scholarly journals Preprocedural Hypertension Is Not a Risk Factor for Postoperative Bleeding following Image-Guided Core Needle Breast Biopsy

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Ninad Salastekar ◽  
Alexis Saunders ◽  
Kushal Patel ◽  
Katherine Willer
Keyword(s):  
Risk Factor ◽  
Breast Biopsy ◽  
Postoperative Bleeding ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Core Needle ◽  
Image Guided ◽  
Prolonged Bleeding ◽  
Number Of Patients ◽  
Manual Pressure

Objective. To evaluate the association between preprocedural hypertension and the risk of prolonged bleeding following image-guided core needle breast biopsy in nonpregnant/nonlactating women. Methods. A single institution-based, retrospective cohort study of 400 women who underwent image-guided core needle breast biopsy was conducted. Males and pregnant and lactating women were excluded. Preprocedural systolic or diastolic blood pressure greater than 140 or 90 mm of Hg, respectively, was defined as hypertension. Prolonged bleeding was defined >15 minutes of local, manual pressure required to achieve hemostasis following the biopsy. Severe bleeding complications defined as clinical significant hematoma formation, prolonged bleeding requiring an ER visit, hospitalization, or surgical intervention were also recorded. Results. The difference in the mean time for which manual pressure was held after biopsy for patients with and without preprocedural hypertension was not statistically significant (13 ± 7 vs. 13 ± 8 minutes, respectively, P  = 0.856). There was no difference in the number of patients requiring manual postoperative pressure >15 minutes between those with preprocedural hypertension and the normotensive patients (13% vs. 12%, respectively, P  = 0.765). Bivariate analysis demonstrated statistically significant association between prolonged bleeding and current antithrombotic or antiplatelet medication use ( P  = 0.010), the use of stereotactic guidance ( P  = 0.019), and a tethered vacuum-assisted device ( P  = 0.045). The use of a tethered vacuum-assisted biopsy device was the only variable associated with prolonged bleeding in the multivariate model ( P  = 0.044). Conclusion. Preprocedural hypertension is not a risk factor for prolonged bleeding following image-guided core needle breast biopsies in nonpregnant/nonlactating women.

Menorrhagia in Women with Severe Bleeding Disorders

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4626-4626
Author(s):  
Susan Halimeh ◽  
Joanna Davies ◽  
Debra Pollard ◽  
Rezan Abdul-Kadir
Keyword(s):  
Tranexamic Acid ◽  
Surgical Intervention ◽  
Postoperative Bleeding ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Bleeding Disorders ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment ◽  
Factor Concentration

Abstract Abstract 4626 The management of menorrhagia presents a challenge in women with severe bleeding disorders. Conservative medical management is the first line treatment and most women with severe bleeding disorder require combination treatment. Surgical intervention may ultimately be offered to women in whom medical management has failed and whom no longer desire fertility. Women with low factor levels are at risk of perioperative bleeding complications and may require haemostatic support. A total of 50 women with severe factor deficiencies (less than 20iu/dL) were included in this study. 46 women were registered at the Haemophilia Centre at the Royal Free Hospital in London. Four cases were also included from the Rhine-Ruhr Haemophilia Centre in Duisburg, Germany. We reviewed the occurrence of menorrhagia and the management options that were offered. In those that required surgical intervention, the incidence of postoperative bleeding complications and the requirement for factor concentration was also reviewed. The bleeding disorders in these women were 34 (68%) with severe factor XI deficiency, 10 (20%) with severe type 1 and type 3 von Willebrand's disease, 4 (8%) with factor VII deficiency, 2 (4%) had factor V or X deficiencies and one (2%) had a combination of factor VI and VIII deficiency. The ISTH/SSC joint working group bleeding assessment tool was used to assess the severity and frequency of bleeding symptoms among this cohort of women. The bleeding scores ranged from −2 to 30 with a median score of 9.5. In total, 32 out of 50 (64%) women with severe factor deficiency required medical attention for menorrhagia. Medical treatment included hormonal preparations (combined oral contraceptive pill or levonorgestrel intrauterine device), which was used as a first line treatment in 15 out of 32 (46.8%) women. Haemostatic treatment included antifibrinolytic medication such as tranexamic acid, which was used in combination with hormonal therapy. One women required intranasal DDAVP, von Willebrand factor concentrate and tranexamic acid. Failure to control menstrual bleeding occurred in 14 (43.7%) women and surgical intervention was required. 7 out of 14 (50%) women required hysterectomy and the remaining 7 women underwent endometrial ablation. Prophylaxis with factor concentration to cover surgical intervention was given in 8 out of 14 women (64.2%). The remainder received tranexamic acid for 24–48 hours following surgery. Postoperative bleeding occurred in 7 women that had surgical intervention, despite two women receiving prophylaxis. This study highlights the complexity involved in the management of menorrhagia in women with severe bleeding disorders and the high risk of postoperative bleeding. Disclosures: No relevant conflicts of interest to declare.

