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Results for “bleeding”

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PubMed1983

Effect of prophylactic high-dose treatment with ampicillin and cloxacillin on bleeding time and bleeding in patients undergoing elective vascular surgery.

50 patients undergoing elective vascular surgery were randomized to prophylactic antibiotic treatment with ampicillin 2 g X 4 + cloxacillin 1 g X 4 for 4 d following the operation, or to a control group without antibiotics. All patients received heparin subcutaneously 5000 IU X 2, for 7 d. On days 1 and 4 after the operation, the median bleeding time was 1 1/2-2 min longer in the antibiotics group. 5 patients on antibiotics had a bleeding time prolongation beyond the normal range, but only 2 of these, who had additional haemostatic defects, had abnormal bleeding.

Adult↗

PubMed1986

Cumulative effects of quinidine and aspirin on bleeding time and platelet alpha 2-adrenoceptors: potential mechanism of bleeding diathesis in patients receiving this combination.

We observed quinidine-induced prolongation of bleeding time without thrombocytopenia in three subjects. In addition, we noticed a cumulative prolongation of bleeding time by a combination of quinidine and aspirin. We postulated that because both quinidine and aspirin inhibit epinephrine-induced platelet aggregation, a cumulative effect of the two drugs might be responsible for the hemostatic defect. In studies using normal human platelets, we confirmed a marked reduction in epinephrine-induced platelet aggregation by the combination of these two agents. To further study the potential mechanism of this cumulative effect, platelet lysates were incubated with the alpha 2-adrenoceptor antagonist tritiated yohimbine in the presence of quinidine and aspirin. On the basis of the radioligand binding data, the dissociation constant (KD) of alpha 2-adrenoceptors was observed to increase in the presence of quinidine as well as aspirin. The combination of these two agents caused a marked increase in the KD of platelet alpha 2-adrenoceptors without alteration in the number of receptor sites. These data suggest that the cumulative effects of quinidine and aspirin on platelet alpha 2-adrenoceptor KD may relate to the significant reduction in epinephrine-induced platelet aggregation. This phenomenon, coupled with other well-known effects of aspirin on the platelet release reaction and arachidonate metabolism, may lead to bleeding problems in some patients receiving this combination.

Aspirin↗

PubMed1987

Assessment of gastric bleeding in rats: effects of cyclooxygenase inhibitors and 16,16-dimethyl prostaglandin E2 on gastric bleeding.

Gastric bleeding caused by cyclooxygenase inhibitors has been assessed by a novel method. Rats are adapted to a strict light-dark cycle with limited access to food to reduce the stress associated with starvation. Such animals are then labeled with 51Cr-red blood cells from donor animals and dosed with the compound under evaluation. After 24 hr. animals are sacrificed and the amount of blood that has accumulated in the lumen of the cecum is quantitated. The potency of cyclooxygenase inhibitors in this assay to cause gastric bleeding is as follows: indomethacin greater than piroxicam greater than naproxen greater than ibuprofen greater than diflunisal which is similar to their antiinflammatory potency in the rat. In addition, the protective activity of PGE2 on indomethacin-induced gastric bleeding is clearly shown by this method.

16,16-Dimethylprostaglandin E2↗

PubMed1999

Nasopharyngeal angiofibroma in a patient with haemophilia A: a bleeding tumour in a bleeding-prone patient.

Nasopharyngeal angiofibroma is a highly vascular tumour which occurs almost exclusively in adolescent males. Although it is histologically benign, it may cause serious clinical problems because of its tendency to bleed profusely during surgery. This paper presents the first case of nasopharyngeal angiofibroma in a patient with haemophilia A, another well-known disease of bleeding tendency. In this case the tumoural mass was surgically removed with effective factor VIII replacement without any bleeding complication.

Adolescent↗

PubMed1989

Histological changes of the esophageal mucosa in bleeding versus non-bleeding varices.

There is considerable controversy as regards the exact cause of bleeding from esophageal varices. This study examined changes in the mucosa of such patients in an effort to understand the underlying mechanisms. Fifty patients were studied, 20 with a history of variceal bleeding and 30 without who served as controls. Endoscopic biopsies were taken from the inter-variceal mucosa within 5 cm from the cardia and were examined histopathologically. The results showed dilated intra-epithelial blood-filled channels within the squamous epithelium and the lamina propria in all bleeders, and in 50% of the non-bleeders. Evidence of esophagitis was also more pronounced in bleeders (50%) than in non-bleeders (23.3%). It is our opinion that esophagitis and the presence of dilated blood-filled channels may play a role in the initiation of variceal bleeding.

