scholarly journals Evaluation of a shortened course of tranexamic acid for patients with inherited bleeding disorders following dental procedures

2018 ◽  
Vol 5 (1) ◽  
pp. 42-49
Author(s):  
Allison Greig
Keyword(s):  
Tranexamic Acid ◽  
Cost Savings ◽  
Bleeding Risk ◽  
Service Evaluation ◽  
University Hospital ◽  
Bleeding Complications ◽  
Bleeding Disorders ◽  
Telephone Interviews ◽  
Patient Interviews ◽  
Dental Procedures

Abstract People with Inherited Bleeding Disorders (IBD) are often prescribed a course of Tranexamic Acid (TXA) mouthwash for five to seven days following dental procedures to reduce the risk of bleeding. Informal discussions with patients suggested that many do not complete the prescribed course of treatment. A literature review indicated that TXA was prescribed inappropriately for procedures with a low bleeding risk, and that there are inconsistencies in the recommended dose, mode of administration and duration of TXA for this patient group. A new protocol was implemented in the haemophilia centre at St George’s University Hospital NHS Foundation Trust, London, to rationalise the prescribing of TXA in dental procedures. A study was conducted to explore patients’ experience of this new guideline in the form of a service evaluation. Structured telephone interviews were completed following 39 dental procedures to collect data on concerns about bleeding; whether TXA was taken as prescribed and reasons for non-adherence; and any unplanned post-operative treatment. The financial impact of the new guideline was also explored. Patients were supportive of the new regimen, although almost half (46%) did not complete the prescribed course of TXA. The majority (37/39) were prescribed tablets rather than mouthwash. No patients required additional unplanned haemostasis support to control haemorrhage. Cost savings were made by replacing a five- to seven-day course of TXA mouthwash with a three-day course of TXA tablets. Although the data collected from patient interviews supports the new guideline, patients appear to be making decisions about taking TXA based on their own experience rather than following the prescribed regimen. Prescribers should support patients to make informed decisions about their medicines and incorporate patient experience into individualised regimens. Given the lack of bleeding complications experienced in this cohort of patients, it is possible that TXA is being overprescribed. Further work exploring how patients with IBDs make decisions about taking medicines is needed.

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.

Hemorrhagic Complications With Adenotonsillectomy In Children and Young Adults With Bleeding Disorders

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3611-3611
Author(s):  
Deepti M. Warad ◽  
Fareeda TN. Hussain ◽  
Shelagh A. Cofer ◽  
Vilmarie Rodriguez
Keyword(s):  
Young Adults ◽  
Tranexamic Acid ◽  
Surgical Procedures ◽  
Pediatric Patients ◽  
Aminocaproic Acid ◽  
Bleeding Complications ◽  
Recurrent Bleeding ◽  
Bleeding Disorders ◽  
Hemorrhagic Complications ◽  
Children And Young Adults

