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BMC Emergency Medicine Sep 2021First aid performed by immediate responders can be the difference between life and death in the case of trauma with massive bleeding. To develop effective training...
INTRODUCTION
First aid performed by immediate responders can be the difference between life and death in the case of trauma with massive bleeding. To develop effective training programs to teach bleeding control to laypersons, it is important to be aware of beliefs and misconceptions people hold on bleeding and severity of bleeding situations.
METHOD
A controlled study was conducted in which 175 American college students viewed 78 video clips of simulated bleeding injuries. The volume of blood present (between 0 and 1900 ml), rate of blood flow, and victim gender were systematically varied within participants. Participants were asked to rate injury severity, indicate the appropriate first aid action, and estimate the amount of time until death for the victim.
RESULTS
Though the Stop the Bleed® campaign recommends training laypeople to treat 165 ml of blood loss as life threatening, participants largely rated this volume of blood loss as minimal, mild, or moderate and estimated that the victim had just under one hour to live. Increased blood loss was associated with increased recommendations to use a tourniquet. However, in the 1900 ml conditions, participants still estimated that victims had around 22 minutes to live and approximately 15% recommended direct pressure as the intervention. Severity ratings and recommendations to use a tourniquet were also higher for the male victim than the female victim.
CONCLUSIONS
Injury classification, intervention selection, and time to death-estimations revealed that training interventions should connect classifications of blood loss to appropriate action and focus on perceptions of how much time one has to respond to a bleeding. The study also revealed a gender related bias in terms of injury classification and first aid recommendations. Bleeding control training programs can be designed to address identified biases and misconceptions while building on existing knowledge and commonly used terminology.
Topics: Adolescent; Adult; Female; First Aid; Hemorrhage; Humans; Male; Middle Aged; Patient Simulation; Research Design; Tourniquets; Young Adult
PubMed: 34481458
DOI: 10.1186/s12873-021-00496-2 -
American Journal of Veterinary Research Jul 2022To assess the safety and efficacy of the platelet-like nanoparticle (PLN), and to assess its safety in repeated administration.
OBJECTIVE
To assess the safety and efficacy of the platelet-like nanoparticle (PLN), and to assess its safety in repeated administration.
ANIMALS
6 purpose-bred dogs.
PROCEDURES
The PLN was administered IV at 3 different doses using a randomized crossover design. Each dog received a full dose of 8 X 1010 particles/10 kg, half dose, and 10 times the dose, with a 14-day washout period between doses. Biochemical, prothrombin time, partial thromboplastin time, and fibrinogen analyses were performed at baseline and 96 hours postinfusion. A CBC, kaolin-activated thromboelastography, platelet function assay closure time, and buccal mucosal bleeding time were performed at baseline and 1, 6, 24, 48, 72, and 96 hours postinfusion.
RESULTS
No significant changes were observed over time in the thromboelastography parameters, closure time, and buccal mucosal bleeding time. After the administration of the half dose, hematocrit levels decreased significantly at 1, 6, 24, 48, and 96 hours, with all values within the reference range. The platelet count was decreased significantly at hours 1, 6, 24, 48, and 72 after administration of the half dose, with values less than the reference range at all hours but hour 72. No significant changes in serum biochemistry, coagulation panel, and fibrinogen were observed for all doses. No adverse events were noted during the first infusion. Three dogs experienced transient sedation and nausea after repeat infusion.
CLINICAL RELEVANCE
The PLN resulted in a dilution of hematocrit and platelets, and did not significantly alter hemostasis negatively. The safety of repeated doses should be investigated further in dogs.
Topics: Animals; Dogs; Fibrinogen; Hemostasis; Nanoparticles; Partial Thromboplastin Time; Prothrombin Time; Thrombelastography
PubMed: 35895758
DOI: 10.2460/ajvr.22.04.0069 -
Research and Practice in Thrombosis and... Jul 2020Recognizing the complexity of coagulation tests and currently used anticoagulants, we developed this illustrated review on bleeding assessment tools and common...
Recognizing the complexity of coagulation tests and currently used anticoagulants, we developed this illustrated review on bleeding assessment tools and common coagulation screening tests. Quantitative bleeding assessment tools (BATs) are available to standardize the bleeding history and improve the pretest probability prior to coagulation testing. We describe use of BATs and the principles, indications, and limitations of the prothrombin time (PT)/International Normalized Ratio, activated partial thromboplastin time (APTT), and 50:50 mix. Use of these tests to identify coagulation factor deficiencies, specific and nonspecific inhibitors, coagulopathy of liver disease, disseminated intravascular coagulation, and commonly used anticoagulant medications are reviewed. Current literature suggests that unnecessary coagulation testing is rampant. The PT and APTT have astoundingly low sensitivity (1.0%-2.1%) for detection of clinically significant bleeding disorders. Thus, current guidelines recommend against the use of screening PT and APTT in preoperative patients undergoing noncardiac/vascular surgery.
