Risk Factors For Hemorrhagic Complications Research Articles

Incidence, Severity, and Risk Factors of Hemorrhagic Complications of Epilepsy Surgery After 2026 Craniotomies from 2003 to 2019: A Single Center Experience

Surgery is effective in the treatment of epilepsy, particularly focal epilepsy. The aim of this work was to report the incidence and grade of severity of hemorrhagic complications after cranial epilepsy surgery, and investigate the risk factors. Patients who underwent epilepsy surgery via craniotomy between October 2003 and April 2019 were retrospectively analyzed. The incidence of hemorrhagic complications occurring in a 3-month period after cranial surgery was recorded. Other outcomes included the grade of hemorrhagic severity and risk factors. During the inclusion period, 2026 surgical procedures were performed. Sixty-six hemorrhagic complications were recorded. The total incidence of hemorrhagic complications after cranial epilepsy surgery was 3.3%. The most common type of hemorrhagic complications was epidural hemorrhage (57.6%), followed by intraparenchymal hemorrhage (33.3%). Forty-five patients (68.2%) had grade I complications, 4 (6.1%) grade II, 16 (24.2%) grade III, and 1 (1.5%) grade IV. The mortality due to hemorrhagic complications was 1.5% (1 of 66) and hemorrhagic mortality among all cranial surgery was 0.05% (1 of 2026). Left craniotomy induced a higher percentage of severe hemorrhage than the right (34.2% vs. 14.3%). Extratemporal lobe epilepsy induced a higher percentage of severe hemorrhage than other epilepsy type (34.2% vs. 14.3%). However, no statistically significant difference was observed between these two factors (P= 0.067). Hemorrhagic complications were uncommon after open surgery for epilepsy. Most hemorrhagic complications were mild while the severe were rare. Patients with hemorrhagic complications had a good prognosis after effective treatment.

Prevention of Perioperative Bleeding in Patients With Chronic Limb-Threatening Ischemia

Materials and methods: At stage I, we retrospectively studied histories and outpatient medical records of 766 patients with chronic limb-threatening ischemia (from 2006 to 2020) to identify hemorrhagic complications and potential risk factors for their development. We analyzed the effectiveness of different scores for assessment of the bleeding risk. Based on the obtained data, measures to prevent hemorrhagic complications in this cohort of patients were improved. During stage II, 114 patients with 1 or several risk factors for major bleeding underwent surgery between 2021 and 2023. We used the proposed and improved preventive measures for all the patients. Follow-up periods were during the hospital stay and in 6 and 12 months.Results: At stage I, 44 (5.74%) patients were found to have hemorrhagic complications in the early postoperative period: retroperitoneal hematoma, bleeding from an operating wound, and pulsating hematoma (15.9%); gastrointestinal hemorrhage (31.8%); gross hematuria (13.7%), and hemorrhagic stroke (6.8%). The most significant risk factors for bleeding were endovascular intervention using brachial and femoral approaches (P = .000), hybrid intervention (P = .000), dual antiplatelet therapy (P = .014), surgery duration above 60 minutes (P = .001), triple antithrombotic therapy (P = .001), and significant vascular calcification (P = .023). The PRECISE-DAPT score has proven to be of prognostic value (P = .073; odds ratio, 2.88). At stage II, due to the proposed preventive measures, bleeding that required blood transfusion was found in 5 (4.38%) of 114 patients: of them, 1 (0.9%) patient had acute coronary syndrome. There were no major amputations, whereas 3 (2.63%) patients underwent minor amputation. In 6 and 12 months of the follow-up, the total frequency of major cardiovascular complications (cardiac death, myocardial infarction), major and minor amputation was 0.9% and 2.6%, 0% and 1.75%, and 0.9% and 2.6%, respectively.Conclusions: Surgical treatment of patients with chronic limb-threatening ischemia and risk factors for hemorrhagic complications who underwent surgery with the proposed preventive measures demonstrated high efficiency in reducing the number of hemorrhages and associated cardiac complications and low frequency of major and minor amputations in the long-term follow-up.