Abstract Hemorrhagic complications remain a challenge with surgical procedures in patients with bleeding disorders. Tonsillectomy and adenoidectomy are some of the most common surgical procedures performed in pediatric patients. Adequate hemostasis in patients with bleeding disorders is centered on comprehensive hemostatic support and dexterous surgical technique. To assess our institutional experience with children and young adults with bleeding disorders that underwent tonsillectomy and/or adenoidectomy we performed a retrospective chart review of all such patients (age< 25 years) over duration of 20 years from July 1992 to July 2012. Nineteen patients were identified. The mean age was 10.2 years (Range 2.5 – 23.2 years) with 13 females and 6 males. The cohort included 2 patients with platelet disorders, 5 patients with von Willebrand disease and 12 patients with factor deficiencies (see table 1). Sixteen patients (84%) underwent tonsillectomy and adenoidectomy, while 3 patients (16%) underwent tonsillectomy only. Pre-operative treatment in the form of coagulation factor infusion (with a goal of 100% factor levels prior to surgery) or DDAVP was given to 16 patients (84%). Nine patients (47%) received anti-fibrinolytic agent, aminocaproic acid, starting pre-operatively for an average of 15.5 days (Range 10 – 36 days) post-operatively. Six patients (32%) received aminocaproic acid only post-operatively for an average of 12 days (Range 7-14 days). One patient received Tranexamic acid for 19 days. Intraoperative hemostasis was achieved by electrocautery in 16 patients (84%) and coblation technique in 2 patients (10%). Surgical hemostasis technique for 1 patient was undocumented, however this patient did not have any bleeding complications subsequently. Ten patients (53%) experienced post-operative hemorrhage including 2 patients (10%) with early (<24 hours) bleeding and 8 patients (42%) with delayed (>24 hours) bleeding from surgical site. Bleeding resolved spontaneously in 2 patients while 8 patients (42%) required interventions such as cauterization (4 patients), extended aminocaproic acid dosing (4 patients), DDAVP (1 patient), DDAVP and tranexamic acid (1 patient), recombinant factor VII (1 patient), Humate-P® (1 patient), Factor VIII infusion (1 patient) and Factor IX infusion (1 patient). Three patients (30% of bleeding patients) required transfusions including 1 patient that received platelet transfusions, 1 patient received PRBCs and another patient received FFP. Recurrent bleeding was noted in 3 patients and the rate was significantly higher in older patients amongst those with bleeding complications (p=0.0189).Table 1Age (years, months)GenderDiagnosisSeverity of diseasePost-operative bleeding (Early ≤ 24 hours, Delayed >24 hours)Recurrent bleeding14,5MEssential ThrombocythemiaModerateEarlyYes13,6MFactor VII deficiencyMildDelayedNo6,7FFactor VII deficiencyMildDelayedNo7,6FFactor VII deficiencyMildNo-11,2FFactor XI deficiencyMildEarlyNo8,4MHemophilia ASevereDelayedNo9,4FHemophilia A carrierMildDelayedNo15,2FHemophilia A carrierMildNo-5,0MHemophilia BMildNo-23,2MHemophilia BMildDelayedYes6,1FHemophilia B carrierMildNo-6,8FHemophilia B carrierMildNo-15,2FHemophilia B carrierMildNo-11,4FMay-Hegglin anomalyModerateDelayedNo4,0FType 1 von WillebrandMildDelayedNo13,5FType 2A von WillebrandModerateDelayedYes2,5MType 2A von WillebrandModerateNo-9,9FType 2B von WillebrandModerateNo9,1FType III von WillebrandSevereNo- The rate of bleeding complications in pediatric patients with mild bleeding disorders undergoing adenotonsillectomy has been reported to be similar to that of normal population. In our cohort, delayed bleeding was more common than early bleeding consistent with current literature. We observed a higher rate of bleeding complications (53%) than reported in literature despite aggressive hemostatic support and adequate surgical techniques; however, our sample size was limited. Although there was no association between delayed hemorrhage and age, recurrent bleeding was associated with older age. We conclude that patients with bleeding disorders undergoing adenotonsillectomy are at a higher risk of bleeding and require close monitoring with hemostatic support for a prolonged period of time in post-operative period. Disclosures: No relevant conflicts of interest to declare.

Spectrum of Non-Traumatic Bleeding Complaints among women with Bleeding Disorders

2021 ◽  
Vol 15 (9) ◽  
pp. 2955-2957
Author(s):  
Muhammad Sarwar Khan ◽  
Kiran Aamir ◽  
Aamir Ramzan ◽  
Aasma Naz ◽  
Khalil Ahmed Memon ◽  
...  
Keyword(s):  
Urban Areas ◽  
University Hospital ◽  
Common Finding ◽  
Bleeding Disorders ◽  
Early Referral ◽  
Patient Interviews ◽  
Appropriate Treatment ◽  
Probable Presence ◽  
Traumatic Bleeding ◽  
Laboratory Investigations

Objective: To study the spectrum of bleeding complaints among women with bleeding disorders. Methodology: This observational study was done at Dept. of Pathology – Liaquat University Hospital, Hyderabad from January 2019 to July 2019 upon a sample of 121 women, selected via non-probability, consecutive sampling). Women presenting to study setting with complaints of non-traumatic bleeding were included in the study. After taking written informed consent, the data was obtained from patient interviews and laboratory investigations was. The data obtained was analyzed using SPSS v. 21.0. Results: The mean age of the women was 28.13 years (±5.21 SD). Among the 121 women studied, 73.55% hailed from urban areas, while 26.45% were from rural residential background. The most common presenting complaint was menorrhagia (30.58%), followed by bruising (17.36%) and epistaxis (15.7%). Among the underlying hemostatic pathologies, VWD was the most common (15.7%), followed by other platelet dysfunctions comprising the second most common finding (6.6%). Mean duration of presence of symptoms was 34 months (±17 SD). Conclusion: As per the findings of this study, menorrhagia, occasional bruising and epistaxis are reported to be the most common non-traumatic bleeding complaints among women with bleeding disorders. The presence of these symptoms may serve as potential indicators of the probable presence such as bleeding disorders and help in early referral, timely diagnosis and appropriate treatment. Keywords: menorrhagia, epistaxis, Hemostatic Dysfunction, Bleeding Disorder, Non traumatic bleeding complaints

scholarly journals Glanzmann’s Thrombastenia: The Role of Tranexamic Acid in Oral Surgery

