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https://www.readbyqxmd.com/read/28432428/tranexamic-acid-for-treatment-and-prophylaxis-of-bleeding-and-hyperfibrinolysis
#1
Ingrid Pabinger, Dietmar Fries, Herbert Schöchl, Werner Streif, Wolfgang Toller
Uncontrolled massive bleeding with subsequent derangement of the coagulation system is a major challenge in the management of both surgical and seriously injured patients. Under physiological conditions activators and inhibitors of coagulation regulate the sensitive balance between clot formation and fibrinolysis. In some cases, excessive and diffuse bleeding is caused by systemic activation of fibrinolysis, i. e. hyperfibrinolysis (HF). Uncontrolled HF is associated with a high mortality. Polytrauma patients and those undergoing surgical procedures involving organs rich in plasminogen proactivators (e...
April 21, 2017: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/28383471/clinical-practice-guideline-adherence-during-operation-inherent-resolve
#2
Timothy P Plackett, Darren C Cherry, Gerald Delk, Steven Satterly, Jared Theler, Derek McVay, Jacqueline Moore, Stacy A Shackelford
BACKGROUND: The Joint Trauma System (JTS) Clinical Practice Guidelines (CPGs) contributed to the decrease in battlefield morality over the past 15 years. However, it is unknown to what degree the guidelines are being followed in current military operations. METHODS: A retrospective review was performed of all patients treated at three separate US Army Role II facilities during the first ten months of Operation Inherent Resolve in Iraq. Charts were reviewed for patient demographics, clinical care, and outcomes...
April 5, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28323673/clinical-pearls-of-maternal-critical-care-part-2-sickle-cell-disease-in-pregnancy
#3
Vinod Patil, Gamunu Ratnayake, Galina Fastovets
PURPOSE OF REVIEW: The current review outlines the challenges in managing pregnant women with sickle-cell anemia, who are at risk of becoming critically ill during pregnancy. RECENT FINDINGS: Sickle obstetric patients pose unique challenges to the anesthetist and intensivist. We discuss the role of prophylactic transfusions for specific indications like acute anemia and twin pregnancies. The management and prevention of vaso-occlusive crises and chest crisis are also outlined...
March 18, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28225743/damage-control-resuscitation-in-patients-with-severe-traumatic-hemorrhage-a-practice-management-guideline-from-the-eastern-association-for-the-surgery-of-trauma
#4
Jeremy W Cannon, Mansoor A Khan, Ali S Raja, Mitchell J Cohen, John J Como, Bryan A Cotton, Joseph J Dubose, Erin E Fox, Kenji Inaba, Carlos J Rodriguez, John B Holcomb, Juan C Duchesne
BACKGROUND: The resuscitation of severely injured bleeding patients has evolved into a multi-modal strategy termed damage control resuscitation (DCR). This guideline evaluates several aspects of DCR including the role of massive transfusion (MT) protocols, the optimal target ratio of plasma (PLAS) and platelets (PLT) to red blood cells (RBC) during DCR, and the role of recombinant activated factor VII (rVIIa) and tranexamic acid (TXA). METHODS: Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, a subcommittee of the Practice Management Guidelines (PMG) Section of EAST conducted a systematic review using MEDLINE and EMBASE...
March 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28110840/use-of-fresh-frozen-plasma-from-the-2012-french-guidelines-to-recent-advances
#5
REVIEW
Samy Figueiredo, Dan Benhamou
Fresh frozen plasma (FFP) is widely used by anesthetists and/or intensivists managing bleeding patients. In this context, two clinical situations with different benefit/risk ratio for FFP transfusion should be distinguished: moderate or controlled hemorrhage on one side, and massive hemorrhage on the other. In the former situation, administration of FFP is most often ineffective, associated with potential side effects (pulmonary complications, product shortage) and should therefore be restricted. In case of massive hemorrhage, transfusion of FFP, red blood cells and platelets using a ratio close to 1:1:1 is recommended based on a large number of studies...
February 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/28077534/reduced-mortality-by-meeting-guideline-criteria-before-using-recombinant-activated-factor-vii-in-severe-trauma-patients-with-massive-bleeding
#6
J-F Payen, M Berthet, C Genty, P Declety, D Garrigue-Huet, N Morel, P Bouzat, B Riou, J-L Bosson
BACKGROUND: Management of trauma patients with severe bleeding has led to criteria before considering use of recombinant activated factor VII (rFVIIa), including haemoglobin >8 g dl(-1), serum fibrinogen ≥1.0 g l(-1), platelets >50,000 x 10(9) l(-1), arterial pH ≥ 7.20, and body temperature ≥34 °C. We hypothesized that meeting these criteria is associated with improved outcomes. METHODS: In this prospective cohort study of 26 French trauma centres, subjects were included if they received rFVIIa for persistent massive bleeding despite appropriate care after severe blunt and/or penetrating trauma...
