Therapy For Bleeding Control Research Articles

Cervical Cancer- Care Delayed-Care Denied and Death Invited

With about 78 billion global population, in 2020, 19 million new cancers and nearly 1 million deaths due to all types estimated to occur. Cervical cancer does not figure in top 5 most common cancers in both sexes globally, but with 6.5% incidence it forms the fourth top among women worldwide. The cancer registry data across the country in India with simple average of the most recent local rates applied to 2020 population estimates a figure of 1324413 cases and 851678 in 2020 and cumulative prevalence around 2.7 million cases in last 5 years of all categories of cancers in India. Cervical cancers in India account for 10% of all cancers in both sexes and about 18% of cancers among women in India as per the international agency for Cancer Research. Nearly one-third of the global cervical cancer deaths occur in India. It is a preventable condition as it has a long precancerous stage amenable for screening and treating. Cervical cancer Cervix uteri is no 3 with about 123 907 cases (9.45) next only to Breast and Oral cancers with a 2.01 cumulative risk. Cervical cancer death risk as 60000 women die annually. While the incidence and mortality rates of cervical cancer in the world are 13.1/ and 6.9/ per lakh population, in India, it is estimated to be 14.7/and 9.2/ per lakh population. Resulting in about 96,922 new cervical cancer cases and 60,078 deaths ranking second among women cancers. The incidence varies within Indian population basically due to ggeographical and socio-economic disparities in screening practices and care seeking practices across the districts of India. Epidemiologically the symptoms are mild and mimic a venereal disease of low infectiousness and therefore delay in seeking care and reporting at a time when the prognosis is poor. The 5-year survival rate is around 76.0% for those aged ≤50 years with much poorer survival among cases with involvement lymph nodes. We present one such case of a 45 year’s old rural women reporting on 4th May 2021 with symptoms vaginal bleeding, back pain, urine leakage & pelvic pain since 2 months to a gynecologic oncology service at a cancer hospital & research center, Bangalore. She had the history of taking treatment for another 2 months earlier from a traditional healer with no progress. She had consulted a family doctor first who referred her to the Cancer hospital. After an evaluation for abnormal vagina bleeding, cervical biopsies that demonstrated invasive adenocarcinoma of the cervix (Stage IV B CA Cervix) the diagnosis was confirmed. Since it was in an advanced stage, a palliative management including radiation therapy for control of bleeding & pain, and systemic chemotherapy for disseminated disease was opted. After 22 days of treatment she got discharged along with medications prescribed Inj. Amikacin 100mg IV OD, Inj. Pantoprazole 40mg IV OD, DNS which was given by the local doctor. But there was no progress and finally she died on 17th June 2021 after 23 days of discharge. This case emphasizes the need for early care seeking behavior, regular screening for all women over 35-45 years and HPV vaccination for adolescent girls in India.

Recombinant Factor VIIa as Adjunctive Therapy for Bleeding Control in Severely Injured Trauma Patients: Two Parallel Randomized, Placebo-Controlled, Double-Blind Clinical Trials

Recombinant Factor VIIa as Adjunctive Therapy for Bleeding Control in Severely Injured Trauma Patients: Two Parallel Randomized, Placebo-Controlled, Double-Blind Clinical Trials

Cost effectiveness of recombinant activated factor VII for the control of bleeding in patients with severe blunt trauma injuries in the United Kingdom

The aim of this study was to assess the lifetime cost effectiveness of recombinant activated factor VII vs placebo as adjunctive therapy for control of bleeding in patients with severe blunt trauma in the UK. We developed a cost-effectiveness model based on patient level data from a 30-day international, randomised, placebo-controlled Phase II trial. The data were supplemented with secondary data from UK sources to estimate lifetime costs and benefits. The model produced a baseline estimate of the incremental cost per life year gained with recombinant activated factor VII relative to placebo of 12 613 UK pounds. The incremental cost per quality adjusted life year gained was 18 825 UK pounds. These estimates are sensitive to the choice of discount rate and health state utility values used. Preliminary results suggest that relative to placebo, recombinant activated factor VII may be a cost-effective therapy to the UK National Health Service.

Recombinant Factor VIIa as Adjunctive Therapy for Bleeding Control in Severely Injured Trauma Patients: Two Parallel Randomized, Placebo-Controlled, Double-Blind Clinical Trials

Recombinant Factor VIIa as Adjunctive Therapy for Bleeding Control in Severely Injured Trauma Patients: Two Parallel Randomized, Placebo-Controlled, Double-Blind Clinical Trials

Cost-effectiveness analysis of recombinant activated factor VII as adjunctive therapy for bleeding control in severely injured trauma patients in Germany

Uncontrollable bleeding is a leading cause of death in trauma patients and a major cause of preventable morbidity and mortality. Recombinant activated factor VII (rFVIIa) has been shown to decrease the need for red blood cell transfusion among severely injured blunt trauma patients. A significant difference in the incidence of acute respiratory distress syndrome was also observed relative to standard care together with a nonsignificant difference in mortality. While safety and efficacy of rFVIIa in trauma patients has been demonstrated, little is known about its cost-effectiveness.

