scholarly journals Life-Threatening Retroperitoneal Hematoma in a Patient with COVID-19

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Monarch Shah ◽  
John Paul Colombo ◽  
Sanya Chandna ◽  
Haris Rana
Keyword(s):  
Respiratory Illness ◽  
Suspected Case ◽  
Retroperitoneal Hemorrhage ◽  
Active Monitoring ◽  
Safety And Efficacy ◽  
Optimal Dosing ◽  
Therapeutic Anticoagulation ◽  
Hemorrhagic Complications ◽  
Life Threatening ◽  
Risk Of Hemorrhage

COVID-19 is a respiratory illness that affects the human body in many different ways. The disease carries both thrombotic and hemorrhagic complications, especially in those patients who are anticoagulated to prevent the thromboembolic manifestations. In this report, we discuss a case of retroperitoneal hemorrhage in a patient treated with therapeutic anticoagulation which ultimately led to the patient’s death. The literature highlights the importance of anticoagulation because it reduces mortality in patients hospitalized with COVID-19. Although, more recent studies suggest that patients treated with therapeutic anticoagulation are at a higher risk of hemorrhage and increased mortality. Therefore, our case stresses the importance of active monitoring of these patients to detect any suspected case of hemorrhage early to reduce mortality. Overall, more research should be conducted to determine the optimal dosing of anticoagulation that balances safety and efficacy.

scholarly journals Hemorrhagic Complications of Minimally Invasive Urological Surgeries, Treated with Selective Endovascular Embolization

2007 ◽  
Vol 7 ◽  
pp. 784-788
Author(s):  
Sarel Halachmi ◽  
Amos Ofer ◽  
Eduard Gershin ◽  
Ahuva Engel ◽  
Shimon Meretyk
Keyword(s):  
Minimally Invasive ◽  
Open Surgery ◽  
Kidney Tissue ◽  
Case Series ◽  
Endovascular Embolization ◽  
Angiographic Embolization ◽  
Hemorrhagic Complications ◽  
Life Threatening ◽  
Urological Procedures ◽  
Risk Of Hemorrhage

Minimally invasive urological procedures have gained in popularity and replaced open surgery in various urological procedures. Although considered minimally invasive, these procedures are not free from complications, and life-threatening hemorrhage may occur. Herein we describe 3 case series of patients who underwent minimally invasive urological surgeries that were complicated with bleeding. In all 3 patients we used super selective angiographic embolization to stop hemorrhage. Minimally invasive urological surgeries carry the risk of hemorrhage, and patients should be informed about this possibility. In hemodynnmic stable patients endovascular embolization allowed bleeding cessation with maximal preservation of the bleeding kidney tissue.

Safety and Efficacy of Argatroban in the Management of Heparin-Induced Thrombocytopenia

2011 ◽  
Vol 4 ◽  
pp. CMBD.S5118 ◽  
Author(s):  
Bernd Saugel ◽  
Roland M. Schmid ◽  
Wolfgang Huber
Keyword(s):  
Arterial Thrombosis ◽  
Pharmacokinetic Profile ◽  
The United States ◽  
Heparin Therapy ◽  
Direct Thrombin Inhibitor ◽  
Thrombin Inhibitor ◽  
Heparin Induced Thrombocytopenia ◽  
Safety And Efficacy ◽  
Increased Risk ◽  
Life Threatening

Heparin-induced thrombocytopenia (HIT) is a life-threatening adverse reaction to heparin therapy that is characterized by thrombocytopenia and an increased risk of venous and arterial thrombosis. According to guidelines, in patients with strongly suspected or confirmed HIT all sources of heparin have to be discontinued and an alternative, nonheparin anticoagulant for HIT treatment must immediately be started. For both the prophylaxis of thrombembolic events in HIT and the treatment of HIT with thrombosis the direct thrombin inhibitor argatroban is approved in the United States. The objective of this review is to describe the mechanism of action and the pharmacokinetic profile of argatroban, to characterize argatroban regarding its safety and therapeutic efficacy and to discuss its place in therapy in HIT.

