Determining Risk Factors of Bleeding in Patients on Warfarin Treatment

Background. Warfarin is a commonly used oral anticoagulant agent. The most common adverse effects of warfarin are bleeding complications.Methods. We performed a 1-year retrospective chart review of emergency department patients using warfarin. A total of 65 patients with bleeding disorder (study group) and 63 patients without bleeding (control group) were included, making up a total of 128 subjects. Demographic data, frequency of international normalized ratio (INR) checks, and routine blood results were extracted. Logistic regression analysis was used to determine which factors were most closely associated with bleeding complications.Results. Median age was62.0±14.4and61.9±14.5for study group and control group, respectively. Educational status and frequency of INR checks were similar in both groups (P=0.101andP=0.483, resp.). INR levels were higher in the study group (5.45±3.98versus2.63±1.71,P<0.001). Creatinine levels were also higher in the study group (1.14±0.57 mg/dL versus0.94±0.38 mg/dL,P=0.042). Acetylsalicylic acid use was more frequent in the study group and was associated with a 9-fold increase in bleeding complications(P<0.001).Conclusions. High INR levels, high creatinine levels, and acetylsalicylic acid use were associated with bleeding complications in ED patients using warfarin.

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Safety and Efficacy of Single-Dose Ketorolac for Postoperative Pain Management After Primary Palatoplasty: A Prospective Cohort Study With Historical Controls

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211012864 ◽

2021 ◽

pp. 105566562110128

Author(s):

Jason R. Stein ◽

Esperanza Mantilla-Rivas ◽

Marudeen Aivaz ◽

Md Sohel Rana ◽

Ishwarya Shradha Mamidi ◽

...

Keyword(s):

Single Dose ◽

Postoperative Pain Management ◽

Postoperative Hemorrhage ◽

Bleeding Complications ◽

Control Group ◽

Study Group ◽

Safety And Efficacy ◽

Opioid Dose ◽

Historical Controls

Objective: To analyze safety and efficacy of single-dose ketorolac after primary palatoplasty (PP). Design: Consecutive cohort of patients undergoing PP, comparing to historical controls. Setting: A large academic children’s hospital. Patients, Participants: A consecutive cohort of 111 patients undergoing PP (study n = 47) compared to historical controls (n = 64). Interventions: All patients received intraoperative acetaminophen, dexmedetomidine, and opioids while the study group received an additional single dose of ketorolac (0.5 mg/kg) at the conclusion of PP. Main Outcome Measures: Safety of ketorolac was measured by significant bleeding complications and need for supplementary oxygen. Efficacy was assessed through bleeding, Face Legs Activity Cry Consolability (FLACC) scale, and opioid dose. Results: Length of stay was similar for both groups (control group 38.5 hours [95% CI: 3.6-43.3] versus study group 37.6 hours [95% CI: 31.3-44.0], P = .84). There were no significant differences in all postoperative FLACC scales. The mean dose of opioid rescue medication measured as morphine milligram equivalents did not differ between groups ( P = .56). Significant postoperative hemorrhage was not observed. Conclusions: This is the first prospective study to evaluate the safety and efficacy of single-dose ketorolac after PP. Although lack of standardization between study and historical control groups may have precluded observation of an analgesic benefit, analysis demonstrated a single dose of ketorolac after PP is safe. Further investigations with more patients and different postoperative regimens may clarify the role of ketorolac in improving pain after PP.

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Self-Care Training and Information Support of Patients With Mechanical Heart Valve on International Normalized Ratio and the Bleeding Complications

10.21203/rs.3.rs-118985/v1 ◽

2020 ◽

Author(s):

Shirdel Zandi ◽

Behzad Imani ◽

GHolamreza Safarpor

Keyword(s):