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Rocco Franco ◽  
Michele Miranda ◽  
Laura Di Renzo ◽  
Antonino De Lorenzo ◽  
Alberta Barlattani ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Autosomal Recessive ◽  
Oral Surgery ◽  
University Hospital ◽  
Chromosome 17 ◽  
Bleeding Complications ◽  
Excessive Bleeding ◽  
Continuous Bleeding

Glanzmann’s thrombastenia (GT) is the most frequent inherited condition. GT is a genetic autosomal recessive disease caused by the alteration of the genes ITGA2B and ITGB3, located on the chromosome 17. The incidence of GT is calculated in 1 on 1000000. The patients, during their life, show episodes of mucocutaneous bleeding, epistaxis, and gingival bleeding. Some subjects required continuous bleeding transfusion. The aim of this case report is to demonstrate that oral assumption of tranexamic acid is a gold standard to prevent excessive bleeding. The patient GM of 36 years old with GT type 1 needs dental extractions of the teeth 4.7 and 4.8 at the “Tor Vergata” University Hospital in Rome. The specialist suggests that 3 days before surgery, the patient must take 6 vials every day of tranexamic acid that is used in obstetrics and gynecology. The teeth were extracted and applied suture. The patient is observed and is recommended mouth rinse with tranexamic acid. No bleeding complications were observed.

The Use of a Surgical Patch Coated With Human Coagulation Factors in Surgical Routine: A Multicenter Postauthorization Surveillance

2006 ◽  
Vol 12 (4) ◽  
pp. 445-450 ◽  
Author(s):  
Sylvia Haas
Keyword(s):  
Vascular System ◽  
Clinical Importance ◽  
Cost Savings ◽  
Bleeding Risk ◽  
Coagulation Factors ◽  
Bleeding Complications ◽  
Lower Probability ◽  
Blood Component ◽  
Excessive Bleeding ◽  
Surgical Interventions

Local hemostyptic agents are of great value to significantly reduce bleeding complications and various devices have become available for clinical use. The aim of this multicenter postauthorization surveillance was to study the surgeons’ expectations regarding efficacy and safety of the surgical patch coated with human coagulation factors (TachoSil) under routine clinical conditions. A total of 408 patients had been included in this trial and the patients had to have an expected increased bleeding risk either due to patient related hemorrhagic risk factors or operations associated with an expected increase of bleeding complications. The main types of surgical interventions were operations on the liver (26%), vascular system (16%), gastrointestinal tract (10%), heart (8%), kidney (7%), thorax (7%), spleen (4%), and pancreas (4%). Other operations (18%) were reported in the fields of neurosurgery, urology, gynecology, dermatology, and on the thyroid gland. Based on subjective assessments the results have shown that TachoSil has met the surgeons’ expectations to be efficacious and safe as a hemostatic treatment in a broad variety of surgical interventions. The observed benefits far exceed the frequencies of complications and many of the observed benefits easily translate into cost savings. In almost 50% of the cases the surgeons thought that the use of the topical hemostat TachoSil may have led to savings in blood component therapy. The savings of intra- and postoperative transfusions may lead to less frequent transfusion-related adverse effects and the lower probability of postoperative complications is of clinical importance. In particular, it is worth mentioning that based on the surgeons’ assessment, the use of TachoSil may have helped to save the organ in 17% of the cases. Thus, these clinically relevant benefits may offer opportunities for improvements of hemostasis in patients at risk for bleeding complications and may facilitate the management of excessive bleeding.

