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Hemorrhage and thrombosis

Nitin Agarwal, Georgios A Zenonos, Prateek Agarwal, Frank J Walch, Eileen Roach, Sandra J Stokes, Robert M Friedlander, Peter C Gerszten
BACKGROUND: Pharmacological prophylaxis for venous thromboembolism (VTE) in the neurosurgical population is still a matter of debate, as the risk-to-benefit ratio is not well defined. OBJECTIVE: To further evaluate the risk-to-benefit ratio of VTE prophylaxis (VTEP) for all neurosurgical procedures. METHODS: A prospective evaluation was performed after the initiation of a VTEP protocol for 11 436 patients undergoing neurosurgical procedures over 24 mo...
March 9, 2018: Neurosurgery
Atsushi Aikawa, Masaki Muramatsu, Yusuke Takahashi, Yuko Hamasaki, Junya Hashimoto, Mai Kubota, Takeshi Kawamura, Yoshihiro Itabashi, Yoiji Hyodou, Seiichiro Shishido
During pediatric kidney transplant, surgical challenges occasionally occur. In particular, vascular anastomosis should be considered for children with small body weight < 12 kg, multiple renal arteries, vascular anomaly, and inferior vena cava occlusion. In pediatric patients, a living-donor renal graft is usually donated from a parent. Therefore, the renal artery and vein are too large to be anastomosed with the recipient's internal iliac artery and external iliac vein. In children who are > 12 kg, the renal artery and vein could be anastomosed with the external iliac artery and the external iliac vein...
March 2018: Experimental and Clinical Transplantation
Kazuhiro Toyama, Atsushi Yasumoto, Fumihiko Nakamura, Shunya Arai, Mineo Kurokawa
Acquired hemophilia A (AHA) is a hemorrhagic disorder. Whether or not severe thrombotic events can develop without the use of bypassing agents in AHA patients is unclear. An 80-year-old woman with AHA underwent immunosuppressive therapy with prednisolone at 1 mg/kg daily. After achieving remission, she suddenly developed multiple organ failure due to acute systemic thrombosis and died within a few hours of the diagnosis. Patients with AHA, especially those with risk factors for thrombosis, have a considerable risk of developing thrombosis during the recovery phase of factor VIII activity and should be carefully monitored by coagulation testing...
March 9, 2018: Internal Medicine
Roberta Rossini, Giuseppe Tarantini, Giuseppe Musumeci, Giulia Masiero, Emanuele Barbato, Paolo Calabrò, Davide Capodanno, Sergio Leonardi, Maddalena Lettino, Ugo Limbruno, Alberto Menozzi, U O Alfredo Marchese, Francesco Saia, Marco Valgimigli, Walter Ageno, Anna Falanga, Antonio Corcione, Alessandro Locatelli, Marco Montorsi, Diego Piazza, Andrea Stella, Antonio Bozzani, Alessandro Parolari, Roberto Carone, Dominick J Angiolillo
Perioperative management of antithrombotic therapy in patients treated with coronary stents undergoing surgery remains poorly defined. Importantly, surgery represents a common reason for premature treatment discontinuation, which is associated with an increased risk in mortality and major adverse cardiac events. However, maintaining antithrombotic therapy to minimize the incidence of perioperative ischemic complications may increase the risk of bleeding complications. Although guidelines provide some recommendations with respect to the perioperative management of antithrombotic therapy, these have been largely developed according to the thrombotic risk of the patient and a definition of the hemorrhagic risk specific to each surgical procedure, key to defining the trade-off between ischemia and bleeding, is not provided...
March 12, 2018: JACC. Cardiovascular Interventions
Chao He, Xiaojuan Liu, Wei Peng, Chuan Li, Tian-Fu Wen
BACKGROUND: Simultaneous splenectomy during liver transplantation (LT) is debated. The present meta-analysis assessed the efficacy and safety of splenectomy on the outcome of LT patients. METHODS: We searched PubMed, Embase, and Wanfang databases for relevant studies published until the date of July 15, 2017. Quality assessment of the included studies was performed using a modified Newcastle-Ottawa Scale judgment. The data were analyzed using RevMan5.3 software...
March 2018: Medicine (Baltimore)
Zhong-Wu Chen, Zheng-Yu Lin, Yi-Ping Chen, Jian Chen, Jin Chen
Objective: The objective of this study is to investigate the clinical efficacy and safety of Habib™ VesOpen, a new intravascular radiofrequency ablation (RFA) catheter in percutaneous puncture of portal vein tumor thrombus (PVTT) in patients with primary hepatocellular carcinoma. Materials and Methods: Collected data of patients with primary hepatocellular carcinoma with portal vein trunk or main branch who were treated by the RFA of portal vein tumor ablation with Habib™ VesOpen, a new intravascular RFA catheter...