Adult↗

PubMed1999

Demographic predictors of resource utilization for bleeding peptic ulcer disease: the Ontario GI Bleed Study.

Peptic ulcer disease (PUD) and its complications impose a substantial burden on health care resources. To help identify subpopulations in which preventative measures might achieve maximal cost savings, the authors studied the variation in resource utilization and cost for management of bleeding PUD among demographic subgroups. Resource utilization profiles and direct medical cost estimates were generated for consecutive admissions for bleeding PUD at four hospitals in southern Ontario via chart review and adaptation of an administrative cost database. Multiple linear regression models were developed to identify independent demographic predictors of direct medical case cost and hospital length of stay (LOS). Among 158 admissions, the average LOS and case costs were 5.73 days and $2,953 (Canadian) respectively. Age, comorbid illness, nonsteroidal anti-inflammatory drug use, and the absence of prior PUD or upper gastrointestinal hemorrhage were associated with higher cost in univariate analysis, whereas increasing age and comorbidity predicted LOS. Only age and absence of prior PUD persisted as independent predictors of direct medical cost and LOS in a stepwise multiple linear regression. Costs for managing bleeding PUD vary substantially among demographic subgroups. More careful stratification of treatment costs is needed when economic models of interventions to prevent or to treat PUD are applied to specific subpopulations.

Adult↗

PubMed2000

Management of intracranial bleeding associated with anticoagulation: balancing the risk of further bleeding against thromboembolism from prosthetic heart valves.

Mechanical heart valves are associated with a risk of thromboembolism and anticoagulation is generally recommended. However, this is inevitably associated with a risk of intracranial bleeding. The case of a patient who sustained an intracranial bleed while taking warfarin for a prosthetic aortic valve and a further two intracranial bleeds while on heparin as an inpatient is discussed and the literature on the management of intracranial haemorrhage in patients on warfarin with prosthetic valves is reviewed.

Aged↗

PubMed2002

Massive bleeding from Dieulafoy's lesion of the small intestine in a child--therapy for the bleeding from gastrointestinal tract out of endoscopic observation.

Dieulafoy's lesion is recognized as a submucosal artery associated with a minute mucosal defect and a rare cause of severe gastrointestinal hemorrhage. Especially, that of distal jejunum or ileum is extraordinarily rare. It is very difficult to detect the lesion in these parts. We experienced massive bleeding from Dieulafoy's lesion of the distal jejunum in a 12-year-old girl. Preoperative angiography and intraoperative palpation detected the point of bleeding. She was rescued by partial jejunectomy. Compiled reports suggested that careful palpation was useful for detection of the location of the bleeding point, which was enhanced as vascular dilatation by the angiogram, during the operation comparatively.

Arteries↗

PubMed1989

A randomised controlled trial of propranolol for the prevention of initial bleeding in cirrhotic patients with portal hypertension. Preliminary results. The Italian Multicenter Project for Propranolol in the Prevention of Bleeding.

The preliminary analysis of a multicentre, randomised, single-blind trial of propranolol for prophylaxis of first bleeding in cirrhosis is reported. 174 consecutively-chosen patients with large oesophageal varices were randomly assigned to either propranolol, in doses which reduced the resting heart rate by 25% (85 patients), or to vitamin K (89 patients). 25 patients had to be withdrawn from treatment with propranolol because of poor tolerance. The 30-month cumulative proportion of patients free of bleeding was 74% in the propranolol group and 63% in the vitamin K group; corresponding survival figures were 59% and 74%, respectively. These differences were not statistically significant. A retrospective analysis, according to the presence of ascites at randomisation showed that a significantly higher proportion of patients without ascites in the propranolol group were free of bleeding compared with those in the control group (87% vs 64%; p = 0.023). No significant differences were found in patients with ascites at randomisation. Length of survival was not significantly affected by treatment in any subgroup, although it was shorter in ascitic patients given propranolol than in controls (33% vs 63%; p = 0.07). If confirmed on a longer follow-up, these results suggest that propranolol could prevent primary variceal haemorrhage in patients with well-compensated cirrhosis.

Aged↗

PubMed2006

Recombinant activated factor VII for bleeding in patients without inherited bleeding disorders.

(1) Recombinant activated factor VII (rFVIIa) is licensed in Canada for the prevention and treatment of bleeding in hemophiliacs, but it is increasingly used to control bleeding in non-hemophilic patients during surgery, or during treatment for severe trauma or intracerebral hemorrhage (ICH). (2) In one clinical trial, there was a significant reduction in mortality among patients with ICH treated with rFVIIa. In another trial, administration of rFVIIa significantly reduced the number of trauma patients needing massive blood transfusions although there was no significant difference in mortality. (3) Adequately powered randomized controlled trials are needed to clarify the efficacy and safety of rFVIIa for non-bleeding disorder indications. Phase III trials in ICH and trauma are underway. (4) There is potential for non-hemophilic use, particularly if clinical efficacy and cost effectiveness are established.