Heart Valve ◽

Intervention Group ◽

Mechanical Heart Valve ◽

Self Care ◽

International Normalized Ratio ◽

Information Support ◽

Bleeding Complications ◽

Target Range ◽

Control Group ◽

Care Training

Abstract BackgroundPatients with mechanical heart valve due to the possibility of coagulation complications require lifelong use of anticoagulants and International Normalized Ratio (INR) control. But if not taken care of properly, anticoagulant therapy itself can put people at risk for bleeding and be life-threatening. ObjectivesThe aim of this study was to determine the effect of Self-care training and information support of patients with mechanical heart valve on INR and the bleeding complications.DesignA randomized double-blind controlled trial.Settings and MethodsParticipants were recruited via convenience sampling from Farshchian hospital in Hamadan, Iran; and were randomly divided into two groups control (n=80) and intervention (n=80). Participants in the control group received only routine training; in addition, the intervention group received 6 sessions of self-care training and 6 months of information support. Monthly the level of INR and incidence of bleeding were determined. Data were analyzed using independent t-test and chi-square in spss16 software at a significance level of 0.05.ResultsDuring 6 months of follow-up, except for the third month, the frequency of INR levels in therapeutic target range (2.5-3.5) in the intervention group was significantly higher than the control group (p<0.05). Also in the intervention group, the incidence of bleeding complications was relatively less than the control group, but this difference was not statistically significant (p>0.05).ConclusionProper self-care training and information support in patients with mechanical heart valve replacement have positive results. By doing self-care, the level of a therapeutic target range of INR maintained and the incidence of bleeding complications can be reduced.

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(P2-81) A Survey of the Health Effects of Bushfire Smoke on Patients Attending Two Sydney Emergency Departments

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11005267 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s162-s163

Author(s):

G.O. Watkins

Keyword(s):

Emergency Departments ◽

Respiratory Symptoms ◽

Medication Use ◽

Control Group ◽

Study Group ◽

Shortness Of Breath ◽

Chest Tightness ◽

Respiratory Pathology ◽

The Subject ◽

Emergency Department Patients

The objective of this survey was to investigate the incidence of respiratory symptoms reported by emergency department patients during the Christmas 2001–2002 Sydney bushfire disaster. Two hundred and thirty patients attending two Sydney emergency departments for any reason completed questionnaires regarding respiratory symptoms. The symptoms investigated were cough, shortness of breath, chest tightness and wheeze. The same questionnaire was subsequently administered to a similar control group who were not exposed to bushfire smoke. 51% of those surveyed during the bushfires reported one or more of the respiratory symptoms investigated compared to 31% of the control group. This difference was statistically significant (p < 0.01). A significantly higher proportion of respiratory patients in the study group reported an exacerbation of their condition and increased medication use during the bushfires (p < 0.01). The results are consistent with other research on the subject and suggest that exposure to bushfire smoke causes an increased incidence of respiratory pathology.

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Dynamic spine hyperflexion is related to vertebral compression fractures in postmenopausal women

10.21203/rs.3.rs-379183/v1 ◽

2021 ◽

Author(s):

ZhiRong Zheng ◽

Tian Tian ◽

WeiBo Liu ◽

XiangYu Wang ◽

Meng Gao ◽

...

Keyword(s):

Postmenopausal Women ◽

Demographic Data ◽

Quantitative Computed Tomography ◽

Vertebral Compression Fractures ◽

Control Group ◽

Study Group ◽

Retrospective Case ◽

Compression Fractures ◽

Osteoporotic Vertebral Fractures ◽

Fracture Prevalence

Abstract Background: Previous studies on osteoporotic vertebral fractures are usually based on the neutral posture of the spine; however, the fractures are usually associated with the curvature of the spine. Therefore, we aimed to ascertain the relationship between vertebral compression fractures and thoracolumbar hyperflexion Cobb angles (TLHCobb) and determine the clinical cut-off of the TLHCobb angle.Methods: In this retrospective case-control study, TLHCobbs were collected from 154 postmenopausal women with thoracolumbar fractures (study group) and 310 postmenopausal women with lumbar instability or spondylolisthesis (control group). Demographic data, clinical data, and quantitative computed tomography (QCT) findings were compared between the groups. Chi-squared tests and unpaired t-tests were used to assess the group characteristics and proportions. Logistic regression was used to examine the association between vertebral compression fractures and TLHCobb.Results: Fracture prevalence was higher in the higher TLHCobb study group than that in the control group [OR = 2.81 (2.15–3.67)] after adjusting for age, BMI, and QCT findings. TLHCobbs at and > 20.05° were associated with an increased fracture prevalence and ORs of 2.79 (1.82–4.27) and 4.83 (3.24–7.20), respectively. TLHCobb and QCT values differed between the study and control groups (p < 0.001 for both). There were no significant differences in body mass index (BMI), disk height, or coronal TLCobb between the two groups.Conclusion: There was an association between the prevalence of vertebral compression fractures and TLHCobbs in postmenopausal women, and a TLHCobb > 20.05° can be an indicator of vertebral fracture.

