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Anesthesiology Apr 2015
Review
Topics: Animals; Blood Coagulation; Blood Coagulation Factors; Humans; Postoperative Hemorrhage; Wounds and Injuries
PubMed: 25654437
DOI: 10.1097/ALN.0000000000000608 -
Journal of Vascular Surgery Nov 2016The purpose of this study was to evaluate the clinical and long-term outcome of patients who underwent covered stent treatment because of late-onset postpancreatectomy... (Comparative Study)
Comparative Study
OBJECTIVE
The purpose of this study was to evaluate the clinical and long-term outcome of patients who underwent covered stent treatment because of late-onset postpancreatectomy hemorrhage in a greater number of patients. A secondary study goal was to compare embolization techniques with covered stents regarding differences in early and late clinical outcome, rebleeding, and vessel patency.
METHODS
Between December 2008 and June 2015, 27 consecutive patients suffering from major hemorrhage after pancreatic surgery underwent either covered stent placement or embolization of the affected visceral artery. The patients' medical reports and radiologic images were retrospectively reviewed. The main study end point was technical and clinical success, including survival and complications; the secondary end points were perfusion distal to the target vessel and, for covered stent placement, patency of the affected artery.
RESULTS
Covered stent placement was successful in 14 of 16 patients (88%); embolization was successful in 10 of 11 (91%) patients. For the embolization group, the overall 30-day and 1-year survival rate was 70%, and the 1- and 2-year survival rate was 56%; for the covered stent group, these rates were 81% and 74%, respectively. The 30-day patency of the covered stent was 84%, and 1-year patency was 42%; clinically relevant ischemia was observed in two patients. Infarction distal to the embolized vessel occurred in 6 of 11 patients (55%).
CONCLUSIONS
Endovascular treatment using either covered stents or embolization techniques is an effective and safe emergency therapy for life-threatening postpancreatectomy hemorrhage with good clinical success rates and long-term results. Covered stent placement preserving vessel patency in the early postoperative phase should be preferred to embolization if it is technically feasible.
Topics: Adult; Aged; Aged, 80 and over; Computed Tomography Angiography; Embolization, Therapeutic; Emergencies; Endovascular Procedures; Female; Humans; Kaplan-Meier Estimate; Male; Medical Records; Middle Aged; Pancreatectomy; Postoperative Hemorrhage; Prosthesis Design; Retrospective Studies; Risk Factors; Stents; Time Factors; Treatment Outcome; Vascular Patency
PubMed: 27462001
DOI: 10.1016/j.jvs.2016.05.071 -
International Journal of Surgery... 2013Results of preoperative conventional coagulation assays are a poor predictor of hemorrhage after liver transplantation. In this study, we evaluated the factors that are...
BACKGROUND
Results of preoperative conventional coagulation assays are a poor predictor of hemorrhage after liver transplantation. In this study, we evaluated the factors that are predictive of intra-abdominal coagulopathic hemorrhage after living donor liver transplantation surgery.
METHODS
During the period from January 2009 to December 2012, 118 adults underwent living donor liver transplantation (LDLT) in our institution. Of those patients, 18 (15.3%) developed intra-abdominal coagulopathic hemorrhage (n = 7) or hemorrhage due to non-coagulopathic causes (n = 11) that required emergency medical, radiological, or surgical intervention within the first month after LDLT. Possible predictors of postoperative coagulopathic hemorrhage included donor-related factors, age, body mass index, MELD score, INR value, intra-operative blood transfusion, graft/recipient weight ratio, anhepatic phase, cold ischemia time, operative time, APACHE II score, onset of re-bleeding, and hemoglobin levels during rebleeding episodes.
RESULTS
There were no differences in any of the variables between the two groups (coagulopathic and noncoagulopathic hemorrhage) except for cold ischemia time. We found that cold ischemia time was significantly longer in patients with postoperative coagulopathic hemorrhage (160.50 ± 45.02 min) than in patients with hemorrhage due to non-coagulopathic causes (113.55 ± 29.31 min; P = 0.027).
CONCLUSION
Prolonged cold ischemia time is associated with postoperative intra-abdominal coagulopathic hemorrhage in patients after LDLT. It is, therefore, necessary to shorten the cold ischemia time in order to reduce the risk of postoperative intra-abdominal hemorrhage due to coagulopathic causes.
