Treatment Of Acute Hemorrhage Research Articles

Whole blood transfusion in the treatment of acute hemorrhage, a systematic review and meta-analysis.

Whole blood (WB) transfusion received renewed interest after recent armed conflicts. The effectiveness as compared with blood component transfusion (BCT) is, however, still topic of debate. Therefore, this study investigated the effect of WB ± BCT as compared with BCT transfusion on survival in trauma patients with acute hemorrhage. Studies published up to January 16, 2023, including patients with traumatic hemorrhage comparing WB ± BCT and BCT were included in meta-analysis. Subanalyses were performed on the effectiveness of WB in the treatment of civilian or military trauma patients, patients with massive hemorrhage and on platelet (PLT)/red blood cell (RBC), plasma/RBC and WB/RBC ratios. Methodological quality of studies was interpreted using the Cochrane risk of bias tool. The study protocol was registered in PROSPERO under number CRD42022296900. Random effect pooled odds ratio (OR) for 24 hours mortality in civilian and military patients treated with WB as compared with BCT was 0.72 (95% confidence interval [CI], 0.53-0.97). In subanalysis of studies conducted in civilian setting (n = 20), early (4 hours, 6 hours, and emergency department) and 24 hours mortality was lower in WB groups compared with BCT groups (OR, 0.65; 95% CI, 0.44-0.96 and OR, 0.71; 95% CI, 0.52-0.98). No difference in late mortality (28 days, 30 days, in-hospital) was found. In military settings (n = 7), there was no difference in early, 24 hours, or late mortality between groups. The WB groups received significant higher PLT/RBC ( p = 0.030) during early treatment and significant higher PLT/RBC and plasma/RBC ratios during 24 hours of treatment ( p = 0.031 and p = 0.007). The overall risk of bias in the majority of studies was judged as serious due to serious risk on confounding and selection bias, and unclear information regarding cointerventions. Civilian trauma patients with acute traumatic hemorrhage treated with WB ± BCT as compared to BCT had lower odds on early and 24-hour mortality. In addition, WB transfusion resulted in higher PLT/RBC and plasma/RBC ratios. Systematic Review and Meta-Analysis; Level III.

Radiological embolization procedures in acute gastrointestinal, peritoneal and muscular hemorrhage

Treatment of acute hemorrhage is particularly challenging due to its sudden onset and the fact that it is often life-threatening. Potential causes include bleeding ulcerations of the gastrointestinal tract or tumor bleeding, but acute bleeding can also occur spontaneously or be traumatic, iatrogenic, or inflammatory. To demonstrate the basic principles of catheter embolization, as well as various embolic materials and their properties. Today there are awide range of embolization materials available. Ultimately the duration and extent of the desired occlusion are decisive when selecting an embolic material. Mechanical occlusion devices, particulates, and liquid embolic agents are available. Irrespective of the wide range of different etiologies, radiological embolization therapy is avery safe treatment option in cases of computed tomographic evidence of active hemorrhage. Ultimately, the interventionalist's comprehensive knowledge of the relevant characteristics is crucial for the success of therapy.

Treatment of Acute Hemorrhage from Esophageal Varices in Cirrhotic Patients.

Cirrhosis describes the end stages of chronic inflammation and progressive scarring of the liver and may lead to hepatocellular dysfunction and portal venous hypertension. Liver cirrhosis in itself is a major cause of mortality worldwide, accounting from more than 1 million deaths in 2010. Esophageal varices are common in cirrhosis such that Christensen et al. documented their occurrence in 90% of patients with cirrhosis within 10 years of follow up, 40% experiencing variceal bleeding. Acute hemorrhage from esophageal varices will classically appear as hematemesis and/or melena in patients with a history of cirrhosis. It is most often diagnosed by performance of an EGD which will reveal actively bleeding varices. Because of the high rate of morbidity and mortality associated with esophageal variceal bleeding, one must have a high index of suspicion in any patient with chronic liver disease or cirrhosis. As such, empiric management for variceal hemorrhage should be initiated any time this diagnosis is considered.