October 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27808036/national-variation-in-transfusion-strategies-in-patients-with-upper-gastrointestinal-bleeding
#7
Kristin J Steinthorsdottir, Peter Svenningsen, Rasmus Fabricius, Jens Hillingsøe, Lars Bo Svendsen, Martin Sillesen
INTRODUCTION: An optimal transfusion strategy for patients with upper gastrointestinal bleeding (UGIB) has yet to be established. The national guidelines contain recommendations for patients with life-threating bleeding in general, but no specific recommendations for patients with UGIB. We hypothesised that there are variations in transfusion strategies for patients with UGIB across the Danish regions. METHODS: We performed a retrospective, register-based, analysis on transfusions given to all patients with non-variceal UGIB in Denmark in 2011-2013...
November 2016: Danish Medical Journal
https://www.readbyqxmd.com/read/27753568/compatibility-of-hydroxyethyl-starch-and-tranexamic-acid-for-battlefield-co-administration
#8
Nicholas M Studer, Ahmad H Yassin, Donald E Keen
INTRODUCTION: The current Tactical Combat Casualty Care Guidelines recommend tranexamic acid (TXA) administration for casualties in whom massive blood transfusion is anticipated. However, despite Hextend being the recommended resuscitation fluid, the guidelines recommend against using TXA with Hextend. This appears to be due to a concern about pharmaceutical compatibility, despite the absence of a direct study of compatibility in the literature. METHODS: Two solutions of Hextend and TXA were examined for compatibility...
October 2016: Military Medicine
https://www.readbyqxmd.com/read/27749352/massive-transfusion-protocols-a-survey-of-academic-medical-centers-in-the-united-states
#9
Angela B Treml, Jed B Gorlin, Richard P Dutton, Barbara M Scavone
BACKGROUND: Massive transfusion protocols (MTPs) have been adopted in many hospitals, and they may improve outcomes, as well as decrease the number of blood products transfused. However, there are no specific guidelines regarding the number and types of products that should be included in these protocols. MTPs may vary from hospital to hospital. METHODS: A short, web-based survey was sent to blood bank medical directors at academic institutions to learn details about MTPs...
January 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27716381/improving-outcomes-for-hospital-patients-with-critical-bleeding-requiring-massive-transfusion-the-australian-and-new-zealand-massive-transfusion-registry-study-methodology
#10
J C Oldroyd, K M Venardos, N J Aoki, A J Zatta, Z K McQuilten, L E Phillips, N Andrianopoulos, D J Cooper, P A Cameron, J P Isbister, E M Wood
BACKGROUND: The Australian and New Zealand (ANZ) Massive Transfusion (MT) Registry (MTR) has been established to improve the quality of care of patients with critical bleeding (CB) requiring MT (≥ 5 units red blood cells (RBC) over 4 h). The MTR is providing data to: (1) improve the evidence base for transfusion practice by systematically collecting data on transfusion practice and clinical outcomes; (2) monitor variations in practice and provide an opportunity for benchmarking, and feedback on practice/blood product use; (3) inform blood supply planning, inventory management and development of future clinical trials; and (4) measure and enhance translation of evidence into policy and patient blood management guidelines...
October 6, 2016: BMC Research Notes
https://www.readbyqxmd.com/read/27716278/a-systematic-review-on-the-rotational-thrombelastometry-rotem%C3%A2-values-for-the-diagnosis-of-coagulopathy-prediction-and-guidance-of-blood-transfusion-and-prediction-of-mortality-in-trauma-patients
#11
REVIEW
Precilla V Veigas, Jeannie Callum, Sandro Rizoli, Bartolomeu Nascimento, Luis Teodoro da Luz
INTRODUCTION: Viscoelastic assays have been promoted as an improvement over traditional coagulation tests in the management of trauma patients. Rotational thromboelastometry (ROTEM®) has been used to diagnose coagulopathy and guide hemostatic therapy in trauma. This systematic review of clinical studies in trauma investigates the ROTEM® parameters thresholds used for the diagnosing coagulopathy, predicting and guiding transfusion and predicting mortality. METHODS: Systematic literature search was performed using MEDLINE, EMBASE and Cochrane databases...
October 3, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27661423/infection-after-orthopaedic-trauma-prevention-and-treatment
#12
Heather C Yun, Clinton K Murray, Kenneth J Nelson, Michael J Bosse
Trauma to the extremities is disproportionately represented in casualties of recent conflicts, accounting for >50% of injuries sustained during operations in Iraq and Afghanistan. Infectious complications have been reported in >25% of those evacuated for trauma, and 50% of such patients were treated in the intensive care unit (ICU). Osteomyelitis has been reported in 9% (14% of intensive care unit patients), and deep-wound infection in 27% of type III open-tibia fractures. Infections complicating extremity trauma are frequently caused by multidrug-resistant bacteria and have been demonstrated to lead to failure of limb salvage, unplanned operative take-backs, late amputations, and decreased likelihood of returning to duty...