Topics: Abdomen; Adult; Aged; Cold Ischemia; Cross-Sectional Studies; Female; Humans; Liver Transplantation; Living Donors; Male; Middle Aged; Postoperative Hemorrhage; Radiography; Retrospective Studies; Risk Factors; Ultrasonography
PubMed: 24161418
DOI: 10.1016/j.ijsu.2013.10.004 -
The Journal of Extra-corporeal... Dec 2013Heparin is the most widely used anticoagulant for cardiopulmonary bypass (CPB). Several authors suggest that lower doses of heparin during CPB would produce lower... (Observational Study)
Observational Study
Heparin is the most widely used anticoagulant for cardiopulmonary bypass (CPB). Several authors suggest that lower doses of heparin during CPB would produce lower postoperative chest tube losses and fewer transfusion events. In the present study, a heparin dose-response (HDR) test was used to determine the heparin dose for each patient. We hypothesize that higher doses of heparin do not cause increased postoperative bleeding and transfusion events in postoperative patients undergoing CPB when the heparin dose is determined by a HDR test. This prospective observational study followed 66 patients undergoing CPB-supported primary coronary artery bypass grafting. Patients were placed in one of two groups, sensitive (n = 37) or resistant (n = 29) based on the result of a HDR test slope. Data on patient characteristics, secondary outcomes, transfusion, and the primary outcome, chest tube losses, were collected. Patient characteristics differed in the baseline activated coagulation time (ACT) and thromboelastograph G parameter as well as number of patients with hypercholesterolemia. The resistant group had lower postheparin and postprotamine ACTs and heparin sensitivity index. Initial heparin dose, total heparin dose, heparin dose per kilogram, HDR, and protamine dose were higher in the heparin-resistant group. The primary outcome, postoperative chest tube loss volume, was collected at four time points and the two groups were then compared. The heparin-resistant group was noninferior to the sensitive group and had clinically fewer transfused patients and transfusion events. The resistant group was noninferior to the sensitive group with respect to chest tube losses at all measured time points. Higher doses of heparin determined by a HDR test do not cause increased postoperative chest tube losses or increased transfusion events.
Topics: Aged; Blood Transfusion; Cardiopulmonary Bypass; Dose-Response Relationship, Drug; Female; Heparin; Humans; Male; Middle Aged; Postoperative Hemorrhage; Prospective Studies; Treatment Outcome
PubMed: 24649570
DOI: No ID Found -
Chirurgia (Bucharest, Romania : 1990) 2017One of the most significant complications following pancreaticoduodenectomy is represented by postoperative hemorrhage.
UNLABELLED
One of the most significant complications following pancreaticoduodenectomy is represented by postoperative hemorrhage.
AIM
This study undertook an analysis of the cases that presented intraluminal bleeding of mechanical gastrojejunal anastomosis following pancreatico duodenectomy (PD) in the last five years. From January 2012 until January 2017, 84 consecutive pancreaticoduodenectomies were performed and managed by the same surgical team. The preferred procedure of reconstruction was Whipple (76 patients). The gastrojejunal anastomosis was performed with Panther linear stapler GIA in all cases. ISGPS classification regarding postpancreatectomy hemorrhage was used to evaluate severity. Out of 84 consecutive PD, a total of 7cases of intraluminal bleeding (8.33 %) were observed, detected on average on postoperative day 4. Relaparotomy was inevitable in two patients. Three patients from the studied group with intraluminal postpancreatectomy hemorrhage died. In the studied group there were no cases of bleeding from the pancreatico-enteric or bilio-enteric anastomosis.
CONCLUSION
Mechanical anastomosis might be questionable, severe hemorrhage demanding urgent relaparotomy which is correlated with high mortality rates. Intralumenal postpancreatoduodenectomy hemorrhage is a significant complication whose management depends on multiple factors and with a potentially fatal outcome.
Topics: Anastomosis, Surgical; Carcinoma, Pancreatic Ductal; Female; Humans; Male; Pancreatic Neoplasms; Pancreaticoduodenectomy; Postoperative Hemorrhage; Prevalence; Reoperation; Retrospective Studies; Risk Factors; Romania; Survival Rate; Time Factors; Treatment Outcome
PubMed: 28266291
DOI: 10.21614/chirurgia.112.1.39 -
The Journal of Thoracic and... May 2018To derive and validate an objective definition of postoperative bleeding in neonates and infants undergoing cardiac surgery with cardiopulmonary bypass. (Observational Study)
Observational Study
OBJECTIVE
To derive and validate an objective definition of postoperative bleeding in neonates and infants undergoing cardiac surgery with cardiopulmonary bypass.