Thrombophylaxis in Patients Undergoing Bariatric Surgery

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2080-2080
Author(s):  
Addie A Hill ◽  
Poy P Theprungsirikul ◽  
Maureen T Quigley ◽  
Mary E Menduni ◽  
Thadeus L Trus ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
High Risk ◽  
Risk Stratification ◽  
Postoperative Bleeding ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Delayed Bleeding ◽  
Vte Prophylaxis ◽  
Risk Patients ◽  
History Of

Abstract Background: Patients undergoing bariatric surgery are at increased risk for symptomatic venous thromboembolism (VTE). Although the incidence of clinical VTE is lower than in other general and orthopedic surgical procedures, pulmonary embolism is an independent predictor of death after gastric bypass surgery. The optimal strategy for postoperative thrombophylaxis in bariatric surgery has yet to be elucidated. In 2010 our institution proposed a guideline for postoperative thrombophylaxis for bariatric surgery based on risk stratification. Patients were considered high risk if they had history of VTE or a BMI >/= 60 kg/m2 or if they had two or more of the following: age > 50, BMI >/= 50 kg/m2, male sex, recent history of smoking, obstructive sleep apnea, varicose veins, or hormone therapy within 30 days. All patients undergoing bariatric surgery received enoxaparin 40 mg SC twice daily in addition to mechanical thrombophylaxis including venodynes and compression stockings during the hospital stay. Prophylactic IVC filter insertion was not recommended. High-risk patients received an extended course of anticoagulation for 10 days after discharge. Methods: We retrospectively reviewed the medical charts of 692 patients who underwent bariatric surgery at Dartmouth-Hitchcock Medical Center from 2009 to 2014. We analyzed the incidence of VTE and bleeding complications under two different institutional thrombophylaxis protocols: an earlier protocol of VTE prophylaxis based on surgeon's preference (n = 62) and our subsequent protocol based on risk stratification (n = 630). Results: Prior to implementing our protocol the incidence of VTE and bleeding complications in patients who underwent bariatric surgery was 1.6% (1 in 62) for each. After 2010, with the implementation of extended VTE prophylaxis for high-risk patients, the incidence of postoperative VTE was 0% (0 in 630) and the incidence of postoperative bleeding was 2.7% (17 in 630). Of 17 patients who developed postoperative bleeding, 14 (82%) developed bleeding before postoperative day 3 during the hospitalization and 3 (18%) experienced delayed bleeding after hospital discharge. Of 3 patients with delayed bleeding, only 1 was on the extended thrombophylaxis protocol. Severe bleeding, defined as the need for packed red blood cell transfusions or re-operation, occurred in 1.6% (10 in 630). Conclusion: Our study demonstrates that a protocol based on risk stratification is effective at reducing the risk of symptomatic VTE in patients undergoing bariatric surgery. Although the incidence of all postoperative bleeding appears to have increased slightly after implementation of the protocol, the incidence of severe bleeding appears unchanged. As most of the post-operative bleeding events occurred during the hospitalization period, extending the length of pharmacologic thromboprophylaxis was not associated with an increase in bleeding. This study is limited by its retrospective design and the small number of patients studied prior to implementing the extended VTE prophylaxis protocol. Nevertheless, the findings are promising with respect to VTE risk reduction after bariatric surgery and suggest that prospective evaluation of the thromboprophylaxis protocol is in order. Disclosures No relevant conflicts of interest to declare.

