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The Cochrane Database of Systematic... Mar 2018Post-extraction bleeding (PEB) is a recognised, frequently encountered complication in dental practice, which is defined as bleeding that continues beyond 8 to 12 hours... (Review)
Review
BACKGROUND
Post-extraction bleeding (PEB) is a recognised, frequently encountered complication in dental practice, which is defined as bleeding that continues beyond 8 to 12 hours after dental extraction. The incidence of post-extraction bleeding varies from 0% to 26%. If post-extraction bleeding is not managed, complications can range from soft tissue haematomas to severe blood loss. Local causes of bleeding include soft tissue and bone bleeding. Systemic causes include platelet problems, coagulation disorders or excessive fibrinolysis, and inherited or acquired problems (medication induced). There is a wide array of techniques suggested for the treatment of post-extraction bleeding, which include interventions aimed at both local and systemic causes. This is an update of a review published in June 2016.
OBJECTIVES
To assess the effects of interventions for treating different types of post-extraction bleeding.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 24 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 12), MEDLINE Ovid (1946 to 24 January 2018), Embase Ovid (1 May 2015 to 24 January 2018) and CINAHL EBSCO (1937 to 24 January 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. We searched the reference lists of relevant systematic reviews.
SELECTION CRITERIA
We considered randomised controlled trials (RCTs) that evaluated any intervention for treating PEB, with male or female participants of any age, regardless of type of teeth (anterior or posterior, mandibular or maxillary). Trials could compare one type of intervention with another, with placebo, or with no treatment.
DATA COLLECTION AND ANALYSIS
Three pairs of review authors independently screened search records. We obtained full papers for potentially relevant trials. If data had been extracted, we would have followed the methods described in the Cochrane Handbook for Systematic Reviews of Interventions for the statistical analysis.
MAIN RESULTS
We did not find any randomised controlled trial suitable for inclusion in this review.
AUTHORS' CONCLUSIONS
We were unable to identify any reports of randomised controlled trials that evaluated the effects of different interventions for the treatment of post-extraction bleeding. In view of the lack of reliable evidence on this topic, clinicians must use their clinical experience to determine the most appropriate means of treating this condition, depending on patient-related factors. There is a need for well designed and appropriately conducted clinical trials on this topic, which conform to the CONSORT statement (www.consort-statement.org/).
Topics: Female; Humans; Male; Oral Hemorrhage; Postoperative Hemorrhage; Tooth Extraction
PubMed: 29502332
DOI: 10.1002/14651858.CD011930.pub3 -
Emergency Medicine Clinics of North... May 2018Post-tonsillectomy hemorrhage represents a potentially life-threatening condition that occurs in up to 5% of pediatric patients. Minor bleeding often precedes severe... (Review)
Review
Post-tonsillectomy hemorrhage represents a potentially life-threatening condition that occurs in up to 5% of pediatric patients. Minor bleeding often precedes severe hemorrhage. Patients with minor or self-resolving bleeding should be observed in the emergency department or admitted for monitoring. Patients with severe bleeding should be immediately assessed for airway and hemodynamic stability. Management of severe bleeding includes immediate surgical consultation or initiation of the transfer process to a center with surgical capabilities, direct pressure to the site of hemorrhage with or without the additional of a hemostatic agent, possible rapid sequence intubation, and management of hemodynamic instability with volume resuscitation.
Topics: Child; Humans; Pain Management; Pediatrics; Postoperative Hemorrhage; Risk Factors; Tonsillectomy
PubMed: 29622331
DOI: 10.1016/j.emc.2017.12.009 -
Khirurgiia 2021Surgical treatment of pancreatic diseases is always associated with a large number of complications. Postoperative hemorrhage is a specific complication of pancreatic...
Surgical treatment of pancreatic diseases is always associated with a large number of complications. Postoperative hemorrhage is a specific complication of pancreatic surgery requiring a clear classification and surgical strategy. According to literature data, postoperative hemorrhage occurs in 3-30% of cases. Incidence of hemorrhages depends on intraoperative, anamnestic, histological and postoperative factors. Early postoperative hemorrhage (within 24 hours after surgery) is usually a consequence of technical errors in intraoperative hemostasis, perioperative coagulation disorders. The mechanism of delayed bleeding is more complex and often associated with various arrosive factors: pancreatic fistula, biliary fistula, abscess. Currently, there is no a single treatment algorithm for patients with postpancreatectomy hemorrhage. According to various researchers, contrast-enhanced CT is preferred for diagnosis. In recent years, the role of endovascular hemostasis has significantly increased. This problem requires further study and development of a single treatment and diagnostic algorithm that will reduce mortality in these patients.