Infective endocarditis and stroke: when does it bleed? A single center retrospective study

BackgroundInfective endocarditis (IE) is a serious condition with a high mortality, represents a rare cause of stroke and an increased risk of intracranial hemorrhage. In this single center study, we characterize stroke patients with IE. We were interested in risk factors for intracranial hemorrhage and outcome of patients with intracranial hemorrhage compared to patients with ischemic stroke.MethodsPatients with IE and symptomatic ischemic stroke or intracranial hemorrhage admitted to our hospital between January 2019 and December 2022 were included in this retrospective study.Results48 patients with IE and ischemic stroke or intracranial hemorrhage were identified. 37 patients were diagnosed with ischemic stroke, 11 patients were diagnosed with intracranial hemorrhage. The intracranial hemorrhage occurred within the first 12 days after admission. We identified Staphylococcus aureus detection and thrombocytopenia as risk factors for hemorrhagic complications. An increased in-hospital mortality in patients with intracranial hemorrhage (63.6% vs. 22%, p = 0.022) was found, whereas patients with ischemic stroke and patients with intracranial hemorrhage do not differ regarding favorable clinical outcome (27% vs. 27.3%, p = 1.0). 27.3% patients with intracranial hemorrhage and 43.2% patients with ischemic stroke underwent cardiac surgery. Overall, 15.7% new ischemic strokes occurred after valve reconstruction, whereas no new intracranial hemorrhage was observed.ConclusionsWe found an increased in-hospital mortality in patients with intracranial hemorrhage. Beside thrombocytopenia, we identified S. aureus detection as a risk factor for intracranial hemorrhage.

Successful administration of eltrombopag in preparation for peritoneal dialysis catheter placement in a girl with MYH9-related disease.

MYH9-related disease is an autosomal dominant disorder characterized by macrothrombocytopenia, nephropathy, inclusion bodies in leukocytes, sensorineural hearing loss, and cataract. Severe cases require kidney replacement therapy in the patient's second decade of life; thrombocytopenia constitutes a major risk factor for hemorrhagic complications during dialysis initiation or kidney transplantation. Prophylactic platelet transfusion prior to surgery is commonly administered to affected patients in these cases. However, transfusion in such patients has limitations other than the general risk of allergic reactions and blood-borne infections; it may also trigger alloimmunization, leading to platelet transfusion resistance or the development of anti-donor antibodies in potential kidney transplant recipients. Here, we describe prophylactic administration of eltrombopag, an oral thrombopoietin receptor agonist, prior to laparoscopic peritoneal dialysis catheter placement in a 15-year-old girl with MYH9-related disease. Her platelet count was approximately 30 × 103/μL at baseline; it increased to 61 × 103/μL on the day before surgery, thereby avoiding the need for platelet transfusions. There were no major bleeding or adverse events associated with eltrombopag administration. Thus, eltrombopag may be a safe and effective alternative to prophylactic platelet transfusions in patients with MYH9-related disease.

Risk factors for hemorrhagic complications following robotic-assisted partial nephrectomy.

