacy in ulcer healing and have been widely used in the past few decades. Endoscopic hemostasis, which includes local epinephrine injection, heater probe coagulation, use of hemostatic clips, and/or band ligation, is highly effective with an overall hemostatic success rate of 85%-90%. However, 10%-20% of patients could not be cured by the current standard combination treatment. Recurrent ulcer bleeding, despite an initial successful hemostasis, is also a big problem for longer hospitalization stays, higher mortality, and higher complication rates, especially for malignant ulcer bleeding. How to manage all types of peptic ulcer bleeding and how to prevent early recurrent peptic ulcer bleeding remain unresolved clinical problems. Recently, several novel medications and endoscopic methods have been developed. Potassium competitive acid blockers have shown a stronger and longer acid suppression than PPI. Hemostatic powder spray and hemostatic gel emulsion are novel hemostatic weapons with emerging evidence, which are potential missing pieces of the puzzle. This literature review will go through the development of endoscopic hemostasis to the prospects of novel endoscopic treatments.

Thrombin and Thrombin-Incorporated Biomaterials for Disease Treatments.

Thrombin, a coagulation-inducing protease, has long been used in the hemostatic field. During the past decades, many other therapeutic uses of thrombin have been developed. For instance, burn treatment, pseudoaneurysm therapy, wound management, and tumor vascular infarction (or tumor vasculature blockade therapy) can all utilize the unique and powerful function of thrombin. Based on their therapeutic effects, many thrombin-associated products have been certificated by the Food and Drug Administration, including bovine thrombin, human thrombin, recombinant thrombin, fibrin glue, etc. Besides, several thrombin-based drugs are currently undergoing clinical trials. In this article, the therapeutic uses of thrombin (from the initial hemostasis to the latest cancer therapy), the commercially available drugs associated with thrombin, and the pros and cons of thrombin-based therapeutics (e.g., adverse immune responses related to bovine thrombin, thromboinflammation, and vasculogenic "rebounds") are summarized. Further, the current challenges and possible future research directions of thrombin-incorporated biomaterials and therapies are discussed. It is hoped that this review may provide a valuable reference for researchers in this field and help them to design safer and more effective thrombin-based drugs for fighting against various intractable diseases.

Mechanisms and management of the coagulopathy of trauma and sepsis: trauma-induced coagulopathy, sepsis-induced coagulopathy, and disseminated intravascular coagulation

Disseminated intravascular coagulation can occur due to different causes but commonly following sepsis. Trauma-induced coagulopathy (TIC) occurs on hospital arrival in approximately 25% of seriously injured patients who initially presents with impaired hemostasis and a bleeding phenotype that can later progress to a prothrombotic phase. Following traumatic injury, ineffective hemostasis is driven by massive blood loss, tissue damage, and hyperfibrinolysis. This initial impaired hemostasis continues until surgical or other management strategies not only to stop the causes of hemorrhage but also progresses to a prothrombotic and hypofibrinolytic state, also termed fibrinolytic shutdown. Prothrombotic progression is also promoted by inflammatory mediator release, endothelial injury, and platelet dysregulation, which is commonly seen in sepsis with increased mortality. Unlike TIC, the early phase of sepsis is frequently complicated by multiorgan dysfunction described as sepsis-induced coagulopathy (SIC) that lacks a hemorrhagic phase. The phenotypes of SIC and TIC are different, especially in their initial presentations; however, patients who survive TIC may also develop subsequent infections and potentially sepsis and SIC. Although the pathophysiology of SIC and TIC are different, endothelial injury, dysregulated fibrinolysis, and coagulation abnormalities are common. Management includes treatment of the underlying cause, tissue injury vs infection is critical, and supportive therapies, such as hemostatic resuscitation and circulatory support are essential, and adjunct therapies are recommended in guidelines. Based on clinical studies and certain guidelines, additional therapies include tranexamic acid in the limited timing of initial traumatic injury and anticoagulants, such as antithrombin and recombinant thrombomodulin in disseminated intravascular coagulation.

Alternative anticoagulation during extracorporeal detoxification

The role of heparin anticoagulation in the development of hemorrhagic syndrome after extracorporeal detoxification (ECD) procedures in patients with initial hemostasis disorders, as well as the place of alternative citrate anticoagulation in extracorporeal treatment have not yet received a final assessment and require further study. The aim of this work was to compare the results of treatment of patients with severe intoxication using heparin and citrate as anticoagulants during ECD procedures. The conducted study confirms that the use of heparin anticoagulation in ECD leads to a spasmodic progression of the manifestations of DIC that were present before the procedure. Citrate anticoagulation demonstrates the benefits consisting in the absence of a spasmodic increase in coagulopathy, hypofibrinemia, and thrombocytopenia during an ECD session, which is characteristic of the heparin use. However, when ECD is initiated against the background of more severe initial coagulopathy and, interrelatedly, more severe multiple organ failure (MOF), this does not improve treatment outcomes. Moreover, among patients with severe MOF taken for ECD, there was a greater mortality rate and a large proportion of deaths during and immediately after the session when using citrate anticoagulation. Thus, ECD procedures with citrate anticoagulation may have a negative impact on the condition of patients who already have severe MOF and severe coagulopathy. This risk may be associated with metabolic disorders, especially dangerous in such severe patients, and does not outweigh the risk of an increase in hemostasis disorders characteristic of heparin anticoagulation. Probably, ECD with citrate anticoagulation has to be carried out at an earlier stage of the disease, and in cases of severe MOF already present in the patient, it is advisable to use traditional heparin anticoagulation.

Nonvariceal Upper Gastrointestinal Hemorrhage: The Interventional Radiologist's Perspective

AbstractNonvariceal upper gastrointestinal (GI) bleeding is one of the most common diseases of the GI tract and represents a high percentage of emergency room admissions. Eighty percent to 90% of upper GI bleeds are nonvariceal, with a mortality of 1 to 10% of patients. Selective embolization of the arterial source can be achieved with many therapeutic alternatives available in the interventional radiologist's arsenal, such as particles, coils, liquid emboli, selectively infused vasoconstrictor agents, or a combination of these techniques. Up to 95% of patients can obtain initial hemostasis without angiographic intervention. However, rebleeding is common, occurring in up to 50% of patients and persistent hemorrhage has been described in 7 to 30% of patients with mortality rates up to 14%.

Efficacy of a novel self-assembling peptide gel for initial hemostasis during cold snare polypectomy for multiple duodenal adenomas.

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