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Absence of bleeding complications in patients undergoing cortical surgery while receiving valproate treatment

Journal of Neurosurgery ◽

10.3171/jns.1997.87.2.0252 ◽

1997 ◽

Vol 87 (2) ◽

pp. 252-256 ◽

Cited By ~ 51

Author(s):

Gail D. Anderson ◽

Yi-Xin Lin ◽

Carrie Berge ◽

George A. Ojemann

Keyword(s):

Laboratory Data ◽

Retrospective Chart Review ◽

Bleeding Complications ◽

Control Group ◽

Content Type ◽

Elective Surgical Procedures ◽

Clinical Observations ◽

Estimated Blood Loss ◽

Significant Difference ◽

Hematological Effects

✓ Valproate (VPA) is associated with a variety of idiosyncratic hematological effects including thrombocytopenia, inhibition of platelet aggregation, and fibrinogen depletion. This has led some investigators to recommend discontinuation of VPA therapy prior to elective surgical procedures. However, administration of VPA therapy is not altered prior to surgery at the authors' center and no VPA-associated bleeding complications have been observed. Therefore, a retrospective chart review was conducted to verify the clinical observations in patients who had undergone cortical resection while receiving antiepileptic drugs (AEDs). Baseline, surgical, and postoperative laboratory data were available for a total of 313 patients, 111 of whom were receiving VPA and 202 of whom were receiving AEDs without VPA (control patients). Eighty-seven percent of the patients receiving VPA were also being treated with at least one other AED. The control group was approximately equally divided between monotherapy (55%) and polytherapy (45%) treatments. Platelet counts were significantly lower in the control polytherapy (284 ± 74 × 109/L) and both VPA groups (279 ± 113 × 109/L) as compared with the control monotherapy group (314 ± 85 × 109/L). Baseline fibrinogen levels were significantly lower in the VPA than in the control groups (223 ± 91 g/dl vs. 278 ± 95 g/dl). Both pre- and postoperatively, the VPA group had lower red blood cells counts, hematocrit, and hemoglobin levels. There was no significant difference between groups in estimated blood loss during surgery or qualitative wound discharge postsurgery. There was only one case of a bleeding complication, which occurred 14 days postoperatively in a patient receiving carbamazepine monotherapy. The results of this study confirm the clinical observations of an absence of bleeding complications in patients receiving VPA therapy at the time of surgery, despite differences in laboratory parameters.

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Thoracentesis under clopidogrel is not associated with excessive bleeding events: a cohort study

Respiratory Research ◽

10.1186/s12931-020-01549-z ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Sivan Perl ◽

Marina Bondarenco ◽

Noam Natif ◽

Yitschak Shpirer ◽

Sharon Enghelberg ◽

...

Keyword(s):

Bleeding Event ◽

Group Versus ◽

Retrospective Chart Review ◽

Hospitalized Patients ◽

Bleeding Complications ◽

Control Group ◽

Bleeding Events ◽

Excessive Bleeding ◽

Red Cell Transfusion ◽

Event Rates

Abstract Background Thoracentesis is a low-risk procedure for bleeding (approx. 2%). Data regarding safety of thoracentesis under treatment with clopidogrel is scarce, and current guidelines are not evidence based. We performed a retrospective study to evaluate the rate of bleeding complications of thoracentesis under clopidogrel in hospitalized patients. Methods Retrospective chart review of hospitalized patients undergoing thoracentesis with or without clopidogrel treatment. Demographic and clinical data, diagnostic ICD9 codes, and use of ultrasound were extracted. Bleeding endpoints were defined as hemothorax, drop of > 2 g/dL hemoglobin, or need for packed red cell transfusion. Results The study group comprised of 88 cases and 169 controls. Four bleeding complications were noted in the cases group, versus 5 in the control group (RR 1.53, 95% CI 0.4–5.5). Conclusion Thoracentesis may be performed safely in patients receiving clopidogrel. Bleeding event rates are consistent with previous reports of thoracentesis in general.

