Prevention Of Postoperative Bleeding Research Articles

Long-term results of combined viscotrabeculotomy–trabeculectomy in refractory developmental glaucoma

To evaluate the outcomes of combined viscotrabeculotomy-trabeculectomy in patients with refractory developmental glaucoma and to compare the success and complication rates with classical trabeculotomy-trabeculectomy procedure. Patients who were selected for this study had cloudy corneas with a diameter of 13 mm or greater and with an initial intraocular pressure (IOP) of 27 mmHg or more, and they were divided into two groups. Group 1 consisted of 40 eyes of 24 patients who had undergone combined viscotrabeculotomy-trabeculectomy with a mean follow-up time of 55.6+/-18.4 months, and group 2 consisted of 35 eyes of 20 patients who had undergone classical trabeculotomy-trabeculectomy with a mean follow-up time of 57.2+/-19.0 months. Pre- and postoperative IOPs, mean antiglaucoma medication, mean corneal diameter, success rates, intra- and postoperative complications were compared between two groups. Mean IOP reduced from a preoperative level of 33.2+/-5.3 and 32.8 mmHg to 14.2+/-3.1 and 15.3+/-3.3 in group 1 and group 2, respectively (P<0.001). The mean number of antiglaucoma medications used after surgery was significantly lower in group 1 (P<0.05). Kaplan-Meier survival analysis showed that the success probability at the last visits was 90 and 71.4% in group 1 and group 2, respectively, and the difference was statistically significant (P=0.01). The most common early postoperative complication was transient IOP elevation in group 1 and hyphema in group 2 (for each, P<0.001). Use of viscoelastic materials during trabeculotomy-trabeculectomy may increase the success rate of the procedure by prevention of postoperative hemorrhage, anterior chamber shallowing, adhesion of the incision lips or fibroblastic proliferation.

The use of desmopressin in congenital factor XI deficiency: a systematic review

Factor XI (FXI) deficiency is a rare inherited coagulation disorder characterized by infrequent spontaneous bleeding, but increased risk of hemorrhagic complications especially after trauma or surgery. Treatment options for FXI-deficient patients include virus-inactivated fresh frozen plasma, plasma-derived FXI concentrates, and activated recombinant FVII. Inhibitors of fibrinolysis, such as tranexamic acid, and desmopressin (DDAVP) have also been used in these patients, especially in mild cases. The current knowledge on the use of the latter agent in this congenital bleeding condition is systematically reviewed here. Although limited, the available literature data suggest the potential role of DDAVP for either treatment of bleeding episodes or the prevention of postoperative bleeding in patients with milder FXI defects. However, these findings need to be supported by further trials on large population of patients.

Long-term results of viscotrabeculotomy in congenital glaucoma: comparison to classical trabeculotomy

Background:To evaluate the outcomes of viscotrabeculotomy in patients with primary congenital glaucoma and to compare the success and complications rates with classical trabeculotomy.Patients and methods:Patients who were selected for this...

Eliminating Perioperative Adverse Events at Ascension Health

For Ascension Health's Healthcare That Is Safe strategy, Sacred Heart Hospital (SHH) and Columbia St. Mary's (CSM) served as alpha sites to develop strategies to eliminate perioperative adverse events (POAEs). The alpha sites set an interim goal of a 50% reduction of POAEs, then 100%, or elimination of POAEs by July 2008. The alpha sites identified a process for data management to establish clear, measurable elements for each of the five strategies of the alpha initiative; created an infrastructure to foster transformational change in the operating room suite; and implemented tactics to measure the success of the five strategies. STRATEGIES AND TACTICS: The sites implemented tactics for five strategies: (1) prevention of errors due to human factors, (2) prevention of surgical site infections, (3) prevention of adverse perioperative cardiac events, (4) prevention of postoperative venous thromboembolism, and (5) prevention of postoperative hemorrhage. Both alpha sites achieved > or = 90% reduction in the POAE rate. A number of key learnings were drawn from the alpha experiences, including the need to adjust to evolving definitions and guidelines for implementation and measurement of perioperative care.