October 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27592155/major-obstetric-hemorrhage
#13
A Le Gouez, F J Mercier
Major obstetric hemorrhage is a challenge for anesthesiologists because it remains responsible for over 10% of maternal deaths in high-income countries. A standardized multidisciplinary management, described in locally validated protocols and based on international guidelines is mandatory to prevent these deaths. The first difficulty relies on the systematic underestimation of the bleeding. Collection bags must be used to facilitate the diagnosis and therefore rapid management. The etiologies in antenatal or postpartum must be well-known in order to be treated adequately...
November 2016: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
https://www.readbyqxmd.com/read/27566811/management-of-bleeding-in-vascular-surgery
#14
REVIEW
Y E Chee, S E Liu, M G Irwin
Management of acute coagulopathy and blood loss during major vascular procedures poses a significant haemostatic challenge to anaesthetists. The acute coagulopathy is multifactorial in origin with tissue injury and hypotension as the precipitating factors, followed by dilution, hypothermia, acidemia, hyperfibrinolysis and systemic inflammatory response, all acting as a self-perpetuating spiral of events. The problem is confounded by the high prevalence of antithrombotic agent use in these patients and intraoperative heparin administration...
September 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27389129/bundles-of-care-for-resuscitation-from-hemorrhagic-shock-and-severe-brain-injury-in-trauma-patients-translating-knowledge-into-practice
#15
Shahid Shafi, Ashley W Collinsworth, Kathleen M Richter, Hasan B Alam, Lance B Becker, Malcolm R Bullock, James M Ecklund, John Gallagher, Raj Gandhi, Elliott R Haut, Zachary L Hickman, Heidi Hotz, James McCarthy, Alex B Valadka, John Weigelt, John B Holcomb
No abstract text is available yet for this article.
October 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27340007/delayed-severe-abciximab-induced-thrombocytopenia-a-case-report
#16
Łukasz Piątek, Agnieszka Janion-Sadowska, Jacek Kurzawski, Urszula Grabowska, Marianna Janion
BACKGROUND: Thrombocytopenia is a possible side effect of routinely administered medical agents widely used in the management of patients with acute coronary syndromes (ACS). It is usually observed within 24 h after abciximab infusion. Differential diagnosis is challenging and the management controversial. METHODS: We present a case of abciximab-induced thrombocytopenia which occurred after a standard treatment. RESULTS: A 57-year-old male was admitted with ST-segment elevation ACS...
September 2016: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/27215884/pediatric-wartime-injuries-in-afghanistan-and-iraq-what-have-we-learned
#17
Xiaoming Shi, Mary J Edwards
The majority of the documented experience in pediatric trauma care during the past decade of conflict is from the inpatient Role 3 mission. Pediatric patients (defined as 14 years of age or less) accounted for 5% to 10% of combat admissions. Care for these patients was resource intensive and mortality rates significantly higher than those seen in pediatric hospitals in the United States. The largest documented experience to date with explosive injuries and massive transfusions in children were reported from this conflict...
April 2016: U.S. Army Medical Department Journal
https://www.readbyqxmd.com/read/27108468/massive-transfusion-protocol-a-local-two-years-experience
#18
M Tonglet, J M Minon, F Pitance, S Degesves
Evidence supporting the implementation of a Massive Transfusion Protocol (MTP) and its effect on patients' outcome is still limited. However, we implemented in June 2013 a local MTP for trauma and nontrauma massively bleeding patients. Twenty months later, we propose here a short presentation of our MTP population and a critical analysis of the actual data supporting MTP implementation.
2015: Acta Anaesthesiologica Belgica
https://www.readbyqxmd.com/read/27099820/systemic-and-topical-use-of-tranexamic-acid-in-spinal-surgery-a-systematic-review
#19
REVIEW
Sebastian F Winter, Carlo Santaguida, Jean Wong, Michael G Fehlings
Study Design Combination of narrative and systematic literature reviews. Objectives Massive perioperative blood loss in complex spinal surgery often requires blood transfusions and can negatively affect patient outcome. Systemic use of the antifibrinolytic agent tranexamic acid (TXA) has become widely used in the management of surgical bleeding. We review the clinical evidence for the use of intravenous TXA as a hemostatic agent in spinal surgery and discuss the emerging role for its complementary use as a topical agent to reduce perioperative blood loss from the surgical site...
May 2016: Global Spine Journal
https://www.readbyqxmd.com/read/27013812/an-audit-of-requests-for-fresh-frozen-plasma-in-a-tertiary-care-center-in-south-india
#20
Jyothi B Lingegowda, Joshua Daniel Jeyakumar, Prakash H Muddegowda, R Pitchai, Niranjan Gopal, Pammy Sinha
AIM: To audit the fresh frozen plasma (FFP) usage with an insight into various guidelines. MATERIALS AND METHODS: The blood bank records pertaining to FFP usage in patients admitted in our medical college hospital were retrospectively reviewed for 2 years for usage of FFP in various departments and evaluated for appropriateness of usage based on various guidelines, which included the 2013 guidelines published by the National Health and Medical Research Council and the Australasian Society for Blood Transfusion...
January 2016: Journal of Laboratory Physicians
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