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low trauma anticoagulation

Benilde Cosmi
Idiopathic or unprovoked venous thromboembolism is an event occurring in the absence of any apparent provoking or triggering environmental risk factors, such as surgery, trauma, and immobilization. Areas covered: Unprovoked VTE can be associated with occult cancer, but only limited, and not extensive cancer screening, may be warranted, as the rate of occult cancer is low in such patients. Routine thrombophilia testing is not currently recommended as it does not influence the management of the disease. The duration of anticoagulation for unprovoked VTE after the first three months is still debated as the disease tends to recur regardless of treatment duration...
October 14, 2016: Expert Review of Cardiovascular Therapy
Juan Antonio Llompart-Pou, Mario Chico-Fernández, Marcelino Sánchez-Casado, Fermín Alberdi-Odriozola, Francisco Guerrero-López, María Dolores Mayor-García, Javier González-Robledo, María Ángeles Ballesteros-Sanz, Rubén Herrán-Monge, Rafael León-López, Lucía López-Amor, Ana Bueno-González
BACKGROUND: Injury patterns may differ in trauma patients when age is considered. This information is relevant in the management of trauma patients and for planning preventive measures. METHODS: We included in the study all patients admitted for traumatic disease in the participating ICUs from November 23(rd), 2012 to July 31(st), 2015 with complete records. Data on epidemiology, injury patterns, severity scores, acute management, resources utilisation and outcome were recorded and compared in the following groups of age: ≤55years (young adults), 56-65 years (adults), 66-75 years (elderly), >75years (very elderly)...
September 2016: Injury
D Brilej, D Stropnik, R Lefering, R Komadina
BACKGROUND: Early recognition and management of trauma related coagulopathy improves the outcome. Trauma facilities should implement an algorithm to identify the bleeding trauma patient with coagulopathy. OBJECTIVE: The scope of the paper is to identify the indicators of early coagulopathy and to optimize the indications for thromboelastometry and coagulation support. DESIGN: Cohort study based on data from trauma registry. SETTING: Data of 493 major trauma patients treated in GH Celje from 2006 to 2014 were included into The TraumaRegister DGU(®) (TR-DGU)...
September 22, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Marc Maegele, Oliver Grottke, Herbert Schöchl, Oliver A Sakowitz, Michael Spannagl, Jürgen Koscielny
BACKGROUND: Direct (non-vitamin-K-dependent) oral anticoagulants (DOAC) are given as an alternative to vitamin K antagonists (VKA) to prevent stroke and embolic disease in patients with atrial fibrillation that is not due to pathology of the heart valves. Fatal hemorrhage is rarer when DOACs are given (nonvalvular atrial fibrillation: odds ratio [OR] 0.68; 95% confidence interval [95% CI: 0.48; 0.96], and venous thromboembolism: OR 0.54; [0.22; 1.32]). 48% of emergency trauma patients need an emergency operation or early surgery...
September 5, 2016: Deutsches Ärzteblatt International
Jennifer J Robertson, Alex Koyfman
BACKGROUND: Cervical artery dissection (CeAD) is an infrequent, yet potentially devastating, cause of stroke. While uncommon, CeAD is important for emergency physicians to quickly diagnose and treat because of the potential for cerebral ischemia, stroke, blindness, or death. To our knowledge, no review articles in the emergency medicine literature have been published on CeAD. A literature search of MEDLINE/PubMed, Embase, and other major abstracts in the English language was performed for the following terms: cervical artery, vertebral artery, and carotid artery dissection...
September 12, 2016: Journal of Emergency Medicine
Stavros K Kakkos, Joseph A Caprini, George Geroulakos, Andrew N Nicolaides, Gerard Stansby, Daniel J Reddy, Ioannis Ntouvas
BACKGROUND: It is generally assumed by practitioners and guideline authors that combined modalities (methods of treatment) are more effective than single modalities in preventing venous thromboembolism (VTE), defined as deep vein thrombosis (DVT) or pulmonary embolism (PE), or both. This is an update of the review first published in 2008. OBJECTIVES: The aim of this review was to assess the efficacy of combined intermittent pneumatic leg compression (IPC) and pharmacological prophylaxis versus single modalities in preventing venous thromboembolism...
September 7, 2016: Cochrane Database of Systematic Reviews
Albrecht Encke, Sylvia Haas, Ina Kopp
BACKGROUND: Venous thromboembolism (VTE) is the third most common cardiovascular condition, after myocardial infarction and stroke. Prophylactic measures in accordance with current guidelines can significantly reduce the risk of VTE and the associated morbidity and mortality. Until now, the German interdisciplinary, evidence- and consensus-based (S3) clinical practice guideline on VTE prophylaxis was based on a complete review of all pertinent literature available in MEDLINE up to January 2008...