Prevention of postoperative bleeding in anticoagulated patients undergoing oral surgery: use of platelet-rich plasma gel

Purpose: This study evaluated the effectiveness of a protocol using platelet-rich plasma (PRP) to prevent bleeding after dental extraction in patients treated with anticoagulant oral therapy. Materials and Methods: Forty patients with mechanical heart-value replacement who were treated with anticoagulant oral therapy were selected for the study. Each patient was treated with PRP gel placed into residual alveolar bone after extraction without heparin administration after suspension of oral anticoagulant drugs (36 hours). Results: Only 2 patients reported hemorrhagic complications (5%). Sixteen patients (40%) had mild bleeding that was easy to control with hemostatic topical agents; this mild bleeding terminated completely 1 to 3 days after the surgical procedures. The remaining 22 patients (55%) presented with adequate hemostasis. Conclusions: Oral surgery in heart surgical patients under oral anticoagulant therapy may be facilitated with PRP gel. Its use is an advanced and safe procedure. This biological and therapeutical improvement can simplify systemic management and help avoid hemorrhagic and/or thromboembolic complications.

Con: Aprotinin should not be used in patients undergoing hypothermic circulatory arrest

ANTIFIBRINOLYTIC AGENTS reduce blood loss and transfusion during cardiac surgery using cardiopulmonary bypass. 1 Fremes SE Wong BI Lee E et al. Metaanalysis of prophylactic drug treatment in the prevention of postoperative bleeding. Ann Thorac Surg. 1994; 58: 1580-1588 Abstract Full Text PDF PubMed Scopus (202) Google Scholar , 2 Munoz JJ Birkmeyer JO O'Connor GT Dacey LJ Is ϵ-aminocaproic acid as effective as aprotinin in reducing bleeding with cardiac surgery? A meta-analysis. Circulation. 1999; 99: 81-89 Crossref PubMed Scopus (154) Google Scholar This effect has been shown for synthetic agents (ϵ-aminocaproic acid and tranexamic acid) and the naturally occurring aprotinin. Hemostatic superiority of one antifibrinolytic agent over another has not been shown, however. 1 Fremes SE Wong BI Lee E et al. Metaanalysis of prophylactic drug treatment in the prevention of postoperative bleeding. Ann Thorac Surg. 1994; 58: 1580-1588 Abstract Full Text PDF PubMed Scopus (202) Google Scholar , 2 Munoz JJ Birkmeyer JO O'Connor GT Dacey LJ Is ϵ-aminocaproic acid as effective as aprotinin in reducing bleeding with cardiac surgery? A meta-analysis. Circulation. 1999; 99: 81-89 Crossref PubMed Scopus (154) Google Scholar Because procedures involving deep hypothermic circulatory arrest (DHCA) in adults have often been termed “bloodbaths” by clinicians, support for the prophylactic use of aprotinin in such cases has emerged. 3 Smith CR Spanier TB Aprotinin in deep hypothermic circulatory arrest. Ann Thorac Surg. 1999; 68: 278-286 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar , 4 Royston D A case for aprotinin in patients having deep hypothermic circulatory arrest. J Card Surg. 1997; 12: 214-221 PubMed Google Scholar The bulk of the rather limited existing literature on this subject addresses adults undergoing DHCA for thoracic aortic procedures, so this discussion is limited to that clinical context. The discussion addresses two questions: 1.Is aprotinin safe for DHCA? 2.Is aprotinin desirable for DHCA?