The aim of this study was to analyze the risk factors for hemorrhagic complications in patients who underwent robotic-assisted partial nephrectomy. We retrospectively reviewed the records of 260 patients who underwent robotic-assisted partial nephrectomy. Hemorrhagic complications were defined as bleeding, hematoma, or arteriovenous fistula requiring hemostatic medication, blood transfusion, or therapeutic intervention. Hemorrhagic complications were graded according to the modified Clavien classification system, and the hemorrhagic complication group comprised only those complications with Clavien grade II or higher. Thereafter, we investigated the presence of any relevant association between perioperative factors and hemorrhagic complications. Of 260 patients included in the study, 32 (12.3%) had hemorrhagic complications. The postoperative hemoglobin level was significantly lower in the hemorrhagic complication group than in the group without complications. The hemorrhagic complication group had significantly more essential blood loss and a significantly longer length of hospital stay. In the univariate analysis, type 2 diabetes mellitus, Radius-scores tumor size as maximal diameter exophytic/endophytic properties of the tumor nearness of the deepest portion of the tumor to the collecting system or renal sinus anterior (a)/posterior (p) descriptor location relative to the polar line., sum of the renal size plus renal sinus involvement in the PADUA score is a simple anatomical system that can be used to predict the risk of surgical and medical perioperative complications in patients undergoing open NSS, prolonged console time (>180 minutes), prolonged warm ischemic time (>25 minutes), and method of pedicle control were statistically significant risk factors. In the multivariate logistic regression analysis, warm ischemic time >25 minutes was the only significant risk factor for hemorrhagic complications (odds ratio, 3.51; 95% confidence interval, 1.28-9.59; p = 0.01). Patients who undergo robotic-assisted partial nephrectomy with a warm ischemic time >25 minutes are significantly more likely to have hemorrhagic complications and should hence receive careful perioperative follow-up.

Venous thromboembolic and hemorrhagic events after meningioma surgery: A single-center retrospective cohort study of risk factors.

Microsurgical resection of meningiomas in a majority of cases leads to a favorable outcome. Therefore, severe postoperative adverse events are less acceptable. The main purpose of this study was to investigate the incidence of symptomatic venous thromboembolism (VTE) and hemorrhagic complications in patients after operative treatment of intracranial meningiomas and to identify the risk factors in this patient subgroup. Of 106 patients undergoing elective craniotomy for meningioma overall incidence of symptomatic VTE was noted in 5.7% (six patients). For the risk-factor analysis older age (57.20 ± 11.60 vs. 71.00 ± 0.90 years, p < 0.001), higher body mass index (27.60 ± 4.80 vs. 33.16 ± 0.60 kg/m2, p < 0.001), WHO grade II (3.00% vs. 33.33%, p = 0.02), lower intraoperative blood loss (466.00 ± 383.70 vs. 216.70 ± 68.30 mL, p < 0.001), bedridden status and neurologic deficit (0.00% vs. 33.33%, p = 0.003 and 38.00% vs. 100.00%, p = 0.004) were associated with greater VTE risk. No risk factors for hemorrhagic complications were identified on univariate analysis. In conclusion, the incidence of VTE in meningioma patients is not negligible. Identified risk factors should be taken into account in the decision-making process for chemoprophylaxis when the risk of bleeding decreases.

Predictors of hemorrhagic complications after intravenous thrombolysis in acute cerebral infarction patients: A single-center study of 391 cases.

For patients with ischemic stroke, intravenous (IV) thrombolysis with Urokinase within 6 hours has been accepted as beneficial, but its application is limited by high risk of hemorrhagic complications after thrombolysis. This study aimed to analyze the risk factors of hemorrhagic complications after intravenous thrombolysis using Urokinase in acute cerebral infarction (ACI) patients.Total 391 consecutive ACI patients were enrolled and divided into 2 groups: the hemorrhagic complications group and the non-hemorrhagic complications group. The related data were collected and analyzed.Univariate analysis showed significant differences in prothrombin time, atrial fibrillation (AF), Mean platelet volume, large platelet ratio (L-PLR), triglyceride (TG), Lactate dehydrogenase, alanine aminotransferase (ALT), high-density lipoprotein, and baseline National Institute of Health Stroke Scale score between the hemorrhagic complications and the non-hemorrhagic complications group (P < .1). Multivariate logistic regression analysis indicated that AF (odds ratio [OR] = 2.91, 95% confidence interval [CI] = 1.06–7.99 P = .039) was the risk factor of hemorrhagic complications, while ALT (OR = 0.27, 95% CI = 0.10–0.72 P = .009) and TG (OR = 0.16, 95% CI = 0.06–0.45 P = .000) were protective factors of hemorrhagic complications.For patients with AF and lower levels of ALT or TG, the risk of hemorrhagic complications might increase after ACI.