PubMed: 32685885
DOI: 10.1002/rth2.12339 -
Journal of Gastric Cancer Mar 2022The use of direct oral Xa inhibitors (DXaIs) to prevent venothrombotic events is increasing. However, gastrointestinal bleeding, including that related to endoscopic...
PURPOSE
The use of direct oral Xa inhibitors (DXaIs) to prevent venothrombotic events is increasing. However, gastrointestinal bleeding, including that related to endoscopic resection, is a concern. In this study, we evaluated bleeding and coagulation times during the perioperative period of gastric endoscopic submucosal dissection (ESD).
MATERIALS AND METHODS
Patients who consecutively underwent gastric ESD from August 2016 to December 2018 were analyzed. Bleeding rates were compared among the 3 groups (antiplatelet, DXaIs, and control). DXaI administration was discontinued on the day of the procedure. Prothrombin time (PT), activated partial thromboplastin time, and the ratio of inhibited thrombin generation (RITG), which was based on dilute PT, were determined before and after ESD.
RESULTS
During the study period, 265 gastric ESDs were performed in 239 patients, where 23 and 50 patients received DXaIs and antiplatelets, respectively. Delayed bleeding occurred in 17 patients (7.4%) and 21 lesions (7.1%). The bleeding rate in the DXaI group was significantly higher than that in the other groups (30.4%, P<0.01), and the adjusted odds ratio of bleeding was 5.7 (95% confidence interval, 1.4-23.7; P=0.016). In patients using DXaIs, there was a significant (P=0.046) difference in the median RITG between bleeding cases (18.6%) and non-bleeding cases (3.8%).
CONCLUSIONS
A one-day cessation of DXaIs was related to a high incidence of bleeding after gastric ESD, and monitoring of residual coagulation activity at trough levels might enable the predicted risk of delayed bleeding in patients using DXaIs.
PubMed: 35425658
DOI: 10.5230/jgc.2022.22.e2 -
Clinical Chemistry and Laboratory... Apr 2023The platelet function analyser (PFA) is a prevalent platelet function screening instrument, and comes in two models-the original PFA-100 and the contemporary PFA-200.... (Review)
Review
The platelet function analyser (PFA) is a prevalent platelet function screening instrument, and comes in two models-the original PFA-100 and the contemporary PFA-200. The instruments have 'identical' output, being a 'closure time' (CT). Moreover, normal reference ranges provided by the manufacturer, for the specific test cartridges, are the same for both models. There are three different types of test cartridge: collagen/epinephrine (C/Epi), collagen/adenosine diphosphate (C/ADP), and "Innovance PFA P2Y" (only available in certain geographical locations). The PFA-100 was released in the mid 1990s, and so is approaching 50 years of age. The PFA-200, released in some locations in the mid 2010s, is destined to eventually replace the PFA-100, but is not yet available in the USA. The test system is highly sensitive to von Willebrand disease (VWD; C/Epi and C/ADP) and to aspirin therapy (C/Epi only), but only has moderate sensitivity to defects in platelet function and/or deficiencies in platelet number. Accordingly, recommendations for use for screening platelet function vary according to user experience. Some workers have alternatively used the PFA to assess thrombosis risk or pre-operative bleeding risk. In this review, we provide an overview of the history of PFA, and summarise its current clinical utility.
Topics: Humans; Sensitivity and Specificity; Platelet Function Tests; von Willebrand Diseases; Epinephrine; Adenosine Diphosphate; Collagen; Blood Platelets
PubMed: 35859143
DOI: 10.1515/cclm-2022-0666 -
Molecular Medicine (Cambridge, Mass.) Nov 2021Thrombocytopenia is one of the most common hematological disease that can be life-threatening caused by bleeding complications. However, the treatment options for...
BACKGROUND
Thrombocytopenia is one of the most common hematological disease that can be life-threatening caused by bleeding complications. However, the treatment options for thrombocytopenia remain limited.