The Additive Effects of Antifibrinolytics: Dangers in the OR

The use of antifibrinolytic agents in recent years had been heralded as a major breakthrough in the prevention of postoperative bleeding. However, whenever the delicate balance between coagulation and fibrinolysis is altered, the potential exists for disaster. There have been a number of complications reported in the literature related to the use of antifibinolytics. With the availability of oral epsilon aminocaproic acid (EACA) as treatment for the symptoms of hemophilia and other secondary bleeding disorders, the possibility exists that a patient presenting for heart surgery may already be receiving antifibrinolyic therapy. A 72 year-old female underwent double valve replacement which was complicated by postoperative bleeding. Her medical history included gastrointestinal bleeding which was being treated with oral EACA. The patient was heparin resistant with a dose response of 55 sec/unit/ml. Heparin was administered during cardiopulmonary bypass to maintain the ACT between 400–500 seconds using a heparin-coated bypass circuit. In spite of this, the patient became thrombocytopenic and bled excessively in the postoperative period. Administration of additional antifibrinolyic agents in the operating room may be contraindicated when the patient is receiving this therapy preoperatively, and may contribute to the development of a procoagulant state during bypass.

Inguinal hernia repair in patients with coagulation problems: Prevention of postoperative bleeding with human fibrin glue

Background: Our purpose was to establish the efficacy of human fibrin glue (HFG) in preventing coagulative complications after inguinal hernia repair in patients with coagulation disorders. Methods: A randomized controlled trial of 50 patients with coagulation disorders undergoing hernia repair was performed. Patients had concurrent coagulopathies as a consequence of liver disease or long-term treatment with anticoagulants. Coagulopathies were defined according to the following criteria: prothrombin time <10.5 seconds, activated partial thromboplastin time <21 seconds, and fibrinogen <230 mg/dL. Patients were randomized in a 1:1 ratio with (group A) or without (control group B) use of HFG. Results: Postoperative hemorrhagic complications were significantly reduced in group A (4%) compared with group B (24%). Conclusion: This study shows that HFG is effective in preventing local hemorrhagic complications after herniorrhaphy in patients with concurrent coagulation disorders. This implies that the use of HFG reduces the costs of prolonged hospitalization related to such complications. (Surgery 1999;125:315-7.)

Inguinal hernia repair in patients with coagulation problems: Prevention of postoperative bleeding with human fibrin glue

Inguinal hernia repair in patients with coagulation problems: Prevention of postoperative bleeding with human fibrin glue

Continuous infusion therapy in haemophilia.

The application of coagulation factor therapy by continuous infusion (CI) was first suggested by Brinkhous in the early 1950s. The recent introduction of this mode of therapy to everyday practice was made possible after the demonstration of a good stability of most factor concentrates which were also found safe regarding potential bacterial contamination. Other developments included a better understanding of the pharmacokinetics of factors concentrates as well as the availability of a new delivery system. Continuous infusion was shown to be superior to bolus injection (BI) in achieving a stabile haemostatic effect, in the prevention of post-operative bleeding and was found to save between 20-50% in the required factor. This mode of therapy was found effective in haemophilia A and B as well as among patients with inhibitors to FVIII and with von Willebrand disease (vWD).

Metaanalysis of prophylactic drug treatment in the prevention of postoperative bleeding