Evaluation of Risk Factors for Bleeding After Ultrasound-Guided Liver Biopsy.

PurposeThis study was performed to analyze the risk factors for hemorrhagic complications after ultrasound-guided liver biopsies.Patients and MethodsIn this retrospective study, we reviewed 1193 ultrasound-guided percutaneous liver biopsies performed in our hospital from January 2018 to December 2020. Relevant patient characteristics, indications for biopsy, laboratory findings, biopsy technique, hemorrhagic complications, and pathologic outcomes were collected.ResultsWe analyzed 834 procedures performed on 807 patients with complete data. The bleeding group comprised 45 patients with post-procedure bleeding, and non-bleeding group comprising the remaining 789 patients. Univariate analysis showed that age (p < 0.001), number of needle passes (p = 0.009), platelet count (p = 0.002), prothrombin time (p < 0.001), and international normalized ratio (p < 0.001) were associated with post-procedure bleeding. Multivariable regression analysis showed that age under 18 years (p < 0.001), low platelet count (p = 0.001), and increased needle passes (p = 0.025) were independent risk factors for bleeding complications.ConclusionSex and focal liver lesions did not affect the risk of post-procedure bleeding. The international normalized ratio and prothrombin time were associated with an increased incidence of bleeding; however, they had no predictive value. Age, number of needle passes, and platelet count were identified as reliable predictors of bleeding.

Extensive Aortic Stent Graft Coverage for Thoracoabdominal Aortic Aneurysm is Associated With Hemorrhagic Complications Induced by Disseminated Intravascular Coagulation

Hybrid endovascular repair for thoracoabdominal aortic aneurysm (TAAA) is a less invasive alternative treatment than conventional open repair. However, disseminated intravascular coagulation (DIC) and hemorrhagic complications can occur postoperatively. We investigated risk factors for hemorrhagic complications after hybrid endovascular TAAA repair. Sixty-one patients who underwent elective hybrid endovascular TAAA repair between 2007 and 2020 were included. Laboratory data before and after placing stent graft were collected, and DIC was diagnosed using a scoring system established by the Japanese Association for Acute Medicine. The length of the stent graft used to cover the aorta was defined as the aortic coverage length, which was measured using the first postoperative computed tomography image. Predictors of unexpected hemorrhagic complications were evaluated. Postoperative thrombocytopenia was observed in 57 (93%) patients, and their platelet count decreased significantly after stent graft placement (14.3 [9.5-18.0] vs. 8.2 [5.4-10.9]×104/µL, P < 0.001). Fifteen (25%) and 45 patients (74%) were diagnosed with DIC before and after stent graft placement, respectively. Hemorrhagic complications were observed in 21 patients (34%). Multivariate logistic regression analysis revealed that aortic coverage length was an independent risk factor for hemorrhagic complications (odds ratio 1.441/50 mm increase; 95% confidence interval, 1.041-1.994, P=0.027). The cutoff value for aortic coverage length obtained from the receiver operating characteristic curve (area under the curve=0.72) was 304.4 mm (sensitivity 0.76, specificity 0.70). Aortic coverage length is a risk factor for hemorrhagic complications. Patients undergoing extensive aortic coverage greater than 304 mm should be closely monitored.

Mild Head Trauma (MHT) and Antiplatelet Therapy. Reply to Lorenzati et al. Comment on "Savioli et al. Mild Head Trauma: Is Antiplatelet Therapy a Risk Factor for Hemorrhagic Complications? Medicina 2021, 57, 357".

We read your data with interest, and we truly appreciate the similar experience [...].

Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study

BackgroundHemorrhagic events remain a major concern in patients under extracorporeal membrane oxygenation (ECMO) support. We tested the association between anticoagulation levels and hemorrhagic events under ECMO using anti-Xa activity monitoring.MethodsWe performed a retrospective multicenter cohort study in three ECMO centers. All adult patients treated with veno-venous (VV)- or veno-arterial (VA)-ECMO in 6 intensive care units between September 2017 and August 2019 were included. Anti-Xa activities were collected until a hemorrhagic event in the bleeding group and for the duration of ECMO in the non-bleeding group. All dosages were averaged to obtain means of anti-Xa activity for each patient, and patients were compared according to the occurrence or not of bleeding.ResultsAmong 367 patients assessed for eligibility, 121 were included. Thirty-five (29%) presented a hemorrhagic complication. In univariate analysis, anti-Xa activities were significantly higher in the bleeding group than in the non-bleeding group, both for the mean anti-Xa activity (0.38 [0.29–0.67] vs 0.33 [0.22–0.42] IU/mL; p = 0.01) and the maximal anti-Xa activity (0.83 [0.47–1.46] vs 0.66 [0.36–0.91] IU/mL; p = 0.05). In the Cox proportional hazard model, mean anti-Xa activity was associated with bleeding (p = 0.0001). By Kaplan–Meier analysis with the cutoff value at 0.46 IU/mL obtained by ROC curve analysis, the probability of survival under ECMO without bleeding was significantly lower when mean anti-Xa was > 0.46 IU/mL (p = 0.0006).ConclusionIn critically ill patients under ECMO, mean anti-Xa activity was an independent risk factor for hemorrhagic complications. Anticoagulation targets could be revised downward in both VV- and VA-ECMO.

Radiofrequency Ablation of Liver Tumors in Patients on Antithrombotic Therapy: A Case-Control Analysis of over 10,000 Treatments

PurposeTo evaluate the safety of radiofrequency ablation (RFA) for liver tumors in patients on antithrombotic therapy. Materials and MethodsA total of 10,653 consecutive RFA treatments in 3,485 patients with liver tumors were analyzed. The incidence of complications was analyzed on a treatment basis. The treatments for patients who had received antithrombotic medication up to 1 week prior to RFA comprised the antithrombotic therapy group (n = 806), and the others comprised the control group (n = 9,847). Antithrombotic agents were ceased prior to RFA (aspirin, ticlopidine, clopidogrel, and prasugrel ceased 7 days before RFA; cilostazol, 2 or 3 days before RFA; warfarin, 3 days before RFA; and direct oral anticoagulants, 1 day before RFA) and resumed as soon as possible after RFA. Logistic regression analysis was performed to assess whether the antithrombotic therapy increased the risk of hemorrhagic complications. ResultsHemorrhagic complications were diagnosed after 6 treatments (0.7%) in the antithrombotic group and 48 (0.5%) in the control group, and there was no significant difference between the groups (P = .30). In 3 treatments, hemorrhage was diagnosed on or after 8 days of RFA, all of which were in the antithrombotic group. Thrombotic complications were diagnosed after 2 treatments (0.2%) in the antithrombotic group and after 5 (0.1%) in the control group. In a multivariate analysis, receiving antithrombotic therapy was not an independent risk factor for hemorrhagic complications (adjusted odds ratio, 1.52; 95% confidence interval, 0.60–3.87; P = .38). ConclusionsRFA of liver tumors in patients on antithrombotic therapy is generally safe with appropriate cessation and resumption. Late-onset hemorrhage should be noted in the patients on antithrombotic therapy.