METHODS
Using a retrospective cohort of 124 infants and neonates, we included published bleeding definitions and cumulative chest tube output over different postoperative periods (eg, 2, 12, or 24 hours after intensive care unit admission) in a classification and regression tree model to determine chest tube output volumes that were associated with red blood cell transfusions and surgical re-exploration for bleeding in the first 24 hours after intensive care unit admission. After the definition of excessive bleeding was determined, it was validated via a prospective cohort of 77 infants and neonates.
RESULTS
Excessive bleeding was defined as ≥7 mL/kg/h for ≥2 consecutive hours in the first 12 postoperative hours and/or ≥84 mL/kg total for the first 24 postoperative hours and/or surgical re-exploration for bleeding or cardiac tamponade physiology in the first 24 postoperative hours. Excessive bleeding was associated with longer length of hospital stay, increased 30-day readmission rate, and increased transfusions in the postoperative period.
CONCLUSIONS
The proposed standard definition of excessive bleeding is based on readily obtained objective data and relates to important early clinical outcomes. Application and validation by other institutions will help determine the extent to which our specialty should consider this definition for both clinical investigation and quality improvement initiatives.
Topics: Age Factors; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Chest Tubes; Drainage; Erythrocyte Transfusion; Female; Hospital Mortality; Humans; Infant; Infant, Newborn; Length of Stay; Male; Patient Readmission; Postoperative Hemorrhage; Prospective Studies; Reoperation; Retrospective Studies; Risk Assessment; Risk Factors; Terminology as Topic; Time Factors; Treatment Outcome
PubMed: 29338867
DOI: 10.1016/j.jtcvs.2017.12.038 -
International Journal of Surgery... Mar 2015A systematic review of randomized controlled trials (RCTs) and non-RCTs was performed to evaluate efficacy for the reduction of postoperative blood loss and transfusion... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
A systematic review of randomized controlled trials (RCTs) and non-RCTs was performed to evaluate efficacy for the reduction of postoperative blood loss and transfusion requirements of topical use of tranexamic acid in patients undergoing primary total hip arthroplasty.
METHOD
Potential articles were identified from Medline (1966 - September 2014), Embase (1980 - September 2014), Pubmed (1980 - September 2014) and The Cochrane Central Register of Controlled Trials. Other internet databases are also searched to find trials according to the Cochrane Collaboration guidelines. Moreover, gray literatures are also selected from the reference list of the included studies. High quality randomized controlled trials (RCTs) and non-RCTs were selected. The software RevMan 5.1 was used for the mate-analysis.
RESULTS
Four RCTs and four non-RCT meet the inclusion criteria. There were significant differences in hemoglobin, total blood loss, transfusion requirements and postoperative drainage volume between TXA groups and control groups. There were no significant differences in length of stay, incidence of wound infection, deep vein thrombosis (DVT) and pulmonary embolism (PE) between treatment and control groups.
CONCLUSIONS
Present meta-analysis indicates that the antifibrinolytic agent, also known as tranexamic acid, could reduce hemoglobin decline, volume of drainage, total blood loss and transfusion requirements after THA, and is not related to adverse reactions or complications such as wound infection, DVT and PE.
Topics: Administration, Topical; Antifibrinolytic Agents; Arthroplasty, Replacement, Hip; Blood Transfusion; Humans; Postoperative Hemorrhage; Pulmonary Embolism; Surgical Wound Infection; Tranexamic Acid; Venous Thrombosis
PubMed: 25576011
DOI: 10.1016/j.ijsu.2014.12.023 -
Journal of Gastrointestinal Surgery :... Jul 2022Abdominal visceral resections incur relatively higher rates of postoperative bleeding and venous thromboembolism (VTE). While guidelines recommend the use of...
BACKGROUND
Abdominal visceral resections incur relatively higher rates of postoperative bleeding and venous thromboembolism (VTE). While guidelines recommend the use of perioperative chemical thromboprophylaxis, the most appropriate time for its initiation is unknown. Here, we investigated whether early (before skin closure) versus postoperative commencement of chemoprophylaxis affected VTE and bleeding rates following abdominal visceral resection.