Kết quả sinh thiết kim lõi dưới hướng dẫn siêu âm trong chẩn đoán u bụng tại Bệnh viện Nhi Trung ương

2020 ◽  
Author(s):  
An Bui Van
Keyword(s):  
Solid Tumor ◽  
Core Needle Biopsy ◽  
Gold Standard ◽  
Needle Biopsy ◽  
Clinical Situation ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Ultrasound Guided ◽  
Core Needle ◽  
Abdominal Masses

Background: The gold standard for diagnosing tumor lesions is the result of pathology. Previously, patients had to perform the opened biopsies. Recently, most patients underwent ultrasound - guided core needle biopsy. Objective: recommendations for results and safety of ultrasound-guided core needle biopsy (UCNB) in the diagnosis of abdominal masses in children. Subjects and Methods: From June 2019 to June 2020, there were 105 patients with abdominal solid tumor who had been indicated to perform ultrasound-guided core needle biopsy in the National Children’s Hospital. Results: Of the 105 patients involved in the study, 88 were malignant (accounting for 83.8%) with the majority being neuroblastoma. 100% of patients had been performed procedures successly, but accurate pathological diagnosis reached 95.2%. 10.5% of patients was performed in an emergency clinical situation. Rate of complication with bleeding was 6.7%. Mortality was 1% due to severe hemorhage. Conclusion: Ultrasound-guided core needle biopsy is a method for result successful highly. The rate of severe bleeding complications is acceptable.

Bleeding Indicators and Wound Complications with Ximelagatran and Warfarin after TKR: Findings from 3 Clinical Trials.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1771-1771
Author(s):  
Scott D. Berkowitz ◽  
Charles W. Francis ◽  
Jennifer McElhattan ◽  
Clifford W. Colwell
Keyword(s):  
Postoperative Bleeding ◽  
Bleeding Complications ◽  
Wound Complications ◽  
Surgical Wound ◽  
Onset Of Action ◽  
Double Blind ◽  
Wound Drainage ◽  
Treatment Groups ◽  
Number Of Patients ◽  
Transfusion Requirements

Abstract Introduction: Prophylaxis of venous thromboembolism (VTE) in patients undergoing total knee replacement (TKR) most often entails anticoagulation, yet minimization of excessive postoperative bleeding and wound complications is critical to attain an excellent functional result. Ximelagatran (Exanta®, AstraZeneca), the first oral alternative to warfarin, has a rapid onset of action and requires no coagulation monitoring or dose adjustment. Three randomized, double-blind trials of VTE prophylaxis after TKR comparing ximelagatran 24 and 36 mg BID with well-controlled warfarin (target INR 2.5) were completed: Study 236 (n=680), EXULT A (n=2301), and EXULT B (n=2303). When administered for 7–12 days, ximelagatran 36 mg BID was superior to well-controlled warfarin, while 24 mg yielded numerically better but not statistically superior efficacy over warfarin. Adjudicated bleeding rates did not differ significantly. Objective: To assess the postoperative bleeding complications and overall surgical wound appearance during anticoagulation after TKR. Methods: Two comparison pools were created: 36-mg pool (ximelagatran 36 mg and corresponding warfarin groups from EXULT A and B) and 24-mg pool (ximelagatran 24 mg and corresponding warfarin groups from Study 236 and EXULT A). Bleeding indicators, i.e., postoperative wound drainage, bleeding index, and transfusion requirements, were compared. A prespecified subjective assessment of the surgical wound was performed on postoperative Day 3, end of treatment (Day 7–12), and at follow-up (4–6 weeks). If wound appearance was rated “worse than expected” at any time point, wound characteristics of swelling, drainage, erythema, and bleeding were assessed. Intra-articular bleeding, unusual bruising or hematoma, and bleeding requiring an intervention were also recorded. Results: 36-mg Pool (n=3810) 24-mg Pool (n=2178) Bleeding Indicators Ximelagatran Warfarin Ximelagatran Warfarin Post-op wound drainage, mean in mL (95% CI) 697 (675, 718) 704 (682, 725) 659 (632, 686) 654 (626, 682) Bleeding Index, mean (95% CI) 3.4 (3.3, 3.4) 3.3 (3.2, 3.4) 3.2 (3.1, 3.3) 3.1 (3.0, 3.2) Transfusions Unplanned, % of Pts 8.9 8.1 Not Assessed Not Assessed Total, % of Pts 33.5 33.6 37.6 34.3 Vol. Transfused/Pt, mean (95% CI) 630 mL (602, 659) 606 mL (578, 635) 1.7 U (1.6, 1.8) 1.7 U (1.6, 1.8) Overall wound appearance (worse than expected), % 9.2 8.7 8.9 8.2 Wound characteristics (worse than expected) Swelling, % 5.1 4.5 5.7 4.6 Drainage, % 3.6 2.4 2.7 1.8 Erythema, % 3.9 3.7 2.8 3.5 Bleeding, % 1.7 1.2 Not Assessed Not Assessed In the 36- and 24-mg pools the wound was assessed as “expected” or “better than expected” for ≥90% of the patients in the ximelagatran and warfarin groups. For the small number of patients with “worse than expected” wounds, the differences between the ximelagatran and warfarin groups were not statistically significant. Bleeding complications of the surgical wound, including intra-articular bleeding (<3.5%), unusual bruising or hematoma (<5.0%), and bleeding requiring an intervention (<0.9%), were few and comparable between treatment groups. Conclusions: Analysis of bleeding indicators and complications of the surgical wound revealed no significant differences between treatment groups, supporting the safety of 36 mg for all patients undergoing TKR.