Low Level of Postoperative Plasma Antithrombin III Is Associated with Portal Vein Thrombosis after Liver Surgery

Background: Decreased antithrombin-III (AT-III) is a risk factor of portal vein thrombosis (PVT) in patients with liver cirrhosis. The association between PVT and postoperative AT-III is controversial in patients who underwent liver surgery. The efficacy of postoperative AT-III supplementation on PVT is also uncertain. Methods: Patients who underwent hepatectomy for hepato-biliary disease between 2015-2018 were retrospectively analyzed. Donors and recipients for liver transplantation were excluded. Postoperative PVT was assessed on computed tomography on the day 6-9 after hepatectomy. Results: Of the 325 patients included in this analysis, 19 patients (5.8%) were diagnosed as postoperative PVT. AT-III level on postoperative day (POD) 3 predicted postoperative PVT with a sensitivity/specificity of 74%/59% (area under the curve, 0.644; cut-off value, 60%; p=0.032). Univariate analysis revealed that AT-III level ≤60% on POD3 was the only significant risk factor for postoperative PVT (Table). Postoperative AT-III supplementation was not associated with reduced incidence of PVT. Although postoperative AT-III supplementation and major hepatectomy were the significant risk factors for postoperative hemorrhagic complications in univariate analysis, multivariate analysis revealed that major hepatectomy was the only significant risk factor for hemorrhagic complications. Conclusion: Patients with AT-III level ≤60% on POD3 should be given careful attention to postoperative PVT. Although postoperative supplementation of AT-III is safe without increased risk of hemorrhagic complication, the efficacy of it on PVT is still controversial.

Желудочно-кишечные кровотечения у больных в остром периоде инфаркта миокарда: обзор литературы

Currently, diseases of the circulatory system are the leading cause of death. A particular problem of a modern multidisciplinary hospital is the combination of acute coronary syndrome (ACS) with gastrointestinal bleeding (GIB), since it is characterized by a syndrome of mutual burdening and mutually exclusive approaches to treatment. The development of GIB in patients with ACS increases the mortality rate of patients to 50-80%. Despite the practical importance of this problem, today there are no clear recommendations and uniform principles for managing patients with such a unique scenario. The review describes in detail the reasons for the development of GIB in patients with ACS, discusses the mechanisms of action of drugs used in ACS and their importance in the development of GIB. It was found that the incidence of GIB in patients undergoing percutaneous coronary interventions reaches 4%, and the risk of re-bleeding doubles. The options for the treatment of GIB are considered: the role of endoscopic and drug hemostasis, as well as X-ray endovascular embolization of the gastric arteries, is shown as a minimally invasive alternative to traditional surgical intervention. Indications for discotinuation of dual antiplatelet therapy based on an objective assessment of the severity of bleeding have been formulated. Much attention is paid to the issue of prevention of GIB in patients with ACS. Risk factors for hemorrhagic complications were considered, and the risk assessment of possible GIB using the BARC scale was shown.

Tibial access for supra-inguinal embolization in extremely obese patients

Extreme obesity is a risk factor for hemorrhagic complications of femoral access (FA). Femoral lines, hematomas, pelvic binders and coagulopathy in the trauma scenario may also add difficulty and/or risk to FA. Radial access (RA) for routine peripheral endovascular procedures has been popularized owing to decreased hemorrhagic complications, increased patient satisfaction, and decreased operator radiation dose. However, though uncommon, cerebrovascular complications from RA approach are a known risk. Relatively recently, tibial access (TA) has been used for lower extremity peripheral vascular disease interventions. The advantages of TA mirror that of RA, with few and mostly minor complications, and the risk of iatrogenic cerebral embolization is nil. We report the feasibility of TA for supra-inguinal embolization in two extremely obese patients {body mass index > 40 kg/m2} following motor vehicle accidents. Commercially available base and microcatheters were used to perform embolization of the affected lower abdominal or pelvic arteries in standard fashion via a novel trans-tibial artery approach.