August 8, 2016: Deutsches Ärzteblatt International
A König-Leischnig, J Klewer, B Karich, K Richter
BACKGROUND/AIMS: Proximal femoral fractures are one of the most frequently occurring injuries among elderly people. High rates of inpatient treatment indicate the importance of optimized clinical care. OBJECTIVES: Based on selected outcome parameters in elderly trauma patients with proximal femoral fractures, the current situation of medical care in a trauma center for geriatric patients is presented. METHODS: For a descriptive evaluation of outcome parameters, 250 patients aged 70 years and older have been included...
July 1, 2016: Der Unfallchirurg
Ryley Enz, Robert S Anderson
BACKGROUND: Infants are at risk for vitamin K deficiency bleeding (VKDB) because of limited stores of vitamin K (VK) at birth and a low concentration of VK in human breast milk. Therefore, the administration of intramuscular (IM) VK at birth has been recommended since 1961 in the United States. Infants who do not receive IM VK and who are exclusively breast-fed are at increased risk for VKDB. While VKDB is rare, a common presentation of late onset VKDB is intracranial hemorrhage. CASE REPORT: We report the case of a 4-week-old infant who presented to the emergency department with lethargy and a grossly dilated right pupil...
August 2016: Journal of Emergency Medicine
R Buzelé, L Barbier, A Sauvanet, B Fantin
Splenectomy is attended by medical complications, principally infectious and thromboembolic; the frequency of complications varies with the conditions that led to splenectomy (hematologic splenectomy, trauma, presence of portal hypertension). Most infectious complications are caused by encapsulated bacteria (Meningococcus, Pneumococcus, Hemophilus). These occur mainly in children and somewhat less commonly in adults within the first two years following splenectomy. Post-splenectomy infections are potentially severe with overwhelming post-splenectomy infection (OPSI) and this justifies preventive measures (prophylactic antibiotics, appropriate immunizations, patient education) and demands prompt antibiotic management with third-generation cephalosporins for any post-splenectomy fever...
August 2016: Journal of Visceral Surgery
Daichi Shikata, Hiroshi Nakagomi, Atsushi Takano, Takahiro Nakagomi, Hideki Watanabe, Masahiro Maruyama, Haruka Nakada, Atsushi Yamamoto, Kazushige Furuya, Masao Hada, Yoshiaki Miyasaka, Masao Omata, Toshio Oyama
INTRODUCTION: A spontaneous mesenteric hematoma is a rare condition. Furthermore, it is extremely rare that the mesenteric hematoma caused gastrointestinal bleeding with an unknown etiology. We experienced a case with a spontaneous mesenteric hematoma that ruptured into the jejunum. PRESENTATION OF CASE: A 75-year-old man was referred to our hospital because of anal bleeding and anemia. Abdominal computed tomography (CT) showed a low density mass measuring 3.0cm in diameter, including an enhanced spot...
2016: International Journal of Surgery Case Reports
Amr F Barakat, Ayman A Hussein, Walid I Saliba, Mohammed Bassiouny, Khaldoun Tarakji, Mohamed Kanj, Wael Jaber, L Leonardo Rodriguez, Richard Grimm, M Shazam Hussain, Andrew Russman, Ken Uchino, Dolora Wisco, Peter Rasmussen, Mark Bain, John Vargo, Gregory Zuccaro, David Gottesman, Bruce D Lindsay, Oussama M Wazni
BACKGROUND: The implantation of left atrial appendage closure device (WATCHMAN, Boston Scientific, Natick, MA) is an alternative option to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation. Patients require short-term OAC after implantation to avoid device thrombosis. The 2 clinical trials that assessed this device excluded patients thought not to be candidates for OAC. As such, little is known about the safety of this strategy in patients with previous major bleeding events...
June 2016: Circulation. Arrhythmia and Electrophysiology
Dhanesh R Kamerkar, M Joseph John, Sanjay C Desai, Liesel C Dsilva, Sadhna J Joglekar
BACKGROUND AND AIM: There is lack of substantial Indian data on venous thromboembolism (VTE). The aim of this study was to provide real-world information on patient characteristics, management strategies, clinical outcomes, and temporal trends in VTE. SUBJECTS AND METHODS: Multicentre retrospective registry involving 549 medical records of patients with confirmed diagnosis of VTE (deep vein thrombosis [DVT] confirmed by Doppler ultrasonography; pulmonary embolism [PE] by computed tomography, pulmonary angiography and/or V/Q scan) from 2006 to 2010 at three Indian tertiary care hospitals...