METHODS
In this study, giemsa staining, phalloidin staining, immunofluorescence and flow cytometry were used to identify the effects of 3,3'-di-O-methylellagic acid 4'-glucoside (DMAG), a natural ellagic acid derived from Sanguisorba officinalis L. (SOL) on megakaryocyte differentiation in HEL cells. Then, thrombocytopenia mice model was constructed by X-ray irradiation to evaluate the therapeutic action of DMAG on thrombocytopenia. Furthermore, the effects of DMAG on platelet function were evaluated by tail bleeding time, platelet aggregation and platelet adhesion assays. Next, network pharmacology approaches were carried out to identify the targets of DMAG. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed to elucidate the underling mechanism of DMAG against thrombocytopenia. Finally, molecular docking simulation, molecular dynamics simulation and western blot analysis were used to explore the relationship between DAMG with its targets.
RESULTS
DMAG significantly promoted megakaryocyte differentiation of HEL cells. DMAG administration accelerated platelet recovery and megakaryopoiesis, shortened tail bleeding time, strengthened platelet aggregation and adhesion in thrombocytopenia mice. Network pharmacology revealed that ITGA2B, ITGB3, VWF, PLEK, TLR2, BCL2, BCL2L1 and TNF were the core targets of DMAG. GO and KEGG pathway enrichment analyses suggested that the core targets of DMAG were enriched in PI3K-Akt signaling pathway, hematopoietic cell lineage, ECM-receptor interaction and platelet activation. Molecular docking simulation and molecular dynamics simulation further indicated that ITGA2B, ITGB3, PLEK and TLR2 displayed strong binding ability with DMAG. Finally, western blot analysis evidenced that DMAG up-regulated the expression of ITGA2B, ITGB3, VWF, p-Akt and PLEK.
CONCLUSION
DMAG plays a critical role in promoting megakaryocytes differentiation and platelets production and might be a promising medicine for the treatment of thrombocytopenia.
Topics: Animals; Cell Differentiation; Cell Line, Tumor; Ellagic Acid; Female; Humans; Male; Mice; Molecular Docking Simulation; Phosphatidylinositol 3-Kinases; Platelet Adhesiveness; Platelet Aggregation; Proto-Oncogene Proteins c-akt; Thrombocytopenia
PubMed: 34837956
DOI: 10.1186/s10020-021-00404-1 -
Cureus Nov 2021Acquired hemophilia, as opposed to congenital hemophilia, develops in individuals with no previous history of bleeding disorder with almost similar numbers of males and...
Acquired hemophilia, as opposed to congenital hemophilia, develops in individuals with no previous history of bleeding disorder with almost similar numbers of males and females affected. It is predominantly a disease of the elderly. It is an autoimmune disorder and occurs when the immune system produces antibodies that mistakenly attack healthy tissue, specifically the clotting factors, in particular clotting factor VIII. As a result, affected individuals develop abnormal uncontrolled bleeding into the muscles, soft tissues, and the skin and it can occur spontaneously during surgery, or following trauma, and potentially cause life-threatening bleeding complications in severe cases. The affected individuals may remain undiagnosed or be misdiagnosed, making it difficult to determine the actual frequency of the disorder in the general population. The clinical presentation should suspect it with confirmation by an abnormal coagulation test. Typical laboratory results with a recent onset of abnormal bleeding and an isolated prolongation of the activated partial thromboplastin time (APTT), especially in the elderly and peri- and post-partum women, should raise eyebrows. We present two cases following different symptomatology and emphasize the clinical challenges for junior medical doctors who receive patients on the front end. We hope to emphasize understanding simple coagulation blood results followed by a meaningful discussion with the hematology team towards appropriate and timely management of the bleeding diathesis. We hope this case series report will help junior medical doctors manage patients appropriately and consult with their hematology colleagues.
PubMed: 34909344
DOI: 10.7759/cureus.19792 -
BMC Nephrology Nov 2019Desmopressin is used to reduce bleeding after kidney biopsy but evidence supporting its use is weak, especially in patients with elevated creatinine. The present study...
BACKGROUND
Desmopressin is used to reduce bleeding after kidney biopsy but evidence supporting its use is weak, especially in patients with elevated creatinine. The present study was undertaken to evaluate efficacy of desmopressin in reducing bleeding after percutaneous kidney biopsy.
METHODS
Retrospective cohort study. 269 of 322 patients undergoing percutaneous kidney biopsy between January 1, 2014 and January 31, 2018 were included. Patients had normal bleeding time, platelet count and coagulation profile. Primary outcome was defined as composite of hemoglobin drop ≥1 g/dL, hematoma on post biopsy ultrasound, gross hematuria, erythrocyte transfusion or angiography to stop bleeding. Association of desmopressin with outcomes was assessed using linear (for continuous variables) and logistic (for binary variables) regression models. Propensity score was used to minimize potential confounding.