3:36 PM Abstract No. 112 Hemorrhagic complications of percutaneous nephrolithotomy: factors affecting the complications

To elucidate factors affecting hemorrhagic complications of percutaneous nephrolithotomy (PCNL). Between April 2012 and January 2018, 196 kidneys (right/left: 85/111) in 188 patients (male/female: 83/105, median age: 66) with nephrolithiasis were treated with PCNL. Renal access was obtained mostly through a stone-bearing calyx (79.6%) in the angiography suite prior to PCNL. Medical records and imaging studies were reviewed to record hemorrhagic complications of PCNL, which required abortion of PCNL, blood transfusion, or CT angiography with/without angioembolization. To elucidate the factors affecting the hemorrhagic complications, binary logistic regression analyses were conducted with variables from patients’ demographics (age, sex, body mass index (BMI)), stone characteristics (size, location, CT density, complete or partial staghorn vs. non-staghorn, chemical composition/calcium oxalate-dominance), renal access characteristics (number of calyces punctured, number of renal access for PCNL obtained, accessed calyx (upper, mid, lower), fluoroscopy time/dose) and PCNL characteristics (operator (senior vs. junior), operation time). Of 196 PCNL procedures, 18 (9.2%) were associated with hemorrhagic complications including 5 (2.6%) requiring angioembolization. In univariate analysis, BMI<20 (P = 0.047), complete staghorn (P = 0.047), upper pole stone (P = 0.02), multiple accesses (P <0.01) and renal access fluoroscopy time (P = 0.03) were significant risk factors for hemorrhagic complications of PCNL. Stone composition/calcium oxalate dominance (P = 0.75), PCNL operator (P = 0.15) and operation time (P = 0.25) were not the significant risk factors. In multivariate analysis, BMI<20 (odds ratio (OR) 6.74, confidence interval (CI) 1.50-30.3, P = 0.013), multiple accesses (OR 9.82, CI 2.65-36.4, P = 0.001) and renal access fluoroscopy time (OR 1.04, CI 1.004-1.075, P = 0.028) remained statistically significant. Although hemorrhagic complications of PCNL could be multifactorial, renal access techniques appear to affect the complications. Prolonged manipulation for renal access and PCNL through multiple accesses, especially in patients with BMI<20, may increase the chance of the hemorrhagic complications.

PREDICTORS OF HEMORRHAGIC AND THROMBOTIC COMPLICATIONS OF HEPATOSPLENOMEGALY SYNDROME

Summary. Goal. Investigation of the interactions of coagulation, anticoagulant and fibrinolytic systems with factors of immunoresistance in hepatosplenomegaly syndrome (SHSM).&#x0D; Materials and methods. Materials — сells and blood serum of 58 patients with SHSM against the background of liver cirrhosis complicated by portal hypertension, with the etiological factor — HCV / HBV virus infection (group I, 22 people) and the etiological factor — CMV / VEB virus infection (group II, 36 people), who were admitted to the hospital for bleeding from esophageal varicose veins. Methods - photometric on a biochemical analyzer Stat Fax 1904 Plus (USA). (C3 and C4 components of complement, antithrombin III and plasminogen, concentration of circulating immune complexes (CIC), determination of the coagulation time of venous blood Lee-White, calculation of the prothrombin index, fibrinogen content by the Rutberg gravimetric method. Protein C activity (PrS) by the clotting method on a coagulometer K 3002 Spectramed (Poland). Peripheral blood platelet counts were performed using immersion microscopy according to the Fonio method.&#x0D; Results. Multidirectional changes in the functions of the hemostasis system were revealed: a decrease in antithrombin III activity, protein C content, fibrinogen concentration, a decrease in plasminogen activity, a decrease in platelet counts, an increase in platelet antibodies, an increase in the concentration of the C3 component and a decrease in the C4 component of complement.&#x0D; Conclusions. Hemorrhagic and thrombotic complications of HCV, life-threatening and affecting the tactics and results of surgical and minimally invasive treatment, can occur both in the HCV group on the background of HBV/HCV viral hepatitis, and in the HCV group on the background of herpes virus CMV/VEB infection, but in group I both hemorrhagic and thrombotic complications were dominated by plasma risk factors for and in group II - platelet and immunological (complement component C3) risk factors for hemorrhagic complications, plasma factors of thrombotic complications.

