Bronchoscopic intratumoral injection of tranexamic acid to prevent excessive bleeding during multiple forceps biopsies of lesions with a high risk of bleeding: a prospective case series

Introduction: So far, only heparin-based anticoagulation has been proposed during polymyxin-B hemoperfusion. However, postsurgical septic patients can be at high risk of bleeding due to either surgical complications or septic coagulation derangement. Consequently, heparin should not represent in some cases the anticoagulation regimen of choice in this type of patients. Methods and results: We present a case series of four postsurgical septic patients treated with polymyxin-B hemoperfusion using regional citrate anticoagulation. All the treatments were performed without complications. During each treatment, there were no episodes of filter clotting, no bleeding, and no metabolic complications for any of the patients. Conclusion: To our knowledge, this is the second published report on the use of citrate anticoagulation during polymyxin-B hemoperfusion. Our case series continued to show that regional citrate anticoagulation regimen is feasible and safe during polymyxin-B hemoperfusion treatment in postsurgical septic patients.

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Management of anti-thrombotic therapy in patients with recent percutaneous coronary intervention and acute dengue infection: A case series

Proceedings of Singapore Healthcare ◽

10.1177/2010105819841395 ◽

2019 ◽

Vol 28 (4) ◽

pp. 284-287

Author(s):

Wishnu Aditya ◽

Jonathan Yap ◽

Piotr Chlebicki ◽

Charles Wah Hak Chan ◽

Jack Wei Chieh Tan

Keyword(s):

Percutaneous Coronary Intervention ◽

High Risk ◽

Dengue Infection ◽

Case Series ◽

Coronary Intervention ◽

Careful Consideration ◽

Risk Of Bleeding ◽

Anti Platelet Therapy ◽

Percutaneous Coronary ◽

The Ideal

There is currently little data regarding the ideal management for a patient who has undergone recent percutaneous coronary intervention (PCI) and subsequently develops dengue fever. Patients with recent PCI are at high risk of stent thrombosis with cessation of dual anti-platelet therapy. On the other hand, patients with dengue viral infection are at high risk of bleeding. Managing patients with recent PCI and dengue involves the delicate balancing of the risk of thrombosis and bleeding. Careful consideration of the timing of coronary intervention and the severity of the dengue infection is required. We describe the management of the anti-thrombotic therapy in three different patients with dengue infection and recent PCI and discuss our approach to managing such patients.

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Topical Tranexamic Acid in Total Knee Arthroplasty: Does It Augment the Effect of the Intravenous Administration in Patients with Moderate-to-High Risk of Bleeding? A Randomized Clinical Trial

The Journal of Knee Surgery ◽

10.1055/s-0040-1710549 ◽

2020 ◽

Author(s):

Ahmed A. Abdallah ◽

Asser A. Sallam ◽

Mohamed S. Arafa ◽

Ayman T. Henawy

Keyword(s):

High Risk ◽

Blood Loss ◽

Tranexamic Acid ◽

Total Blood Loss ◽

Transfusion Rate ◽

Total Blood ◽

Risk Of Bleeding ◽

Hidden Blood Loss ◽

Total Knee ◽

Topical Tranexamic Acid

AbstractThis study aimed to compare the superimposed clinical value of topical tranexamic acid (TXA) application when it is simultaneously combined with intravenous (IV) administration versus the use of either IV TXA alone or IA TXA alone during primary total knee arthroplasty (TKA) in patients with moderate-to-high risk of bleeding. We hypothesized that the combined administration approach will result in a more adequate reduction in the perioperative blood loss and blood transfusion rate. Ninety-four patients undergoing primary TKA were randomly allocated into intra-articular (IA) alone, IV alone, and combined group. We used 2 g of IV TXA in the IV TXA alone and combined groups 10 minutes before tourniquet deflation. However, we applied 1.5 g TXA in 100 mL isotonic saline half topically before arthrotomy closure and half retrogradely after wound closure through the drain. Follow-up period was 6 weeks. The primary outcome measures included the drainage blood volume, total blood loss, hidden blood loss, intraoperative blood loss, and the allogenic transfusion rate. Secondary outcomes included postoperative hemoglobin drop, amount of transfused blood units, thromboembolism, and wound complications. Combined administration of TXA provided significantly better results in terms of blood volume collected by the drain, total blood loss, and hidden blood loss (p < 0.01). Contrarily, the intraoperative blood loss, the allogeneic transfusion rate, and the number of transfused units were similar in all groups (p > 0.05). The subgroup analysis revealed that a combined IA and IV TXA administration significantly reduced the total blood loss in patients with either moderate or high risk of bleeding. Moreover, the degree of hemoglobin drop was significantly lesser with the combined approach. No thromboembolic complications or wound infection occurred. In conclusion, the combined use of topical and IV tranexamic acid resulted in a significant reduction in postoperative blood loss and hemoglobin level following TKA but did not influence the rate of allogeneic blood transfusion. This is a Level I, therapeutic study.