Эндоваскулярные методы диагностики и лечения острых кровотечений в просвет желудочно-кишечного тракта

Эндоваскулярные методы диагностики и лечения острых кровотечений в просвет желудочно-кишечного тракта

Bleeding disorders: functionality of global haemostasis assays in attaining clinical outcomes: a review

Many tests used to evaluate haemostasis correspond to artificially created environments. These include some of the traditional screening tests, which were established through understanding the coagulation cascade for example, the prothrombin time (PT), the activated partial thromboplastin time (aPTT) and Fibrinogen estimation. And as such, they have contributed greatly to our current knowledge of the haemostatic process. Unfortunately, these traditional laboratory tests have their limitations. Open to debate for example, is their ability to supply enough information timeously (? laboratory turnaround time) in order to diagnose and treat patients according to their phenotype. Anarchetypical shift in haemostasis measurements using global haemostasis tests that determine the complete process in a more physiological and all-inclusive way are consequently being reevaluated. These tests include: The viscoelastic tests (ROTEM/TEG) improve the treatment of acute haemorrhage, decreasing the transfusion burden, as for example in cardiac surgery and with it a more effective use of blood and blood products, thus lowering overall costs. They also provide rapid, comprehensive and accurate identification of an individual’s haemostasis state, in the laboratory or in the context of near-patient testing as point-of-care instruments. This allows clinicians to drive personalised, clinically and economically sound treatment and monitoring decisions. Thrombin generation measurement; although expensive is elegant. And as well as having an important role in managing haemorrhage it may be sensitive to various factors that contribute to hypercoagulation. The test may also be of value in discriminating between the different phenotypes within the population of severe haemophilia A (HA) patients. It is here to stay. The clot waveform analysis may be less well known (i.e. presently used as a research tool). It shows promise in staging sepsis patients, having a role in the early detection of disseminated intravascular coagulation (DIC) and also in the diagnosis and treatment-monitoring of haemophiliac patients. Flow perfusion chambers which while they may be the ‘ultimate’ global assay has a considerable way to go in order to become of use clinically. Although global haemostasis tests have been available for some time, there is a renewed awareness in their potential use for assessing both normal and abnormal haemostasis. Initial data suggests that they can provide more detailed information regarding the overall haemostatic process and its disorders. However, many challenges still remain such as with the analysers themselves. These involve their trademarked technology, their expense and finally their availability. All four methods still need more background standardisation regarding reagents, methodologies and finally interpretation of results. Much more additional information is required involving all the parameters measured and by inference, their subsequent clinical applications. The present review describes these various global haemostasis tests giving some background information, as well as clinical outcomes and lastly some information on their limitations.

The Conservative and Interventional Treatment of the Complications of Liver Cirrhosis

It is estimated that 1 million persons in Germany suffer from hepatic cirrhosis, which is the final stage of chronic inflammation of the liver. Cirrhosis has multiple causes, all of which lead to structural changes of the liver and to portal hypertension. The main complications of cirrhosis arise in turn: These include bleeding from collateral veins, ascites, hepatocellular carcinoma, encephalopathy, and infection leading to organ failure. We present the treatment of the main complications of liver cirrhosis with reference to the relevant literature (phase II and III trials, meta-analyses, and reviews). Endoscopic treatment (ligation) is used for the primary and secondary prophylaxis of variceal bleeding. Drugs to lower portal pressure (e.g., beta-blockers) are an established means of preventing initial or recurrent variceal bleeding over the long term. Vasoconstrictors such as terlipressin are mainly used to treat acute hemorrhage and type 1 hepatorenal syndrome. The main treatment of ascites is with spironolactone, in combination with a loop diuretic where indicated. A shunt (TIPS) is used to treat severe or repeat variceal hemorrhage or refractory ascites. Antibiotics play a well-established role in the treatment of acute hemorrhage, in the treatment and prevention of spontaneous bacterial peritonitis, and in the treatment of encephalopathy. The treatment of hepatocellular carcinoma depends on its extent of spread and on the degree of decompensation of cirrhosis. For most of the main complications of liver cirrhosis, there are treatments that have been well-tested in randomized trials. Liver transplantation should also be considered in every case.