Life-Threatening Non-Allergic Drug Hypersensitivity Reaction as a Very Rare Side Effect of Rivaroxaban Administration in the Netherlands

2021 ◽  
pp. 153857442110047
Author(s):  
Nadia A. G. Hakkenbrak ◽  
Maarten Truijers
Keyword(s):  
The Netherlands ◽  
Hypersensitivity Reaction ◽  
Anaphylactic Reaction ◽  
Side Effect ◽  
Drug Hypersensitivity ◽  
Oral Anticoagulants ◽  
Clinical Signs ◽  
Hemorrhagic Complications ◽  
Drug Hypersensitivity Reaction ◽  
Life Threatening

Background: Anticoagulant therapy is indicated for the prevention and treatment of thromboembolic disease. Direct oral anticoagulants (DOACs) are frequently prescribed and Rivaroxaban is the most frequently administered DOAC in the Netherlands. Most side effects relate to hemorrhagic complications, however, also non-hemorrhagic side effect may be potentially life threatening. Case presentation: A 74-year-old man presented at the emergency department with a ruptured infrarenal abdominal aortic aneurysm for which open aneurysm repair was performed. Postoperatively, the patient developed neurological deficit, respiratory and circulatory failure following rivaroxaban administration, initiated for atrial fibrillation. Even though, the clinical signs resembled an anaphylactic reaction, the skin-prick test was negative and complications most likely resulted from a non-allergic drug hypersensitivity reaction. Conclusion: This case report shows that non-allergic drug hypersensitivity reactions may mimic an anaphylactic reaction and can be potentially life threatening. In addition, severe non-hemorrhagic complications after rivaroxaban administration do occur and should be considered in case of acute clinical deterioration.

Fab Fragments in Treatment of Digoxin Ingestion

PEDIATRICS ◽  
1983 ◽  
Vol 71 (1) ◽  
pp. 137-137
Author(s):  
THOMAS W. SMITH
Keyword(s):  
Multicenter Trial ◽  
Clinical Safety ◽  
Digitalis Toxicity ◽  
Safety And Efficacy ◽  
Fab Fragments ◽  
Life Threatening ◽  
September Issue

To the Editor.— Accompanying the paper of Zucker et al in the September issue of Pediatrics1 is a listing of sources from which digoxin-specific Fab fragments are stated to be available. Unfortunately, this is no longer the case. All of the individuals and institutions listed have been part of a multicenter trial of clinical safety and efficacy of purified digoxin-specific Fab fragments in the treatment of advanced, life-threatening digitalis toxicity. At the present time, however, supplies of the material are extremely limited, and several of the centers listed have exhausted their supplies of digoxin-specific Fab fragments.

Cancer and COVID-19: A proposed mechanism with therapeutic interventions.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 3135-3135
Author(s):  
Yan Leyfman ◽  
Nancy Emmanuel ◽  
Aleksey Tentler ◽  
Jared Cappelli ◽  
Timothy K Erick ◽  
...  
Keyword(s):  
Respiratory Illness ◽  
Organ Damage ◽  
Multiple Organ ◽  
Therapeutic Interventions ◽  
Actual Number ◽  
Data Registry ◽  
Number Of Patients ◽  
Increased Risk ◽  
Life Threatening ◽  
Active Cancer

3135 Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel betacoronavirus that causes the respiratory illness coronavirus disease 2019 (COVID-19). COVID-19 ranges in severity from an asymptomatic viral infection to life-threatening cases of pneumonia, acute respiratory distress syndrome (ARDS), multi-organ damage and sepsis. Cancer patients are at an increased risk of severe SARS-CoV-2 infection due to their immunocompromised status. We propose a mechanism by which SARS-CoV-2 infection causes multiple organ damage through IL-6-mediated inflammation and hypoxia-induced cellular metabolic alterations leading to cell death. Hypoxia is also induced by malignancy due to alterations in metabolism, resulting in greater IL-6 secretion. Methods: To highlight the possible effect of active cancer on the likelihood of hypoxia in COVID-19, we analyzed the correlation between cancer status and the severity of COVID-19 from the COVID-19 and Cancer Consortium data registry. For cancer status, we looked at progressive cancer and remission of cancer only -- those being the two extremes of presence and absence of uncontrolled cancer. Similar to prior studies, the severity of COVID-19 was used as an indication of hypoxia. Results: We observed a 24% positive deviation between expected and actual number of patients with actively progressing cancer who had hypoxic COVID-19 (moderate to severe), and a 26.9% negative deviation between expected and actual number of patients with active cancer who had no hypoxia with COVID-19 (p<0.0001). Conversely, for patients with cancer in remission, there was only a +5.8% and -5.1% deviation between expected and actual number of patients who did not have hypoxia and who had hypoxia, respectively. Conclusions: These results suggest that in the presence of poorly controlled malignancy, there is an increased likelihood of hypoxia in patients with COVID-19, thereby exacerbating downstream cytokine release syndrome and contributing to prolonged systemic inflammatory injury. Appreciating this pathway, future therapies can be developed to target the pathogenesis of both diseases and prevent progression, as seen with mesenchymal stem cells, which demonstrated a 91% overall survival and 100% survival in patients younger than 85 years old at one month after a single treatment.[Table: see text]

scholarly journals Safety and efficacy of bivalirudin in diabetic acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI)