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Closure or medical therapy of patent foramen ovale in cryptogenic stroke: prospective case series

Neurological Research and Practice ◽

10.1186/s42466-021-00114-3 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Sven Poli ◽

Elisabeth Siebert ◽

Joshua Mbroh ◽

Khouloud Poli ◽

Markus Krumbholz ◽

...

Keyword(s):

High Risk ◽

Medical Therapy ◽

Intracranial Hemorrhage ◽

Patent Foramen Ovale ◽

Case Series ◽

Low Risk ◽

Foramen Ovale ◽

Prospective Case Series ◽

Pfo Closure

Abstract Background Results of randomized controlled trials (RCT) do not provide definite guidance for secondary prevention after ischemic stroke (IS)/transient ischemic attack (TIA) attributed to patent foramen ovale (PFO). No recommendations can be made for patients > 60 years. We aimed to compare interventional and medical PFO-management in cryptogenic IS/TIA patients, including patients > 60 years. Methods Prospective case series including consecutive cryptogenic IS/TIA patients with PFO at Tuebingen university stroke unit, Germany. ‘PFO-closure’ was recommended in patients ≤70 years when featuring high-risk PFO (i.e., with atrial septal aneurysm, spontaneous, or high-grade right-to-left shunt during Valsalva). Primary (recurrent IS/intracranial hemorrhage) and secondary endpoints (e.g., disability) were assessed during ≥1-year follow-up; planned subgroup analyses of patients ≤60/> 60 years. Results Among 236 patients with median age of 58 (range 18–88) years, 38.6% were females and median presenting National Institutes of Health Stroke Scale score was 1 (IQR 0–4). Mean follow-up was 2.8 ± 1.3 years. No intracranial hemorrhage was observed. Recurrent IS rate after ‘PFO-closure’ was 2.9% (95%CI 0–6.8%) and 7% (4–16.4) in high-risk PFO patients ≤60 (n = 103) and > 60 years (n = 43), respectively, versus 4% (0–11.5) during ‘medical therapy alone’ MTA (n = 28). 42 low-risk PFO patients treated with MTA experienced no recurrent IS/TIA. Conclusions In our real-world study, IS recurrence rate in ‘PFO-closure’ high-risk PFO patients ≤60 years was comparable to that observed in recent RCT. High-risk PFO patients > 60 years who underwent PFO-closure had similar IS recurrence rates than those who received MTA. MTA seems the appropriate treatment for low-risk PFO. Trial registration ClinicalTrials.gov, registration number: NCT04352790, registered on: April 20, 2020 – retrospectively registered.

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A Prospective Case Series of High-risk Infants who Developed Autism

Journal of Autism and Developmental Disorders ◽

10.1007/s10803-006-0328-2 ◽

2007 ◽

Vol 37 (1) ◽

pp. 12-24 ◽

Cited By ~ 230

Author(s):

Susan E. Bryson ◽

Lonnie Zwaigenbaum ◽

Jessica Brian ◽

Wendy Roberts ◽

Peter Szatmari ◽

...

Keyword(s):

High Risk ◽

Case Series ◽

Prospective Case Series ◽

High Risk Infants

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Haemostatic agents in critical illness

10.1093/med/9780199600830.003.0052 ◽

2016 ◽

Author(s):

Beverley J. Hunt

Keyword(s):

High Risk ◽

Tranexamic Acid ◽

Arterial Thrombosis ◽

High Rate ◽

Excessive Bleeding ◽

Major Benefit ◽

Haemostatic Agents ◽

Increased Risk ◽

Very High ◽

Previous Assumption

Antifibrinolytics can prevent excessive bleeding during surgery and are also used to reduce established bleeding. By blocking the effects of plasmin, they prevent premature clot breakdown and enhance clot stability. The CRASH-2 trial showed that use of tranexamic acid in those with or at high risk of traumatic haemorrhage reduced mortality by 9%. Importantly for a drug that affects haemostasis, there appears to be no increased risk of either arterial or venous thromboembolism. Aprotinin while an excellent agent in reducing bleeding disproves previous assumption that reducing bleeding improves outcome, for the BART study demonstrated an increased mortality compared with tranexamic acid and EACA. It is still used occasionally in very high risk cardiac surgery patients. DDAVP (desmopressin) stimulates platelet function and is of use in patients with uraemia, although needs to be given with an antifibrinolytics, because it does also stimulate fibrinolytic activity. Off-license use of rVIIa is waning, clinical trials have as yet failed to show major benefit. Moreover, there is a high rate of arterial thrombosis after using rVIIA.

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