Topics: Humans; Incidence; Pancreatectomy; Pancreatic Diseases; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Hemorrhage
PubMed: 33395516
DOI: 10.17116/hirurgia202101177 -
Journal of Cardiac Surgery Nov 2019
Topics: Aged; Anemia; Blood Loss, Surgical; Cardiac Surgical Procedures; Erythrocyte Transfusion; Female; Humans; Male; Postoperative Hemorrhage
PubMed: 31441554
DOI: 10.1111/jocs.14221 -
Otolaryngologic Clinics of North America Jun 2016Tonsillectomy is a commonly performed procedure with an accepted risk of posttonsillectomy hemorrhage (PTH) approaching 5%, but catastrophic effects of hemorrhage are... (Review)
Review
Tonsillectomy is a commonly performed procedure with an accepted risk of posttonsillectomy hemorrhage (PTH) approaching 5%, but catastrophic effects of hemorrhage are exceedingly rare. A variety of surgical techniques and hemostatic agents have been used to reduce the rate of hemorrhage, although none eliminate the risk. Numerous patient, surgical, and postoperative care factors have been studied for an association with PTH. The most consistent risk factors for PTH seem to be patient age and coagulopathies. Surgeon skill and surgical technique are most consistently associated with primary PTH.
Topics: Blood Coagulation Disorders; Clinical Competence; Hemostasis, Surgical; Hemostatic Techniques; Hemostatics; Humans; Postoperative Care; Postoperative Hemorrhage; Risk Factors; Tonsillectomy
PubMed: 27267014
DOI: 10.1016/j.otc.2016.03.008 -
Otolaryngologic Clinics of North America Jun 2016Hemostasis is an important concept in pediatric otolaryngologic surgery. This article details the considerations the otolaryngologist should take when it comes to... (Review)
Review
Hemostasis is an important concept in pediatric otolaryngologic surgery. This article details the considerations the otolaryngologist should take when it comes to clinical evaluation and surgical technique. It begins with the preoperative evaluation, and evolves into the use of different mechanical and chemical methods of operative hemostasis. We detail use of different hemostatic techniques in common pediatric procedures, and finally, we discuss indications for intraoperative and postoperative blood transfusion in pediatric patients if the surgeon encounters significant intraoperative hemorrhage. This paper gives a comprehensive look into the hemostatic considerations for the pediatric patient through the preoperative to postoperative period.
Topics: Blood Loss, Surgical; Blood Transfusion; Child; Hemostasis, Surgical; Hemostatic Techniques; Hemostatics; Humans; Postoperative Hemorrhage; Tonsillectomy
PubMed: 27267013
DOI: 10.1016/j.otc.2016.03.007 -
Diagnostic and Interventional Imaging 2015Postoperative bleeding following abdominal surgery is relatively rare and mainly depends on the type of surgery. Although bleeding is usually controlled by simple local... (Review)
Review
Postoperative bleeding following abdominal surgery is relatively rare and mainly depends on the type of surgery. Although bleeding is usually controlled by simple local treatment of symptoms, specific treatment including surgery or interventional radiology is sometimes necessary. This article reviews the clinical features that must be recognized depending on the type of surgery and especially focuses on the role of the radiologist in the management of this complication.
Topics: Abdomen; Contrast Media; Cooperative Behavior; Extravasation of Diagnostic and Therapeutic Materials; Hemoperitoneum; Hepatectomy; Humans; Interdisciplinary Communication; Multidetector Computed Tomography; Pancreatectomy; Postoperative Hemorrhage; Risk Factors
PubMed: 26078019
DOI: 10.1016/j.diii.2015.03.013 -
Nature Reviews. Cardiology May 2019Paravalvular leak (PVL) is a complication that occurs in 5-17% of patients after surgical prosthetic valve implantation. Whereas PVLs can be benign, some PVLs are... (Review)
Review
Paravalvular leak (PVL) is a complication that occurs in 5-17% of patients after surgical prosthetic valve implantation. Whereas PVLs can be benign, some PVLs are associated with substantial morbidity and mortality. Percutaneous closure using occluders specifically designed to improve closure and reduce procedural complications has now become the first-line treatment for PVL. In this Review, we first detail the frequency and clinical consequences of PVL closure. The role of cardiac imaging in the assessment and management of PVL, including echocardiographic imaging and adjunctive techniques such as CT, is then discussed, together with important considerations for the percutaneous closure of PVL, such as access site and device selection. Finally, we summarize the clinical evidence for percutaneous closure of PVL, including large national registries from Ireland, Spain and the UK, as well as head-to-head data comparing this procedure with surgical closure.