January 2018: Journal of Cancer Research and Therapeutics
Takashi Ishihara, Keiji Nogami, Yasufumi Takeshita, Satoshi Ochi, Midori Shima
Thrombosis and hemorrhage are serious complications in pediatric patients with solid tumors, and enhanced fibrinolysis associated with disseminated intravascular coagulation (DIC) is often observed. Fibrinolytic enzymes also play an important role in metastasis. Limited information is available, however, on the assessment of overall hemostatic function in children with malignant solid tumors. Methods We have investigated comprehensive hemostatic potential in these circumstances using simultaneous thrombin/plasmin generation assay (T/P-GA)...
March 5, 2018: Pediatrics International: Official Journal of the Japan Pediatric Society
Muhammad T Khan, Asad Ikram, Omar Saeed, Taha Afridi, Cathy A Sila, Matthew S Smith, Khadija Irshad, Ashfaq Shuaib
We present a systemic review of available literature on the complications of deep venous thrombosis that develops in patients presenting with acute stroke. There are several pharmacological and physical treatment options available and used. We aim to summarize the management plans currently used at different centers. In conclusion, low-dose anticoagulant therapy for ischemic stroke is recommended. In the case of intracerebral hemorrhage, pneumatic sequential compression devices should be placed initially, followed by the administration of ultra-fractioned heparin on the next day, and then oral anticoagulant therapy to replace the heparin after a week in high-risk patients...
December 23, 2017: Curēus
Fumihiko Nagano, Tomohiro Mizuno, Shuji Mizumoto, Kengo Yoshioka, Kazuo Takahashi, Naotake Tsuboi, Shoichi Maruyama, Shuhei Yamada, Tadashi Nagamatsu
Extracellular histones induce lethal thrombosis by promoting platelet aggregation, neutrophil migration, and cell injuries. Heparin, which has negative charges, can bind to extracellular histones; however, heparin strongly inhibits the activation of coagulation. Since chondroitin sulfate (CS) shows less effect on the coagulation system than heparin does, CS has the potential to become an effective drug for lethal thrombosis with high risk of bleeding. To elucidate the therapeutic mechanisms of CS in lethal thrombosis, we investigated the interaction between CS and extracellular histones...
February 28, 2018: European Journal of Pharmacology
Zeynep Dadaci, Cengiz Kadiyoran, Mustafa Golen, Hilal Akay Cizmecioglu
The authors report a 35-year-old woman who presented 1 month after delivery with the complaint of pain behind her left eye which started during her pregnancy. The patient described increased fullness with dependent head position and pain on left gaze but she had no proptosis and her ocular examination was normal. Magnetic resonance imaging (MRI) revealed an intraconal mass with inhomogeneous contrast enhancement. As the authors did not suspect malignity and her ocular examination was normal without any signs of inflammation, the authors followed the patient closely...
February 26, 2018: Journal of Craniofacial Surgery
Evan Tsiklidis, Carrie Sims, Talid Sinno, Scott L Diamond
Trauma with hypovolemic shock is an extreme pathological state that challenges the body to maintain blood pressure and oxygenation in the face of hemorrhagic blood loss. In conjunction with surgical actions and transfusion therapy, survival requires the patient's blood to maintain hemostasis to stop bleeding. The physics of the problem are multiscale: (a) the systemic circulation sets the global blood pressure in response to blood loss and resuscitation therapy, (b) local tissue perfusion is altered by localized vasoregulatory mechanisms and bleeding, and (c) altered blood and vessel biology resulting from the trauma as well as local hemodynamics control the assembly of clotting components at the site of injury...
February 27, 2018: Wiley Interdisciplinary Reviews. Systems Biology and Medicine
Adnan I Qureshi, Mikayel Grigoryan, Muhammad A Saleem, Emrah Aytac, Shawn S Wallery, Gustavo J Rodriguez, Muhammad F K Suri
BACKGROUND AND PURPOSE: To determine the effectiveness of prolonged microcatheter-based local thrombolytic infusion in treatment of patients with cerebral venous thrombosis who achieved no or suboptimal recanalization with transvenous endovascular treatment. METHODS: Data collection: Prospectively registries supplemented by retrospective review. SETTINGS: Three hospitals with tertiary referral base. PATIENTS: Patients who underwent transvenous endovascular treatment for cerebral venous thrombosis...
February 26, 2018: Neurocritical Care
Jonel Trebicka
Does transjugular intrahepatic portosystemic shunt stent (TIPS) improve survival in a subgroup of patients? Yes. TIPS nearly halves portal pressure and increases the effective blood volume. In cases of acute variceal hemorrhage and with a high risk of treatment failure, defined as either hepatic venous pressure gradient higher than 20 mm Hg, Child B with active bleeding at the endoscopy, or Child C with less than 14 points, early or preemptive placement of TIPS (within 72 hours) improves survival. Also, in suitable patients with intractable or refractory ascites, TIPS improves survival if placed early in the course of treatment...