METHODS
Retrospective review of all elective abdominal visceral resections undertaken between January 1, 2018, and June 30, 2019, across four tertiary-referral hospitals. Major bleeding was defined as the need for blood transfusion, reintervention, or > 20 g/L fall in hemoglobin from baseline. Clinical VTE was defined as imaging-proven symptomatic disease < 30 days post-surgery.
RESULTS
A total of 945 cases were analyzed. Chemoprophylaxis was given early in 265 (28.0%) patients and postoperatively in 680 (72.0%) patients. Mean chemoprophylaxis exposure doses were similar between the two groups. Clinical VTE developed in 14 (1.5%) patients and was unrelated to chemoprophylaxis timing. Postoperative bleeding occurred in 71 (7.5%) patients, with 57 (80.3%) major bleeds, requiring blood transfusion in 48 (67.6%) cases and reintervention in 31 (43.7%) cases. Bleeding extended length-of-stay (median (IQR), 12 (7-27) versus 7 (5-11) days, p < 0.001). Importantly, compared to postoperative chemoprophylaxis, early administration significantly increased the risk of bleeding (10.6% versus 6.3%, RR 1.45, 95% CI 1.05-1.93, p = 0.038) and independently predicted its occurrence.
CONCLUSIONS
The risk of bleeding following elective abdominal visceral resections is substantial and is higher than the risk of clinical VTE. Compared with early chemoprophylaxis, postoperative initiation reduces bleeding risk without an increased risk of clinical VTE.
Topics: Anticoagulants; Humans; Postoperative Complications; Postoperative Hemorrhage; Postoperative Period; Retrospective Studies; Venous Thromboembolism
PubMed: 35318594
DOI: 10.1007/s11605-022-05301-4 -
The Annals of Thoracic Surgery Mar 2008
Topics: Australia; Cardiac Surgical Procedures; Factor VIIa; Hemostatic Techniques; Humans; New Zealand; Postoperative Hemorrhage; Recombinant Proteins; Registries
PubMed: 18291153
DOI: 10.1016/j.athoracsur.2007.07.065 -
Danish Medical Journal Sep 2016Haemorrhage follows surgical intervention, but also fluid substitution may affect the blood loss. Here influence of colloids and lactated Ringer's solution (LR) on... (Review)
Review
BACKGROUND
Haemorrhage follows surgical intervention, but also fluid substitution may affect the blood loss. Here influence of colloids and lactated Ringer's solution (LR) on coagulation competence and haemorrhage is evaluated during cystectomy.
METHODS
A meta-analysis, a prospective observational study and three randomized controlled trials were conducted - 17 patients received HES 130/0.4, 19 patients Dextran 70, 19 patients human albumin, and 54 patients LR - with blinded evaluation of blood loss and outcome while coagulation competence was evaluated by thromboelastography (TEG) and plasma coagulation analyses.
RESULTS
Administration of HES reduced TEG determined "maximal amplitude" (TEG-MA) from 64±6 to 52±7 mm associated with a 2181±1190 mL blood loss. For Dextran values were 65±7 to 49±9 mm and 2339±1471 mL, respectively, for albumin 62±6 to 59±6 mm and 1658±684 mL compared to 65±6 to 64±6 mm and 1559±976 mL with the use of LR. Furthermore, reduced TEG-MA was independently associated with the perioperative blood loss. A straight postoperative course was seen less often after infusion of synthetic colloids versus albumin/LR (7/36 vs. 31/73), P=0.02.
CONCLUSIONS
Perioperative bleeding is related to administration of Dextran 70 followed by HES 130/0.4 whereas albumin and LR result in a similar low level of haemorrhage. Furthermore, evaluation of coagulation competence by TEG-MA appears superior to plasma coagulation analyses for predicting the perioperative blood loss and supports that haemorrhage depends not only on the surgical intervention but also on the perioperative fluid therapy of apparent consequence for outcome.
Topics: Blood Coagulation; Blood Loss, Surgical; Crystalloid Solutions; Fluid Therapy; Humans; Isotonic Solutions; Perioperative Care; Plasma Substitutes; Postoperative Hemorrhage
PubMed: 27585533
DOI: No ID Found