RESULTS
Desmopressin was administered to 100/269 (37.17%) patients. After propensity score adjustment patients who received desmopressin had increased odds of post biopsy bleeding [OR 3.88 (1.95-7.74), p < 0.001]. Creatinine at time of biopsy influenced bleeding risk; gender, emergent vs elective biopsy, obesity, AKI, diabetes, hypertension or bleeding time did not influence bleeding risk. Administration of desmopressin to patients with serum creatinine ≥1.8 mg/dL decreased bleeding risk [OR 2.11 (95% CI 0.87-5.11), p = 0.09] but increased bleeding risk when serum creatinine was < 1.8 mg/dL (OR 9.72 (95% CI 2.95-31.96), p < 0.001).
CONCLUSION
Desmopressin should not be used routinely prior to percutaneous kidney biopsy in patients at low risk for bleeding but should be reserved for patients who are at high risk for bleeding.
Topics: Angiography; Biopsy; Blood Coagulation; Creatinine; Deamino Arginine Vasopressin; Female; Hemostasis, Surgical; Hemostatics; Humans; Kidney; Kidney Diseases; Kidney Function Tests; Male; Middle Aged; Outcome and Process Assessment, Health Care; Patient Selection; Postoperative Hemorrhage; Retrospective Studies; Ultrasonography; United States
PubMed: 31730448
DOI: 10.1186/s12882-019-1595-4 -
Gels (Basel, Switzerland) Mar 2023Scientists have been attempting to improve the properties of mesoporous materials and expand their application since the 1990s, and the combination with hydrogels,... (Review)
Review
Scientists have been attempting to improve the properties of mesoporous materials and expand their application since the 1990s, and the combination with hydrogels, macromolecular biological materials, is one of the research focuses currently. Uniform mesoporous structure, high specific surface area, good biocompatibility, and biodegradability make the combined use of mesoporous materials more suitable for the sustained release of loaded drugs than single hydrogels. As a joint result, they can achieve tumor targeting, tumor environment stimulation responsiveness, and multiple therapeutic platforms such as photothermal therapy and photodynamic therapy. Due to the photothermal conversion ability, mesoporous materials can significantly improve the antibacterial ability of hydrogels and offer a novel photocatalytic antibacterial mode. In bone repair systems, mesoporous materials remarkably strengthen the mineralization and mechanical properties of hydrogels, aside from being used as drug carriers to load and release various bioactivators to promote osteogenesis. In hemostasis, mesoporous materials greatly elevate the water absorption rate of hydrogels, enhance the mechanical strength of the blood clot, and dramatically shorten the bleeding time. As for wound healing and tissue regeneration, incorporating mesoporous materials can be promising for enhancing vessel formation and cell proliferation of hydrogels. In this paper, we introduce the classification and preparation methods of mesoporous material-loaded composite hydrogels and highlight the applications of composite hydrogels in drug delivery, tumor therapy, antibacterial treatment, osteogenesis, hemostasis, and wound healing. We also summarize the latest research progress and point out future research directions. After searching, no research reporting these contents was found.
PubMed: 36975656
DOI: 10.3390/gels9030207 -
Journal of Cardiovascular Pharmacology... 2022DOACs are characterized by a higher incidence of gastrointestinal bleeding and this may be different among males and females. Female patients were underrepresented in...
DOACs are characterized by a higher incidence of gastrointestinal bleeding and this may be different among males and females. Female patients were underrepresented in the DOAC pivotal trials. We aimed to assess real-world differences in gastrointestinal bleeding with oral anticoagulants (DOACs and VKAs) among males and females with atrial fibrillation. We performed a population-based retrospective analysis on linked administrative claims. Atrial fibrillation patients of 65 years and above were considered. Bleeding risk factors were assessed through HASBED and previous history of gastrointestinal disease. A time-to-event analysis compared gastrointestinal bleeding between males and females. The overall cohort consisted of 15338 (55% female) DOAC and 44542 (50% female) VKA users. Most of the patients showed HASBED ≥2. Incidence rate of GI bleeding was higher in females as compared to males among DOAC users (0.90% vs 0.59%), and significant gender difference in GI bleeding was found, after adjustment, in the Cox regression analysis (HR 1.48, 95%CI 1.02-2.16). In the VKA group, no significant difference among genders was found in the time-to-event analysis. Our data suggest that female patients treated with DOACs have a higher risk of GI bleeding versus male patients; this difference is not observed in VKA patients.
Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Databases, Factual; Female; Gastrointestinal Hemorrhage; Humans; Italy; Male; Retrospective Studies; Sex Distribution
PubMed: 34994209
DOI: 10.1177/10742484211054609