scholarly journals Step-by-step of ultrasound-guided core-needle biopsy of the breast: review and technique

2013 ◽  
Vol 46 (4) ◽  
pp. 234-241 ◽  
Author(s):  
Rafael Dahmer Rocha ◽  
Renata Reis Pinto ◽  
Diogo Paes Barreto Aquino Tavares ◽  
Cláudia Sofia Aires Gonçalves
Keyword(s):  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Multidisciplinary Approach ◽  
Breast Biopsy ◽  
High Sensitivity ◽  
Ultrasound Guided ◽  
Core Needle ◽  
Number Of Patients ◽  
Proportional Increase

Ultrasound-guided core-needle biopsy has high sensitivity in the diagnosis of breast cancer. The present study is aimed at detailing the main steps of such procedure, including indications, advantages, limitations, follow-up and description of the technique, besides presenting a checklist including the critical steps required for an appropriate practice of the technique. In the recent years, an increasing number of patients have required breast biopsy, indicating the necessity of a proportional increase in the number of skilled professionals to carry out the procedures and histological diagnoses. A multidisciplinary approach involving the tripod clinical practice-radiology-pathology is responsible for the highest rate of accuracy of the technique and must always be adopted.

Optimizing the Patient Experience during Breast Biopsy

2019 ◽  
Vol 1 (2) ◽  
pp. 131-138 ◽  
Author(s):  
Mary Scott Soo ◽  
Rebecca A Shelby ◽  
Karen S Johnson
Keyword(s):  
Patient Satisfaction ◽  
Patient Experience ◽  
Breast Imaging ◽  
Breast Biopsy ◽  
Patient Communication ◽  
Patient Perspectives ◽  
Core Needle ◽  
Image Guided ◽  
Family Centered ◽  
Patient Concerns

Abstract For years, breast imaging has been the model in radiology for patient communication, and more recently, it has been a leader in the growing patient- and family-centered approach to care. To maintain high levels of patient satisfaction during image-guided core-needle breast biopsies, the radiologist should understand patient perspectives so that interventions can be developed to manage patient concerns. This article reviews patient perspectives before, during, and after imaging-guided breast biopsies, and it describes strategies to help optimize the experiences of patients as they navigate the process.

scholarly journals Image-Guided Core-Needle Breast Biopsy Is an Accurate Technique to Evaluate Patients With Nonpalpable Imaging Abnormalities