Prophylactic drug treatment is one of several strategies to reduce postoperative blood loss and potentially limit homologous blood use in open heart surgery. A computerized MEDLINE search supplemented with manual bibliography reviews was performed for randomized clinical trials published in peer-reviewed English-language journals from January 1980 to June 1993. A metaanalysis was conducted of trials evaluating desmopressin (group DD, n = 13), ϵ-aminocaproic acid or tranexamic acid (group EA, n = 4), and aprotinin (group AP, n = 16). Eligible studies used placebo controls and administered the drug in a prophylactic manner. The primary study end point was postoperative chest tube loss (mL, mean ± standard deviation). There was a significant reduction in postoperative chest tube loss detected for each of the active treatments versus the placebo (DD versus controls: percent reduction 0.11, p = 0.0021; EA versus controls: percent reduction 0.30, p < 0.0001; and AP versus controls: percent reduction 0.36, p < 0.0001). Therapy with EA or AP was associated with a greater reduction in chest tube loss than DD (EA versus DD, p = 0.0033, and AP versus DD, p < 0.0001). Secondary study end points were transfusion requirements, chest reexploration, and perioperative mortality. The volume of postoperative red cell transfusion (mean ± standard deviation) was reduced with EA ( p < 0.0001) or AP treatment ( p < 0.0001) compared with a placebo or DD, whereas the proportion of patients given transfusions was limited only in the AP-treated patients (odds ratio 0.23; 95% confidence interval, 0.16 to 0.33; p < 0.0001). The prevalence of chest reopening for bleeding was decreased in the EA-treated ( p = 0.07) and AP-treated patients ( p = 0.07) versus controls. Mortality was not affected significantly for any of the treatment comparisons. The metaanalysis supports the prophylactic use of ϵ-aminocaproic acid, tranexamic acid, or preferably AP rather than DD for the reduction of postoperative bleeding associated with an open heart operation and the limitation of homologous blood use where indicated.

Preventive oral surgery

Oral surgery plays an important role in any preventive dentistry program. Timely, sound, conservative oral surgical procedures are indicated to prevent untoward results, unnecessary complications, and needless mutilation in the eradication of oral disease. Oral surgery procedures based on time-tested surgical principles contribute greatly to the comfort, health, and well-being of the patient. The contributions of oral surgery to preventive dentistry may be summarized as follows: (a) prevention of errors in therapy due to improper diagnosis; (b) prevention of major surgical problems developing from minor surgical problems; (c) prevention of operative and postoperative complications; (d) prevention of adverse reactions to local anesthetics; (e) prevention of postoperative hemorrhage; (f) prevention of minimizing prosthetic failures; (g) prevention of psychological and functional problems associated with facial deformities and injuries; (h) prevention of death, by early diagnosis of oral malignancies; and (i) prevention of leukoplakia and erythroplasia from progressing into serious lesions.

Prevention of postoperative hemorrhage after pancreatic cystogastrostomy.

Prevention of postoperative hemorrhage after pancreatic cystogastrostomy.

Dental extractions in hemophilia A and B.

To the Editor.— In their article on the effective surgical treatment of patients with classic hemophilia and Christmas disease with human coagulation factor concentrates ( 214 : 1673,1970) Grant and Breckenridge also reported on uncomplicated dental extractions of deciduous and adult teeth in classic hemophilia and in Christmas disease with high levels of the deficient clotting factor during the procedure and maintaining this for two to four days during the postoperative period. Application of a clear plastic gingival splint after oral surgery was an additional useful and simple measure for the prevention of postoperative bleeding. The teeth extracted included four wisdom teeth in each of two patients with hemophilia A and B, respectively. In last year we have done a large number of extractions in 11 patients with classic hemophilia A and three with hemophilia B ( with two exceptions, all were severe cases). The treatment consisted in only one transfusion of freeze-dried

THE TRANSPLANTATION OF FAT IN PROSTATIC AND KIDNEY SURGERY

In the desire to utilize some means less mechanical than the various procedures suggested for the prevention of postoperative hemorrhage in suprapubic prostatectomy, nephrotomy and pyelotomy, this work was undertaken. The use of fat in surgery dates back to 1893, when Neuber suggested its use in lacerations of the liver. His work was followed by Lexer and Czerny, and later by Klopfer in bone surgery. I have been unable to find any reference made to the use of fat in kidney or prostatic surgery, except that of a preliminary report by Dr. Kolischer, 1 which appeared two years ago. The experiments were carried out on dogs. The kidneys were traumatized by crushing and lacerating and nephrotomized in various ways, also decapsulated, and fat from either the same animal or previously obtained from another dog sutured or tied into or over the wounds. Some of the transplants were infected with colon

Prevention of Postoperative Hemorrhage in Intranasal Surgery

Prevention of Postoperative Hemorrhage in Intranasal Surgery