February 2018: Seminars in Liver Disease
Ranit Hizkiyahu, Anat Rabinovich, Jecko Thachil, Eyal Sheiner, Gad Shaked, Gilbert Sebbag, Eli Maymon, Offer Erez
OBJECTIVES: Liver rupture and hematoma are rare life-threatening complications of pregnancy. The aims of the current study are to: (1) characterize in a population-based study all cases of liver hematoma and/or rupture; and (2) validate the utility of the International Society on Thrombosis and Haemostasis (ISTH) modified pregnancy specific disseminated intravascular coagulation (DIC) score in those cases. STUDY DESIGN: A retrospective cohort study including all patients with liver subcapsular hematoma or rupture between the years 1996 and 2012 was conducted...
February 21, 2018: Journal of Maternal-fetal & Neonatal Medicine
Gang-Qin Xu, Bu-Lang Gao, Zi-Liang Wang, Wei-Xing Bai, Jiang-Yu Xue, Liang-Fu Zhu, Tian-Xiao Li
PURPOSE: To investigate characteristics of the posterior cerebral artery anterior temporal branch (ATB) aneurysm and the safety and efficacy of endovascular management. MATERIALS AND METHODS: A total of six patients with ATB aneurysms were enrolled. All six patients had concurrent occlusion of the ipsilateral anterior circulating arteries. The aneurysms ranged 2.5-5.0 mm. All patients were treated and followed up. RESULTS: Four unruptured aneurysms were treated with coil embolization of the aneurysm sac only, with the parent artery maintained in two patients, slow flow in the parent artery in one and thrombosis at the aneurysm neck leading to parent artery occlusion in the last one...
February 17, 2018: World Neurosurgery
Erik N Sorensen, Hannah J Voorhees, Lynn M Dees, Si M Pham, Zachary N Kon, Bartley P Griffith, Erika D Feller
There are no evidence-based guidelines for antithrombotic therapy in left ventricular assist device patients. We evaluated the efficacy of a multi-agent, test-guided protocol, which remained consistent throughout our use of the Heartware HVAD. Thrombelastography and PFA-100 guide antiplatelet titration. Goals are normal kaolin thrombelastography maximum amplitude and prolonged PFA-100. We analyzed incidence and rates of nonprocedural bleeding, stroke, and pump thrombosis for all 81 primary Heartware left ventricular assist devices implanted since 2011...
February 15, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Daniel Dubinski, Sae-Yeon Won, Bedjan Behmanesh, Sepide Kashefiolasl, Christof Geisen, Volker Seifert, Christian Senft, Juergen Konczalla
BACKGROUND: In patients with non-aneurysmal subarachnoid hemorrhage (NA-SAH), the etiology is unknown and the bleeding source remains unidentified. However, the ABO blood type system has a profound role in patient's hemostasis and thrombosis. To date, the aspect of ABO blood type in incidence, clinical course, and outcome after NA-SAH has not been investigated. METHODS: In this retrospective analysis, 81 patients with non-traumatic and non-aneurysmal subarachnoid hemorrhage treated between 2010 and 2014 at the author's institution were included...
February 17, 2018: Acta Neurochirurgica
Azra Zafar, Majed Alabdali, Rizwana Shahid, Danah Aljaafari, Fahd A Al-Khamis, Aishah I Albakr, Saima Nazish, Abdulla A Al-Sulaiman, Alon Abraham
OBJECTIVE: To assess the burden and describe the pattern of neurological disorders requiring admissions in a teaching hospital of Al Khobar. METHODS: This is a retrospective, cross sectional study, carried out in the Neurology Department of King Fahd Hospital of the University from January 2009 to December 2016. Neurological disorders were grouped as ischemic stroke, intracerebral hemorrhage, transient ischemic attack, cerebral venous sinus thrombosis, seizure disorders, central nervous system infection, multiple sclerosis, neuropathies, myopathies, headache, dementia and miscellaneous group...
January 2018: Neurosciences: the Official Journal of the Pan Arab Union of Neurological Sciences
Adelina-Mihaela Sorescu, Tudor Enache, Suzana Guberna
Background and aims: Few studies discuss the prevalence of oral anticoagulation therapy (OAT) in clinical practice, despite their increasing use worldwide. In America, studies established that 20% to 80% of the patients with indication benefit from OAT. In Romania, there is no data regarding the utilization of oral anticoagulants. Thus, this study aims to determine the trends of OAT. Methods: We designed a cross-sectional study of the patients admitted to the Cardiology Department of the "Bagdasar-Arseni" Clinical Emergency Hospital, Bucharest, from the 1st of November 2016 until the 31st of January 2017...
2018: Clujul Medical (1957)
Chancey Carothers, Amanda Giancarelli, Joseph Ibrahim, Brandon Hobbs
BACKGROUND: Patients with traumatic intracranial hemorrhage (TIH) anticoagulated with warfarin are at an increased risk of mortality. Fresh frozen plasma (FFP) and vitamin K have been the standard treatment for warfarin reversal; however, guidelines now recommend the use of prothrombin complex concentrate (PCC) for warfarin reversal in patients with life-threatening bleeding. Our protocol uses one vial (∼1000 units) of activated PCC (aPCC) for warfarin reversal, regardless of the weight or presenting international normalized ratio (INR)...
March 2018: Journal of Surgical Research
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