1998 ◽  
Vol 227 (6) ◽  
pp. 932-939 ◽  
Author(s):  
George M. Fuhrman ◽  
Gunnar J. Cederbom ◽  
John S. Bolton ◽  
Tari A. King ◽  
James L. Duncan ◽  
...  
Keyword(s):  
Breast Biopsy ◽  
Core Needle ◽  
Image Guided

scholarly journals Emergency gastrointestinal surgery in patients undergoing antithrombotic therapy in a single general hospital: a propensity score-matched analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shinya Abe ◽  
Katsunori Ami ◽  
Akira Katsuno ◽  
Noriyasu Tamura ◽  
Toshiko Harada ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Surgical Outcomes ◽  
Antithrombotic Therapy ◽  
Postoperative Bleeding ◽  
Gastrointestinal Surgery ◽  
Bleeding Complications ◽  
Perioperative Outcomes ◽  
Severe Bleeding ◽  
Estimated Blood Loss

Abstract Background This study aimed to review and evaluate the surgical outcomes, particularly intraoperative severe blood loss and postoperative blood complications, of emergency gastrointestinal surgery in patients undergoing antithrombotic therapy (AT). Emergency surgeries for patients with antithrombotic medication have been increasing in the aging population. However, the effect of AT on intraoperative blood loss and perioperative complications remains unclear. Methods We retrospectively reviewed 732 patients who underwent emergency gastrointestinal surgery between April 2014 and March 2019. Patients were classified into AT group and Non-AT group, and propensity score-matched analysis was performed to compare the short surgical outcomes between the groups. Additionally, risk factors in severe estimated blood loss (EBL) and postoperative bleeding complications were assessed. Results Altogether, 64 patients received AT; 50 patients and 12, and 2 were given antiplatelet and anticoagulant, and both drugs, respectively. After propensity score matching, EBL (101 vs. 99 mL; p = 0.466) and postoperative complications (14 vs. 16 patients; p = 0.676) were similar between the groups (63 patients matched paired). Intraoperative severe bleeding (EBL ≥ 492 mL) occurred in 44 patients. Multivariate analysis using the full cohort revealed that antithrombotic drug use was not an independent risk factor for severe bleeding and postoperative bleeding complications. Conclusions This study demonstrated antithrombotic drugs do not adversely affect the perioperative outcomes of emergency gastrointestinal surgery.

Anticoagulation in addition to dual antiplatelet therapy has no impact on long-term follow-up after endovascular treatment of (sub)acute lower limb ischemia

VASA ◽  
2019 ◽  
Vol 48 (4) ◽  
pp. 321-329
Author(s):  
Mariya Kronlage ◽  
Erwin Blessing ◽  
Oliver J. Müller ◽  
Britta Heilmeier ◽  
Hugo A. Katus ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Limb Ischemia ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Short Term ◽  
Long Term Follow Up

Summary. Background: To assess the impact of short- vs. long-term anticoagulation in addition to standard dual antiplatelet therapy (DAPT) upon endovascular treatment of (sub)acute thrombembolic occlusions of the lower extremity. Patient and methods: Retrospective analysis was conducted on 202 patients with a thrombembolic occlusion of lower extremities, followed by crirical limb ischemia that received endovascular treatment including thrombolysis, mechanical thrombectomy, or a combination of both between 2006 and 2015 at a single center. Following antithrombotic regimes were compared: 1) dual antiplatelet therapy, DAPT for 4 weeks (aspirin 100 mg/d and clopidogrel 75 mg/d) upon intervention, followed by a lifelong single antiplatelet therapy; 2) DAPT plus short term anticoagulation for 4 weeks, followed by a lifelong single antiplatelet therapy; 3) DAPT plus long term anticoagulation for > 4 weeks, followed by a lifelong anticoagulation. Results: Endovascular treatment was associated with high immediate revascularization (> 98 %), as well as overall and amputation-free survival rates (> 85 %), independent from the chosen anticoagulation regime in a two-year follow up, p > 0.05. Anticoagulation in addition to standard antiplatelet therapy had no significant effect on patency or freedom from target lesion revascularization (TLR) 24 months upon index procedure for both thrombotic and embolic occlusions. Severe bleeding complications occurred more often in the long-term anticoagulation group (9.3 % vs. 5.6 % (short-term group) and 6.5 % (DAPT group), p > 0.05). Conclusions: Our observational study demonstrates that the choice of an antithrombotic regime had no impact on the long-term follow-up after endovascular treatment of acute thrombembolic limb ischemia whereas prolonged anticoagulation was associated with a nominal increase in severe bleeding complications.

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