Clinical features and endoscopic treatment for aged patients with acute hemorrhage arising from vascular malformation of colon

Objective To investigate the clinical features of aged patients with acute hemorrhage arising from vascular malformation of colon and the efficacy of endoscopic placement of hemoclip in treatment of hemorrhage. Methods Fifty-six patients were diagnosed with acute bleeding arising from vascular malformation of colon by colonoscopy. Patients were assigned to aged group (n = 31,≧60 years of age) and control group (n = 25, 0. 05). The mean number of hemoclips application was 5. 3 ± 2. 4 in aged group and 3. 1 ± 1. 3 in control group (P<0. 05). Conclusions The hemorrhage is more serious in aged patients with acute hemorrhage, because they often complicate with cardiovascular diseases and diabetes. The lesion of hemorrhage can be found and precisely localized using colonoscopy. Promptly endoscopic placement of hemoclip is quite effective in treatment of acute hemorrhage. Key words: Gastrointestinal hemorrhage; Vascular malformations Colon; Hemoclip; Endoscopy

The role of rotational thromboelastometry in real time assessment of haemostasis in surgical settings

In the settings of trauma, liver transplantation and major surgery multifactorial coagulopathies are frequently encountered. The treatment of acutely bleeding patients is critically compromised by monitoring with standard available routine coagulation tests. In contrast to conventional tests, rotational thromboelastometry (ROTEM) provides an automated measurement of interactive dynamic haemostatic processes in whole blood starting with initial haemostasis up to and including fibrinolysis at a given time point. Especially fibrinogen, platelet dysfunction and hyperfibrinolysis pose diagnostic gaps. The aim of this report was to highlight the usefulness of ROTEM in making the correct diagnosis and adoption of therapeutic approaches in a timely manner in liver transplantation and trauma. We describe the value of ROTEM in two haemostatically compromised patients. In the first case, we present the ROTEM-based dynamic assessment and goal-directed treatment of acute haemorrhage in a liver transplant recipient. In the second case, after operation a multitraumatised patient developed uncontrolled massive bleeding unresponsive to conventional treatment and recombinant activated factor VII (rFVIIa) administration. The cessation of bleeding was achieved after guided therapy according to ROTEM results. In orthotopic liver transplantation and severely injured trauma patients ROTEM enables rapid and accurate detection and the differential diagnosis of multifactorial coagulopathies. Also, it provides the basis of rational approach to the use of blood component therapy and pharmacological interventions.

ROTEM-based management for diagnosis and treatment of acute haemorrhage during liver transplantation

Goerlinger, K.; Dirkmann, D.; Kiss, G.1; Dusse, F.; Hanke, A.; Arvieux, C. C.1; Peters, J.Author Information

Ischemic colitis following the treatment of acute hemorrhage in a patient with acquired hemophilia A

Ischemic colitis following the treatment of acute hemorrhage in a patient with acquired hemophilia A

Treatment of acute haemorrhage in a patient with type 3 von Willebrand's disease and alloantibodies against von Willebrand factor with recombinant activated factor VII

BACKGROUND: Recombinant activated factor VII (rFVIIa, NovoSeven®) has been registered for the treatment of bleeding episodes in patients with inherited or acquired haemophilia A or B with inhibitors. The definite spectrum of indications for rFVIIa has not yet been established. METHODS: We describe a case of treatment of acute haemorrhage in a patient with type 3 von Willebrand's disease and alloantibodies against von Willebrand factor with rFVIIa. RESULTS: Surgical manipulations did not result in a control of the bleeding. Haemostasis finally was achieved after the third application of rFVIIa and maintained. No thrombotic or other complications occurred. CONCLUSIONS: This report demonstrates that rFVIIa is safe and effective in patients suffering bleeding episodes based on von Willebrand's disease with inhibitors.