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Obstructive sleep apnoea syndrome does not negatively affect oral and dental health

The Journal of Laryngology & Otology ◽

10.1017/s0022215114003296 ◽

2015 ◽

Vol 129 (1) ◽

pp. 68-72 ◽

Cited By ~ 9

Author(s):

M Acar ◽

İ Türkcan ◽

T Özdaş ◽

C Bal ◽

C Cingi

Keyword(s):

Obstructive Sleep Apnoea ◽

Dental Health ◽

Demographic Data ◽

Educational Status ◽

Sleep Apnoea ◽

Obstructive Sleep Apnoea Syndrome ◽

Control Group ◽

Income Levels ◽

Sleep Apnoea Syndrome ◽

Obstructive Sleep

AbstractObjective:Obstructive sleep apnoea syndrome can lead to unhealthy open-mouth breathing. We investigated the possible relationship between obstructive sleep apnoea syndrome and dental health. We also evaluated other clinical factors that may affect oral health.Methods:We measured sleep using polysomnography and determined the apnoea–hypopnoea index for a total of 291 patients. We also recorded the demographic data, duration of snoring complaints, educational status and income levels for our patient cohort; finally, we calculated the decayed, missing and filled teeth index.Results:Forty-one patients presented with primary snoring (control group) and 250 patients (study group) presented with mild, moderate and severe obstructive sleep apnoea syndrome. We found no correlation between obstructive sleep apnoea syndrome severity and the decayed, missing and filled teeth index (p = 0.057). We also found no correlation between the apnoea–hypopnoea and decayed, missing and filled teeth indexes. Age and the duration of snoring complaints were positively correlated with the decayed, missing and filled teeth index while educational status and income levels were negatively correlated (p < 0.001).Conclusion:Obstructive sleep apnoea syndrome does not negatively affect oral and dental health.

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Efficacy of acupressure on nausea and vomiting among children with leukemia following chemotherapy

Journal of Nursing Education and Practice ◽

10.5430/jnep.v9n1p89 ◽

2018 ◽

Vol 9 (1) ◽

pp. 89

Author(s):

Youssria El-Sayed Yousef ◽

Nora Abd- Elhamid Zaki ◽

Amal Sayed

Keyword(s):

Side Effects ◽

Demographic Data ◽

Nausea And Vomiting ◽

Control Group ◽

Study Group ◽

Experiment Study ◽

History Of ◽

The Mean ◽

Interview Questionnaire ◽

Quasi Experiment Study

Background/Objective: Nausea and vomiting (N&V) remain the main side effects associated with cancer chemotherapy. This study determines the effect of acupressure on the control of N&V among children with leukemia receiving chemotherapy.Methods: This quasi-experiment study was conducted at two Pediatric Oncology Departments in South Egypt. Two groups of children with leukemia aging 6-18 years were included from October 2017 till March 2018. The study group (n = 60) received acupressure, while the control group (n = 60) didn’t. All were subjected to socio-demographic and clinical interview questionnaire and Rhodes Index for N&V Likert scale for assessment of frequency, duration, stress and severity of nausea and vomiting.Results: Both groups had similar demographic data, were similar in diagnosis, disease severity, family history of neoplasia, and experienced similar chemotherapy-related side effects. Significant reduction of frequency, distress and severity of nausea and frequency, duration and severity of vomiting in addition to mean scores N\&V scale among children of the study group after application of acupressure when compared to children in the control group.Conclusions: The application of acupressure at P6 in children with acute leukemia who were receiving chemotherapy led to significant reduction in the mean scores of N&V in addition to their frequency, duration and severity within 48 hours from the beginning of chemotherapy in comparison to the control group. Therefore, acupressure techniques showed be used to reduce chemotherapy induced N&V in children with leukemia.