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Golam Mostofa ◽  
T Parvin ◽  
R Masum Mandal ◽  
S Ali Ahsan ◽  
R Afrin
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Major Bleeding ◽  
Guide Wire ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Safety And Efficacy ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Hemorrhagic Complications

Abstract Background Prevention of hemorrhagic complications has emerged as a priority in patients undergoing Percutaneous Coronary Intervention (PCI) in addition to suppressing thrombotic complications. This goal is challenging to achieve in diabetic Acute Coronary Syndrome (ACS) patients as Diabetes Mellitus (DM) itself is a prothrombotic state with more pronounced vascular injury response and have a worse outcome after PCI compared with non-diabetic patients. In patients with ACS, Bivalirudin has been shown to result in similar rates of composite ischemia as Heparin plus GPI (GP IIb /IIIa inhibitor), while significantly reducing major bleeding and has received class I recommendation for PCI by American College of Cardiology (ACC 2013). Whether Bivalirudin is safe and effective specially in diabetic ACS patients undergoing PCI, as compared with Heparin (UFH) monotherapy, is unknown. Purpose To determine and compare the incidence of in-hospital and 30-day hemorrhagic complications and major adverse cardiac events (MACEs) as evidence of safety and efficacy using Bivalirudin versus Heparin in diabetic ACS patients undergoing PCI. Methods 218 diabetic ACS patients (age&gt;18 years and ≤75 years) who underwent PCI from May 2018 to April 2019 at University Cardiac Centre, BSM Medical University, Dhaka, Bangladesh were randomly assigned to have UFH or Bivalirudin. Before the guide wire crossed the lesion, 111 patients in the UFH group received a bolus of 70–100 U/kg (targeted activated clotting time, ACT: 200–250 s). 107 patients in the Bivalirudin group received a loading dose of 0.75 mg/kg, followed by an infusion of 1.75 mg/kg/h for up to 4 hours. Dual antiplatelet (DAPT) loading as Aspirin 300 mg plus P2Y12 inhibitors (Clopidogrel 600 mg or Prasugrel 60 mg or Ticagrelor 180 mg) was given in all patients before the procedure. The maintenance dose of DAPT was continued for at least one month and patients were followed telephonically up to 30 days. The outcome measures were in-hospital and 30-day hemorrhagic complications and MACEs [death, MI, target vessel revascularization (TVR) and stroke]. Results Patients treated with Bivalirudin compared with Heparin had a significantly lower in-hospital incidence of QMI (0% vs. 6%; p=0.03) and major bleeding (0% vs. 7%; p=0.02). However, the incidence of cardiac death, stent thrombosis, TVR were no differences between two groups (p&gt;0.05). There was only one NQMI in the Bivalirudin group as opposed to 8% in the Heparin group in 30 days following stenting (p=0.04). Conclusion In diabetic ACS patients undergoing PCI, Bivalirudin is safe and effective as it reduces immediate and short-term hemorrhagic complications as well as MACEs as compared with Heparin. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals An unusual experience with endoscopic retrograde cholangiopancreatography

2013 ◽  
Vol 04 (04) ◽  
pp. 114-116 ◽  
Author(s):  
Mallikarjun Patil ◽  
Keyur A. Sheth ◽  
C. K. Adarsh ◽  
B. Girisha
Keyword(s):  
Gastrointestinal Tract ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Guide Wire ◽  
Rare Complication ◽  
Endoscopic Retrograde ◽  
Endoscopic Procedures ◽  
Hepatic Hematoma ◽  
Hemorrhagic Complications ◽  
Life Threatening ◽  
Therapeutic Utility

AbstractThe endoscopic retrograde cholangiopancreatography (ERCP) is known for its varied diagnostic and therapeutic utility for a variety of disorders. However it has greater likelihood of procedure related complications among the endoscopic procedures of gastrointestinal tract. The extraluminal hemorrhagic complications following ERCP are potentially life threatening though relatively rare. We present a 50 year patient with choledocholithiasis and cholelithiasis developing rare complication of subcapsular hepatic hematoma, following ERCP due to guide wire injury.

scholarly journals Retroperitoneal Hematoma Following Enoxaparin Treatment in an Elderly Woman - A Case Report

1970 ◽  
Vol 3 (1) ◽  
pp. 94-97 ◽  
Author(s):  
MM Haq ◽  
SDM Taimur ◽  
SR Khan ◽  
MA Rahman
Keyword(s):  
Acute Coronary Syndrome ◽  
Fatal Outcome ◽  
Anticoagulation Therapy ◽  
Retroperitoneal Hematoma ◽  
Low Molecular Weight ◽  
Retroperitoneal Hemorrhage ◽  
Coronary Syndrome ◽  
Anticoagulation Treatment ◽  
Life Threatening ◽  
Arterial Aneurysms