Uses of recombinant factor VIIa in trauma

Despite advances in the care of the injured, the morbidity and mortality of traumatic hemorrhage remain a significant problem. Traumatologists continue to look for ways to treat bleeding and prevent the sequelae of hemorrhagic shock. Recombinant factor VIIa, developed for the treatment of patients with hemophilia, has been used with some success in acute bleeding associated with injuries. The mechanism of action is via a tissue factor-dependent effect and/or platelet activation. Coagulation occurs at the site of tissue injury, where tissue factor is exposed. Case series have described the beneficial effects of recombinant factor VIIa in the treatment of acute hemorrhage, early treatment of traumatic brain injury, and reversal of premorbid anticoagulation. In addition, there have been numerous reports of recombinant factor VIIa use in acute bleeds secondary to other causes as well as some evidence that recombinant factor VIIa may be efficacious when used prophylactically in high-risk patients and for high-risk procedures. Typical doses range from 50 to 100 microg/kg as a single bolus. Although there has been concern over the risk of inappropriate thrombosis with recombinant factor VIIa administration, this complication has seldom been described in published series. Although case experience is encouraging, no level 1 evidence has been published that demonstrates clinical or economic benefit of the use of recombinant factor VIIa in trauma patients. Many questions remain to be answered, ideally through randomized, prospective clinical trials. In particular, the issues of patient selection, ideal dosing, and factors associated with futile administration need to be elucidated.

The Role of Endoscopy in Managing Acute Lower Gastrointestinal Bleeding

In this issue of the Journal, Jensen et al. report their experience with the use of colonoscopy performed on an urgent basis for the diagnosis and treatment of acute hemorrhage from colonic diverticulosis.1 The study has two key messages. The first is that the endoscopic findings that characterize recent hemorrhage, routinely used in the evaluation of acute upper gastrointestinal bleeding, are also useful in establishing the diagnosis in a subgroup of patients with colonic diverticular hemorrhage. This group of findings, referred to as stigmata of recent hemorrhage, includes active bleeding (e.g., arterial spurting), nonbleeding visible vessels, appearing as discrete pigmented . . .

Editorial: Hemophilic pseudotumor of bone.

ABSTRACT Hemarthrosis is one of the more common and disabling complications of hemophilia. The condition is recurrent more often than not, tends to occur especially in the knees, and eventuates in chronic arthritis. Involvement of bones has been reported less frequently, which adds interest to a report by Jensen and Putman in the current issue of American Journal of Diseases of Children (129:717-719, 1975).The authors report the case of a 21-year-old man, a known hemophiliac since he was 3 months old, who was admitted to the hospital for treatment of acute hemorrhage into his left knee and right hip. A chest roentgenogram, incidentally obtained, disclosed an expansile, destructive lesion in the proximal part of the left clavicle. Only then, on reexamination, was the head of the left clavicle noted to be larger than that of the right clavicle, and only then did the patient recall being struck in the chest

Some Pathological Conditions of the Esophagus; Functional Disturbances, Diverticuli, Varices and Reflux Esophagitis

1. Some standard series of esophagoscopes do not include tubes of sufficient length. Under certain conditions tubes at least 50 cm long are required, preferably with proximal illumination, in which case the view is not impeded by retained food remnants.2. General anesthesia should be used at esophagoscopy in the majority of cases.3. A functional disturbance, appropriately designated “cricopharyngeal achalasia”, occurs at the esophageal mouth, in addition to spasm. In different spastic conditions of the esophagus, dilatation should be tried along with medication. Dilatation may have a striking effect and can be repeated if the effect should prove temporary.4. A hereditary weakness in the posterior hypopharyngeal wall is an important factor in the causation of Zencker's diverticulum in a number of cases, though in these, too, the disease appears fairly late in life.5. Laryngolists should receive training in the treatment of acute hemorrhage from esophageal varices with a compression bougie. Owing to the mod...