Hemorrhagic complications during extracorporeal membrane oxygenation – The role of anticoagulation and platelets

PurposeHemorrhagic complications during extracorporeal membrane oxygenation are frequent and have a negative impact on outcome. We studied the association between activated partial thromboplastin time or platelet count and the occurrence of hemorrhagic complications. The secondary objective was to determine risk factors for hemorrhagic complications. MethodsRetrospective cohort study in a single-center Dutch university hospital. We included all adult patients on extracorporeal membrane oxygenation admitted to the intensive care unit between 2010 and 2017. ResultsWe included 164 consecutive patients of which 73 (45%) had a hemorrhagic complication. The most prevalent hemorrhagic complications were surgical site (62%) and cannula site bleeding (18%). Survival to discharge was 67% in the patients without a hemorrhagic complication and 33% in the patients with hemorrhagic complications (p < .01). A higher activated partial thromboplastin time in the 24 h prior was associated with the occurrence of hemorrhagic complications (adjusted hazard ratio per 10 s increase 1.14; (95% CI 1.05–1.24). Venoarterial extracorporeal membrane oxygenation, duration of support, and higher activated partial thromboplastin time were risk factors for the occurrence of hemorrhagic complications. ConclusionsHigher activated partial thromboplastin time is associated with the occurrence of hemorrhagic complications.

Perioperative hemorrhagic complications in pelvic floor reconstructive surgery.

We sought to assess the incidence, symptoms, and risk factors of perioperative hemorrhagic complications in patients undergoing pelvic floor reconstructive surgery. This is a retrospective study on 694 consecutive patients who underwent pelvic floor reconstructive surgery with or without using mesh in our hospital over a 3-year period. We identified 694 pelvic floor reconstructive procedures from 2014 to 2016, including complete/incomplete colpocleisis (176, 25.4%), sacral colpopexy/hysteropexy with mesh (140, 20.1%), colporrhaphy (77, 11.1%) or vaginal mesh repair (99, 43.1%). Two patients who received only sacrospinous ligament suspension were excluded. There were 68 (9.8%) and 3 (0.1%) patients whose blood loss reached 200 and 500ml respectively. Procedures involving mesh and vaginal hysterectomy (VH) caused more intraoperative blood loss. Postoperative hemoglobin drop was least in colpocleisis (p < 0.05). All 6 of the patients (0.9%) who developed postoperative pelvic hematoma underwent concomitant VH, and 5 of them received mesh. Hemorrhagic complications during or after pelvic floor reconstructive surgery are rare. Mesh use and concomitant VH are two major surgical risk factors for hemorrhagic complications in pelvic floor reconstructive surgery.

Physical Risk Factors of Hemorrhagic Complications Associated with Angio-Seal Closure Device Use in Neurointerventional Procedures.

Few studies have demonstrated detailed physical risk factors of hemorrhagic complications (HCs) associated with the Angio-Seal closure device. This retrospective study aimed to identify the risk factors of HC due to Angio-Seal use. Data from 143 cases that underwent neurointerventional procedures that involved puncturing the femoral artery and that used an Angio-Seal to close the puncture site were reviewed. We divided these cases into HC and no HC groups and retrospectively compared age, sex, past medical and preference history, body mass index (BMI), femoral artery depth, dual antiplatelet therapy use, activated clotting time, general anesthesia use, sheath size, right femoral artery puncture, and treatment time. HC occurred in 7 cases, 2 of which were excluded because of technical failure. Accordingly, we examined physical risk factors in 5 cases (3.5%) in the HC group and in 136 cases (96.5%) in the no HC group. A low BMI and shallow femoral artery depth were significantly associated with HC, whereas the other factors were not. A receiver operating characteristic curve indicated that a BMI cut-off value of 20.98 and a femoral artery depth of 11.1 mm could achieve optimal diagnostic efficiency for predicting HC. Patients with a BMI <21 may require careful hemostasis monitoring, and it is better not to undergo arterial puncture site closure using Angio-Seal for those with a femoral artery depth <11.1 mm.