Canada↗

PubMed1989

Propranolol prevents first gastrointestinal bleeding in non-ascitic cirrhotic patients. Final report of a multicenter randomized trial. The Italian Multicenter Project for Propranolol in Prevention of Bleeding.

We report here the final analysis of a multicentre randomized, single-blind trial of propranolol for prophylaxis of first bleeding in cirrhosis. One hundred and seventy-four consecutive patients with large esophageal varices were randomly assigned to either propranolol in doses reducing the resting heart rate by 25% (85 patients) or to a placebo (vitamin K: 89 patients). Three were lost to follow-up and 26 had to be withdrawn from propranolol because of side effects (n = 23) or low compliance (n = 3). The cumulative value over 42 months of patients free of bleeding was 74% (95% confidence interval = 85%-63%) in the propranolol and 59% (95% CI = 79%-43%) in the control group and the corresponding survival figures were 51% (95% CI = 63%-39%) and 59% (95% CI = 75%-43%): neither of the differences was significant. A retrospective analysis according to the presence of ascites at randomization showed that in the subset without ascites the proportion of patients free of bleeding was significantly higher in the propranolol group than in the control group (83% vs. 61%; 95% CI = 97%-69% and 78%-44%, respectively; P = 0.028); this difference was even more evident in the ascites-free period (94% vs. 58%; 95% CI = 100%-86% and 76%-40%, respectively; P = 0.002). No differences were found in patients with ascites at randomization. Survival was not significantly affected by treatment in any subgroup, although it was shorter in the ascitic patients given propranolol than in controls (33% vs. 49%; 95% CI = 51%-15% and 71%-27%, respectively; P = 0.07).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1988

[Endoscopic therapy of acute upper gastrointestinal bleeding. A breakthrough in non-variceal bleeding?].

Endoscopic therapy adds a new tool to the management of acute upper gastrointestinal hemorrhage. Endoscopic sclerotherapy being now a well established therapy for acute variceal bleeding, a simple and effective therapy for nonvariceal bleeding was missing. Recently coagulation therapy with laser, electric current or thermocouples has come into use, but injection therapy with hemostatic and sclerosing agents seems a simple, costeffective and relatively safe method. In uncontrolled trials the overall success rate in achieving hemostasis was over 90% and the need for emergency surgery was dramatically reduced. Injection therapy appears to be a major advance in the treatment of nonvariceal bleeding, especially in high risk patients.

Administration, Topical↗

PubMed1984

The bleeding gastric ulcer--will it bleed again, and if so, why? A case for repeat endoscopy in evaluating stigmata.

Nine patients qualified for surgery for a bleeding gastric ulcer--all had a 'visible vessel'. Three of these vessels were thrombosed including 2 in patients who had been in shock. The smallest patent vessel was 0,35 mm in diameter, and 6 of the bleeding vessels were subserosal. The features thought to predispose to further bleeding were vessel size, a lateral hole in the main trunk of the vessel and, possibly, previous recanalization or ingestion of a drug which affected haemostasis. Five of 6 patent arteries had a cap of thrombus over the breach forming a false aneurysm. It is suggested that clinically these should pulsate, enlarge, leak--with persistent fresh thrombus in the ulcer crater on repeat endoscopy--and finally rupture. Where the underlying vessel is thrombosed the stigmata of a non-pulsatile 'visible vessel' or thrombus in the ulcer should disappear on repeat endoscopy. The sizes of the arteries in the normal antrum are tabulated.

Arteries↗

PubMed1995

[Bleeding peptic ulcers--how can recurrent bleeding be prevented?].