Retroperitoneal hematoma may occur as a result of trauma, rupture of arterial aneurysms (aortic or iliac), surgical complications, tumors and anticoagulation therapy. A life threatening retroperitoneal hemorrhage or hematoma is an infrequent complication of anticoagulation treatment. Enoxaparin is a low-molecular-weight heparin (LMWH) with several advantages over unfractionated heparin. Nevertheless, enoxaparin use is not without risk and severe retroperitoneal bleeding may occur following its use with a potentially fatal outcome. We report a case of sixty six years old female patient who develops a fatal retroperitoneal hematoma two days after enoxaparin treatment for acute coronary syndrome. Keywords: Retroperitoneal hematoma; Enoxaparin; Acute coronary syndrome. DOI: 10.3329/cardio.v3i1.6434Cardiovasc. j. 2010; 3(1): 94-97

Prehospital External Aortic Compression for Temporizing Exsanguinating Sub-Diaphragmatic Hemorrhage – A Promising Technique, but with Challenges: Four Illustrative Cases, Including Two Survivors

2020 ◽  
Vol 35 (1) ◽  
pp. 115-118
Author(s):  
Bruce Richard Paix ◽  
David John Tingey ◽  
Grant Copley ◽  
Matthew Casson ◽  
Damien Shoolbread ◽  
...  
Keyword(s):  
Lower Limb ◽  
Post Partum ◽  
Promising Technique ◽  
Safety And Efficacy ◽  
Stab Wounds ◽  
Compression Device ◽  
Life Saving ◽  
Limb Trauma ◽  
Life Threatening ◽  
Lower Limb Trauma

AbstractExternal aortic compression (EAC) has long been used to control exsanguinating post-partum hemorrhage, but it has only recently been described in the prehospital trauma setting. This paper reports four cases where manual EAC was used during transport to manage life-threatening bleeding, twice from stab wounds, once from ruptured ectopic pregnancy, and once from severe lower-limb trauma. It showed that EAC has life-saving potential in the prehospital setting, but that safety and efficacy during transport requires the use of a hands-free compression device, such as an aortic tourniquet.

Safety and Efficacy of Tirofiban in Stent-Assisted Coil Embolization of Intracranial Aneurysms

Neurosurgery ◽  
2012 ◽  
Vol 71 (3) ◽  
pp. 710-714 ◽  
Author(s):  
Nohra Chalouhi ◽  
Pascal Jabbour ◽  
David Kung ◽  
David Hasan
Keyword(s):  
Intracranial Aneurysms ◽  
Thromboembolic Events ◽  
Intracranial Hemorrhages ◽  
Maintenance Infusion ◽  
Safety And Efficacy ◽  
Computed Tomographic ◽  
Rescue Treatment ◽  
Arterial Recanalization ◽  
Risk Of Hemorrhage ◽  
Initial Bolus

Abstract BACKGROUND: Thromboembolic complications are a major concern in stent-assisted coiling of intracranial aneurysms that may be prevented with adequate antiplatelet therapy. OBJECTIVE: To assess the safety and efficacy of tirofiban in stent-assisted coiling. METHODS: Two protocols were used. In the initial protocol, tirofiban was administered intravenously as a 0.4 μg/kg per min bolus for 30 minutes followed by 0.10 μg.kg−1 min−1 maintenance infusion. The revised protocol consisted of a 0.10 μg.kg−1 min−1 maintenance infusion alone. RESULTS: Sixty-seven patients received tirofiban, 16 under the initial protocol and 51 under the revised protocol. Thirty (44.8%) patients had sustained a subarachnoid hemorrhage (SAH). Tirofiban infusion was initiated after thromboembolic events in 9 (13.4%) patients and prophylactically in 58 (86.6%). Four (6.0%) intracranial hemorrhages were noted. Three (18.8%) intracranial hemorrhages occurred with the initial protocol in patients treated electively and were fatal in 2 (66.7%) cases. The only complication (1.9%) under the revised protocol was a subclinical worsening of the computed tomographic appearance of an SAH. There was no tirofiban-related morbidity or deaths with the revised protocol. Of 9 patients that received tirofiban as a rescue treatment, 7 (77.8%) had complete and 2 (22.2%) had partial arterial recanalization. No thromboembolic events occurred in patients receiving prophylactic tirofiban. CONCLUSION: A bolus followed by a maintenance dose of tirofiban appears to have a high risk of cerebral hemorrhage. A maintenance infusion without an initial bolus, however, has an exceedingly low risk of hemorrhage and appears to be very safe and effective, even in the setting of SAH.

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