March 2016: Indian Journal of Critical Care Medicine
Nilay N Suthar, Khushali L Patel, Chirag Saparia, Ami P Parikh
BACKGROUND: Incidence of intracerebral hemorrhage (ICH) is twice as high as in Western countries. Prognostic factors for predicting function outcome and mortality play a major role in determining the treatment outcome. METHODS: A prospective study of male and female patients ≥12 years with primary nontraumatic intracranial hemorrhage were included. Hemorrhage caused by trauma, anticoagulant or thrombolytic drugs, brain tumor, saccular arterial aneurysm or vascular malformation were excluded...
April 2016: Annals of African Medicine
Robin Paudel, Luis W Dominguez, Prerna Dogra, Saurav Suman, Simon Badin, Carrie Wasserman
BACKGROUND: Acquired hemophilia A (AHA) classically presents with spontaneous bleeding of mucosal sites, GI tract, and subcutaneous tissues, often leading to large hematomas and ecchymosis. Among documented cases, 50% are idiopathic and few have been associated with trauma or surgery. We present a case of life-threatening bleeding caused by AHA, following trauma and complicated by multiple venous thrombi. CASE REPORT: A 21-year-old man presented with multiple injuries secondary to trauma leading to extensive life-saving surgery...
2016: American Journal of Case Reports
Pernille J Vinholt, Anne Alnor, Mads Nybo, Anne-Mette Hvas
Studies on markers for bleeding risk among thrombocytopenic cancer patients are lacking. This prospective observational cohort study investigated whether platelet parameters and a standardised bleeding questionnaire predicted bleeding or prophylactic platelet transfusions in patients with cancer and thrombocytopenia. Admitted adult patients with cancer and platelet count <80 × 10(9)/L were enrolled, but excluded if they experienced surgery or trauma within 7 days or platelet transfusion within 14 days. Patients were interviewed, blood samples collected and, subsequently, spontaneous bleeding and prophylactic platelet transfusion within 30 days were registered...
September 2016: Platelets
Charles P Shahan, Louis J Magnotti, Shaun M Stickley, Jordan A Weinberg, Leah E Hendrick, Rebecca A Uhlmann, Thomas J Schroeppel, Daniel A Hoit, Martin A Croce, Timothy C Fabian
BACKGROUND: Few injuries have produced as much debate with respect to management as have blunt cerebrovascular injuries (BCVIs). Recent work (American Association for the Surgery of Trauma 2013) from our institution suggested that 64-channel multidetector computed tomographic angiography (CTA) could be the primary screening tool for BCVI. Consequently, our screening algorithm changed from digital subtraction angiography (DSA) to CTA, with DSA reserved for definitive diagnosis of BCVI following CTA-positive study results or unexplained neurologic findings...
June 2016: Journal of Trauma and Acute Care Surgery
Kiyoharu Shimizu, Kiyoshi Yuki, Takashi Sadatomo, Takeshi Hara, Hideo Ohba, Kaoru Kurisu
The risk of anticoagulant-associated intracranial hemorrhage(ICH)is relatively low in patients treated with non-vitamin K antagonist oral anticoagulants(NOAC). The anticoagulant-associated ICH comprises mainly intraparenchimal hemorrhage. Subdural hematoma and subarachnoid hemorrhage(SAH)are rare complications after treatment with NOAC, trauma being the most common cause for these two types of ICH. We report a case of non-traumatic convexal SAH(cSAH)associated with Apixavan. A 68-year-old man with repeated history of cerebral embolism with cardiogenic cause presented with weakness of the lower limbs...
March 2016: No Shinkei Geka. Neurological Surgery
Paul Albertine, Samuel Borofsky, Derek Brown, Smita Patel, Woojin Lee, Anthony Caputy, M Reza Taheri
With advancing technology, the sensitivity of computed tomography (CT) for the detection of traumatic subarachnoid hemorrhage (tSAH) continues to improve. Increased resolution has allowed for the detection of hemorrhage that is limited to one or two images of the CT exam. At our institution, all patients with a SAH require intensive care unit (ICU) admission, regardless of size. It was our hypothesis that patients with small subarachnoid hemorrhage experience favorable outcomes, and may not require the intensive monitoring offered in the ICU...
June 2016: Emergency Radiology
Mikkel Allingstrup, Jørn Wetterslev, Frederikke B Ravn, Ann Merete Møller, Arash Afshari
BACKGROUND: Critical illness is associated with uncontrolled inflammation and vascular damage which can result in multiple organ failure and death. Antithrombin III (AT III) is an anticoagulant with anti-inflammatory properties but the efficacy and any harmful effects of AT III supplementation in critically ill patients are unknown. This review was published in 2008 and updated in 2015. OBJECTIVES: To examine:1. The effect of AT III on mortality in critically ill participants...
February 8, 2016: Cochrane Database of Systematic Reviews
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