Bleeding is the most frequent complication of peptic ulcer disease. Patients with a previous ulcer hemorrhage have a high risk for future bleeding episodes. Therefore, treatment aiming at ulcer prophylaxis is mandatory. Helicobacter pylori infection, acid/pepsin and intake of Aspirin or NSAIDs are the main causal factors involved in the pathogenesis of peptic ulcer disease. Ulcers induced by nonsteroidal anti-inflammatory drugs can be cured by gastric acid suppression (e.g. omeprazole) and prevented by withdrawal of the ulcerogenic substances or co-medication with omeprazole or misoprostol. Acid and Helicobacter pylori are necessary, albeit by themselves not sufficient factors in the causal web of the formerly idiopathic, gastritis-associated peptic ulcer disease of the stomach and the duodenum. Maintenance therapy with antisecretory drugs results in a marked decrease of ulcer recurrences and probably further ulcer complications after an index bleeding, but a definite cure of the ulcer disease is not feasible in the majority of patients. The proportion of patients remaining in remission is dependent on the degree of gastric acid suppression. Therefore, potent antisecretory drugs such as the proton pump inhibitor omeprazole should be used if a physician decides to initiate a long-term maintenance therapy. Several studies have demonstrated beyond doubt that cure of Helicobacter pylori eradication resulted in a stable remission of gastric and duodenal ulcer disease. In addition, a true reinfection after apparent eradication of the bacteria has been rarely observed in adults.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗

PubMed1993

[100 consecutive patients with lower gastrointestinal bleeding: causes of incorrect diagnoses, recurrent bleeding and mortality].

A standard approach involving sequential investigations made it possible to identify a bleeding source in 98 out of 100 patients with massive lower gastrointestinal bleeding. In 5 cases the preoperative diagnosis was incorrect. Only in 2 patients was no pathology detectable. Recurrent bleeding occurred in 8 patients, 5 of whom subsequently died of hemorrhagic shock. The overall mortality was 10%, or 11% if a patient with late death due to massive rebleeding was included. 8 complications or deaths were due to diagnostic (n = 3) and therapeutic (n = 5) errors. The remaining complications with fatal outcome (n = 6) were due to the patient's associated or underlying disease. We conclude that in patients with angiographically visualized arteriovenous malformations in the coecum, a second lesion needs to be ruled out. To prevent some complications a more aggressive therapeutic approach seems necessary. On the other hand, there remain complications and deaths that cannot be prevented in view of the advanced stage of the associated or underlying disease.

Adult↗

PubMed1996

A comparison of clinical and endoscopic features of bleeding and non-bleeding peptic ulcer in Singapore.

Two hundred and seventy-seven consecutive cases of peptic ulcer patients were compared. Of these, 103 presented with acute gastrointestinal haemorrhage and 174 presented with pain. The median age of those who bled (53 years) was not significantly higher than those who presented with pain (50 years) (P > 0.05). Bleeding peptic ulcer patients, when compared to non-bleeding ulcer patients, tended to present with a past history of gastrointestinal haemorrhage, have ingested non-steroidal anti-inflammatory drugs, and have, at endoscopy, ulcers greater than 1.5 cm in diameter. The site and number of ulcers did not influence the mode of presentation. About 60% of bleeding ulcers were found in the duodenum and this proportion of duodenal ulcers was not significantly different in both groups of patients. Gastric ulcer patients who bled tended to be significantly associated with ingestion of non-steroidal anti-inflammatory drugs. Gender and ethnic distribution, smoking and alcohol ingestion were all not associated with the presentation of haemorrhage.

Adult↗

PubMed1989

Measurements of 6-keto-prostaglandin F1 alpha and thromboxane B2 in bleeding time blood: relation to bleeding and vascular disorders?

The body's ability to produce prostacyclin and thromboxane by blood vessels and platelets may be important in hemostatic and thrombotic disorders and in blood pressure regulation. There are limitations to the information that can be derived from measurement of the active substances or metabolites in plasma and urine. Assays for thromboxane and prostacyclin in bleeding time blood reflect production in response to a single standardized vascular injury, and show considerable promise in furthering our understanding of the production of these chemicals in vivo. These assays may improve the assessment of risk of developing thrombotic disorders and improve the ability to monitor treatment. Studies to date have focused largely on the influences of various doses of aspirin on the production of prostacyclin and thromboxane in bleeding time blood, but also suggest that smokers are high thromboxane producers. In addition, individuals who exhibit type A behavior, a behavior pattern characterized by a relatively high level of ambitiousness, hostility, and competitive drive and a chronic sense of urgency appear to be low prostacyclin producers. Diets enriched in sunflower oil were found to diminish thromboxane production, while diets high in canola oil enhanced prostacyclin formation.

6-Ketoprostaglandin F1 alpha↗

PubMedDate not supplied

Angiographic demonstration of bleeding in a unusually located Meckel's diverticulum simulating colonic bleeding.

A case is reported in which bleeding from a Meckel's diverticulum was mistakenly localized to the hepatic flexure of the colon on superior mesenteric angiography. An unusually long and mobile mesentery, allowing the bleeding Meckel's diverticulum to be positioned high in the right upper quadrant, led to this misdiagnosis. The case illustrates several fundamental principles about the technique and interpretation of mesenteric angiograms.

Adult↗