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Application of Amniotic Tissue Matrix to Surgically Excised Hidradenitis Suppurativa Wounds: A Retrospective Review

Surgical Case Reports ◽

10.31487/j.scr.2021.02.10 ◽

2021 ◽

pp. 1-6

Author(s):

Christopher J. Salgado ◽

Faris Hawatmeh ◽

Lalama Maria ◽

Genesis Navas

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hidradenitis Suppurativa ◽

Chart Review ◽

Retrospective Chart Review ◽

Control Group ◽

Study Group ◽

Surgical Wounds ◽

The University ◽

Tissue Matrix

Background: Hidradenitis suppurativa is a painful and disfiguring disease, which requires surgical management in severe cases. Improvements in management are necessary to decrease disease morbidity and improve outcomes. Aim: To determine the efficacy of applying amniotic tissue matrix to surgically-excised hidradenitis suppurativa wounds. Materials & Methods: A 5-year retrospective chart review of patients who underwent surgical treatment of perineal, perianal, and inguinal hidradenitis suppurativa at the University of Miami Hospital was completed. The study group consisted of 5 patients who had amniotic tissue matrix applied to their surgical wounds postoperatively. The control group, 18 patients, did not receive the amniotic tissue matrix application. Results: The average disease surface area in the study group was larger at 1278 ± 723 cm2 compared to 700 ± 555 cm2 for the control group. Duration of intensive care unit admission in the study group was shorter at 4.2 ± 4.3 days compared to 6.7 ± 8.8 days for the control group. Duration of inpatient admission was longer in the study group, 28.2 ± 12.4 days, compared to 24.6 ± 11.9 days for the control group. Postoperative hypergranulation tissue occurred more frequently in the control group (52.6%) than in the study group (20%). Conclusion: While further evaluation in a larger cohort of patients is necessary, application of amniotic tissue matrix to surgically-excised hidradenitis wounds appears to offer an adjunctive improvement to the treatment of hidradenitis.

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Evaluation of dextromethorphan with select antidepressant therapy for the treatment of depression in the acute care psychiatric setting

Mental Health Clinician ◽

10.9740/mhc.2019.03.076 ◽

2019 ◽

Vol 9 (2) ◽

pp. 76-81 ◽

Cited By ~ 3

Author(s):

Jill L. Nofziger ◽

Chris Paxos ◽

Jessica Emshoff ◽

Chanda Mullen

Keyword(s):

Acute Care ◽

Retrospective Chart Review ◽

Antidepressant Therapy ◽

Antidepressant Effect ◽

Control Group ◽

Study Group ◽

Psychiatric Setting ◽

Treatment Of Depression ◽

The Difference ◽

And Control

Abstract Introduction Dextromethorphan (DXM), an N-methyl-D-aspartate receptor antagonist, may have ketamine-like antidepressant effects. Dextromethorphan is extensively metabolized via cytochrome P450 (CYP) 2D6, and its half-life in extensive metabolizers is 2 to 4 hours. The purpose of this study was to evaluate the effects of DXM in combination with a moderate-to-strong CYP2D6 inhibitor antidepressant on depression in an acute care psychiatric setting. Methods This was a single-center, retrospective chart review of adult patients with a depressive disorder diagnosis. Patients who received select antidepressant therapy with or without scheduled DXM were included. The primary outcome was the difference in time to improvement of depressive symptoms, which was an average composite of physician documentation, nurse documentation, and first time to 24 hours without as-needed anxiolytics or antipsychotics. The study group consisted of patients who received DXM with select antidepressant therapy, whereas the control group included those who received only select antidepressant therapy. Results A total of 40 patients were included. The median time to clinical improvement was 3.00 days and 2.83 days for the study group and control group, respectively (P = .986). The incidence of perceptual disturbances and delusions was higher in the study group as compared with the control group (55% and 35% vs 30% and 25%, respectively). Discussion Dextromethorphan was not associated with a rapid antidepressant effect. The commonly used dose of 30 mg daily may have been too low to have an effect; additionally, the most frequently utilized select antidepressant, bupropion, has moderately less CYP2D6 inhibition than fluoxetine and paroxetine.

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