Topics: Comparative Effectiveness Research; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Postoperative Hemorrhage; Prosthesis Failure; Septal Occluder Device; Wound Closure Techniques
PubMed: 30659248
DOI: 10.1038/s41569-018-0147-0 -
Journal of Hepato-biliary-pancreatic... May 2023Postoperative hemorrhage (POH) is a severe adverse event following pancreatic injury. The present study aimed to investigate the risk factors and outcomes of POH after... (Clinical Trial)
Clinical Trial
BACKGROUND
Postoperative hemorrhage (POH) is a severe adverse event following pancreatic injury. The present study aimed to investigate the risk factors and outcomes of POH after pancreatic injury.
METHODS
All patients with a confirmed diagnosis of pancreatic injury who underwent surgical intervention between January 2010 and December 2018 were identified and extracted from the trauma database. Logistic regression was performed to identify the risk factors for POH and specific outcomes.
RESULTS
A total of 88 cases that underwent surgical intervention were analyzed, and POH occurred in 31 (35.23%) patients. After multivariable analysis, independent predictors of POH were intra-abdominal abscess (IAA) (p = .002), intestinal fistula (p = .008), shock on admission (p = .003), absence of abdominal suction drainage (p = .005), and higher body mass index (BMI) (p = .005). In addition, patients with POH after pancreatic injury also showed more complications, prolonged hospital and ICU durations, and a significantly higher mortality rate (p = .004).
CONCLUSIONS
Patients with IAA, intestinal fistula, shock on admission, absence of abdominal suction drainage, and higher BMI score were associated with POH after pancreatic injury. Moreover, POH was associated with a poor prognosis.
CLINICAL TRIAL REGISTER
The study was registered on ClinicalTrials.gov (Unique identifier: NCT03681041).
Topics: Humans; Intestinal Fistula; Pancreatic Diseases; Pancreatic Fistula; Postoperative Complications; Postoperative Hemorrhage; Retrospective Studies; Risk Factors
PubMed: 36270802
DOI: 10.1002/jhbp.1251 -
Ear, Nose, & Throat Journal Apr 2023To review our experience on post-tonsillectomy and/or adenoidectomy hemorrhage (PTAH) at a tertiary pediatric referral hospital and to evaluate the management and risk...
OBJECTIVE
To review our experience on post-tonsillectomy and/or adenoidectomy hemorrhage (PTAH) at a tertiary pediatric referral hospital and to evaluate the management and risk factors for recurrent postoperative hemorrhage and for delayed bleeding after day 14.
METHODS
A retrospective chart review was performed for all pediatric patients admitted to The Children's Hospital at Westmead for PTAH between July 01, 2014, and June 30, 2019. Patients with recurrent hemorrhage and those with bleeding after day 14 were selected for subanalysis.
RESULTS
Of the 291 patients admitted for PTAH, 31 (11%) patients had recurrent postoperative hemorrhage, and 11 (4%) patients had delayed bleeding after day 14. Surgical intervention for cessation of hemorrhage was required in 88 (30%) patients, including 2 patients who required return to the theater more than once. Nine (3%) patients received blood transfusions. The average number of days between bleeding episodes was 4 days. Recurrent postoperative hemorrhage occurred in 8.5% of patients who were managed operatively at their first presentation compared to 11.4% of patients who were managed nonoperatively (odds ratio: 1.1; 95% confidence interval 0.43-2.8). No association was found between abnormal coagulation profile, surgical indication, and risk of delayed postoperative hemorrhage.
CONCLUSIONS
Recurrent or delayed postoperative hemorrhage represents a small proportion of children with postoperative bleeding and cannot be reliably predicted. Management of first presentations with either a conservative or a surgical approach is reasonable since the risk of recurrent of PTAH may be unrelated to the choice of management at initial presentation. Careful preoperative counseling of patients and their families is important to help set expectations in the event of PTAH.
Topics: Child; Humans; Tonsillectomy; Adenoidectomy; Retrospective Studies; Postoperative Hemorrhage; Risk Factors
PubMed: 33689495
DOI: 10.1177/0145561321999594