Recombinant Factor VIIa as Adjunctive Therapy for Bleeding Control in Severely Injured Trauma Patients: Two Parallel Randomized, Placebo-Controlled, Double-Blind Clinical Trials

Uncontrolled bleeding is a leading cause of death in trauma. Two randomized, placebo-controlled, double-blind trials (one in blunt trauma and one in penetrating trauma) were conducted simultaneously to evaluate the efficacy and safety of recombinant factor VIIa (rFVIIa) as adjunctive therapy for control of bleeding in patients with severe blunt or penetrating trauma. Severely bleeding trauma patients were randomized to rFVIIa (200, 100, and 100 microg/kg) or placebo in addition to standard treatment. The first dose followed transfusion of the eighth red blood cell (RBC) unit, with additional doses 1 and 3 hours later. The primary endpoint for bleeding control in patients alive at 48 hours was units of RBCs transfused within 48 hours of the first dose. Among 301 patients randomized, 143 blunt trauma patients and 134 penetrating trauma patients were eligible for analysis. In blunt trauma, RBC transfusion was significantly reduced with rFVIIa relative to placebo (estimated reduction of 2.6 RBC units, p = 0.02), and the need for massive transfusion (>20 units of RBCs) was reduced (14% vs. 33% of patients; p = 0.03). In penetrating trauma, similar analyses showed trends toward rFVIIa reducing RBC transfusion (estimated reduction of 1.0 RBC units, p = 0.10) and massive transfusion (7% vs. 19%; p = 0.08). Trends toward a reduction in mortality and critical complications were observed. Adverse events including thromboembolic events were evenly distributed between treatment groups. Recombinant FVIIa resulted in a significant reduction in RBC transfusion in severe blunt trauma. Similar trends were observed in penetrating trauma. The safety of rFVIIa was established in these trauma populations within the investigated dose range.

A randomised, placebo-controlled, double-blind study to investigate the efficacy and safety of rFVIIa as adjunctive therapy for control of bleeding in patients with severe blunt trauma: a re-analysis following the exclusion of early (< 48 hours) deaths

A randomised, placebo-controlled, double-blind study to investigate the efficacy and safety of rFVIIa as adjunctive therapy for control of bleeding in patients with severe blunt trauma: a re-analysis following the exclusion of early (< 48 hours) deaths

Von Willebrand Factor Levels Do Not Increase with Age in Patients with Type 1 Von Willebrand Disease.

A number of inherited and acquired factors modulate von Willebrand factor antigen (VWF:Ag) levels, including blood type, race, activity and stress level, thyroid hormone status, and, in women, time in menstrual cycle. In reported studies a positive correlation between VWF:Ag and/or factor VIII levels and age has been demonstrated, with an increase of 5 – 6 IU/dL per decade (Conlan MG et al, 1993; Kamphuisen PW et al, 1998). Those studies have primarily assessed VWF and factor VIII as risk factors for ischemic heart disease, cerebrovascular disease, and venous thromboembolism. None of the subjects had von Willebrand disease (VWD). Their VWF:Ag levels were in the higher normal or elevated range. The purpose of this study was to determine whether there is a relationship between age and VWF:Ag level in patients with Type 1 VWD. We collected the data from 36 patients who were diagnosed with type 1 VWD and followed at the Penn Comprehensive Hemophilia and Thrombosis Program up to a period of 13 years (See Table 1 below). For each patient, date of birth, VWF:Ag levels with corresponding test dates were collected by reviewing the medical histories and the lab results. Test results obtained during pregnancy, DDAVP testing, or during prophylaxis or therapy for bleeding control were excluded. One year was set as the observation period, so the adjacent VWF:Ag levels that were tested less than one year were excluded from the dataset. When two test results were available on a patient within a one-year period, the lower test result was used.To investigate whether there was a relationship between VWF:Ag levels and age, cross-sectional analyses (across each visit) and longitudinal analyses were performed using scatter plots, Spearman and Pearson correlations, and regression analysis. No significant increase in VWF:Ag levels with age was demonstrated. The fact that we did not find an increase in VWF:Ag levels over time in our patients could be due to the relatively small number of patients studied or could reflect a subtype of VWD, due to our selection criteria. Only patients with abnormal values were included. Some patients have a prior diagnosis of VWD and bleeding symptoms, but have normal values when tested. Since these patients are adults, this may be due, at least in part, to an age-related increase. Type 1 VWD may occur secondary to decreased VWF synthesis and/or clearance. It is possible that age-related effects on VWF levels will differ depending on the underlying factor(s) resulting in a lower VWF level. Further studies correlating a patient's values longitudinally with the underlying pathophysiology of their disease would aid in our understanding of their bleeding risks over time.Patient #Age at Last Visit, range (mean)Females (%)Race % (Cauc/AA/Other)VWF:Ag mean3617–70 (34)8978/19/349%