Heparin-Free Hemodialysis with Prophylactic Change of Dialyser and Blood Lines

1988 ◽  
Vol 11 (4) ◽  
pp. 255-258 ◽  
Author(s):  
L. Preuschof ◽  
F. Keller ◽  
J. Seemann ◽  
G. Offermann
Keyword(s):  
Blood Flow ◽  
Bleeding Risk ◽  
Practical Method ◽  
Bleeding Complications ◽  
Major Surgery ◽  
Severe Bleeding ◽  
Total System ◽  
Bleeding Disorders ◽  
Clotting Time ◽  
High Bleeding Risk

Heparinization during hemodialysis may cause severe bleeding complications in patients with high bleeding risk. Heparin-free hemodialyses (n=208) were performed in 46 unselected patients with high bleeding risk after kidney transplantation (n=25), after major surgery (n=10), and with bleeding disorders (n=11). Dialyser and blood lines were primed without heparin. In addition to the established measures (high blood flow, intermittent rinsing), system clotting was prevented by prophylactically changing the dialyser and blood lines in 107 of 208 dialyses (52 percent). Total system clotting with blood loss ranging from 100 to 250 ml occurred in six cases (3 percent). Mean hemodialysis time (± SD) was 4.1 hours (± 0.4), rising volume of the extracorporeal system 1.4 liters/hour (± 0.6), blood flow 244 ml/min (± 38), clotting time 12 min (+ 4), and weight loss 2.5 kg (± 1.5). Mean hemodialysis creatinine clearance was 110 ml/min (± 34) and BUN clearance 138 ml/min (± 48). Heparin-free hemodialysis with prophylactic change of system is thus a safe and practical method of treatment for patients at high bleeding risk, but it is less effective, more expensive and the patient requires closer care.

scholarly journals Regenerative Surgery with Dental Implant Rehabilitation in a Haemophiliac Patient

TH Open ◽  
2021 ◽  
Vol 05 (01) ◽  
pp. e104-e106
Author(s):  
Christian Bacci ◽  
Alessia Cerrato ◽  
Gastone Zanette ◽  
Samantha Pasca ◽  
Ezio Zanon
Keyword(s):  
Tranexamic Acid ◽  
Factor Viii ◽  
Coagulation Factor ◽  
Bleeding Risk ◽  
University Hospital ◽  
Second Molar ◽  
Unsuccessful Treatment ◽  
First Case ◽  
Patient Reported ◽  
High Bleeding Risk

AbstractThis study aimed to describe the first case of regenerative surgery in haemophiliac implant. Patients with haemophilia often present dental problems. A multidisciplinary approach is suggested in case of dental surgeries to reduce the high bleeding risk. A 41-year-old male patient with mild haemophilia A (FVIII 8.4%), presenting previous epistaxis, noncomplicated tooth extractions and traumatic haemartroses, all treated with single infusions of coagulation factor concentrates, was referred to the dental clinic of the Padua University Hospital based on the recommendation of his attending dentist. At first dental visit the patient reported intense pain in the right lower second molar, with impaired chewing function. After an endodontic unsuccessful treatment the element was judged as no longer recoverable. In agreement with the patient the dental element was then extracted, after a combined administration of recombinant factor VIII 3000 IU (35 IU/kg), and tranexamic acid 1,000 mg. The extraction was performed under local anaesthesia, paraperiosteal and truncular, moderate sedation, elevation of an envelope flap. After extraction, a preservation of the alveolus was carried out with bovine matrix bone graft covered with a resorbable membrane. Three months after the surgery a flapless implant was placed after a single infusion of factor VIII 2000 IU, tranexamic acid 1,000 mg, and a local para-periostal anaesthesia, without any complication. Oral surgeon and haematologist expert in coagulation diseases must therefore collaborate together to define a shared protocol for managing surgery in those patients.

scholarly journals Anti-fibrinolytic agents in bleeding disorders – A clinical perspective

2016 ◽  
Vol 3 (2) ◽  
pp. 80-83
Author(s):  
Saket Badle ◽  
Daniel P. Hart
Keyword(s):  
Tranexamic Acid ◽  
Meta Analysis ◽  
Evidence Base ◽  
World Health ◽  
Bleeding Complications ◽  
Bleeding Disorders ◽  
Transfusion Requirements ◽  
Clinical Narrative ◽  
Proven Efficacy ◽  
The 1960S

Abstract Tranexamic acid (TXA) is a synthetic antifibrinolytic drug used widely used to control bleeding complications in a wide variety of clinical situations. Soon after its development in the 1960s it found use in treatment of women with menorrhagia, and in inherited bleeding disorders. Subsequently it was used in surgery and with proven efficacy to reduce transfusion requirements and bleeding complications. Recent meta-analysis have provided further evidence of efficacy and safety. Tranexamic acid is now on the World Health Organization’s (WHO) list of essential drugs, and is the focus of ongoing worldwide trials. Similarly, there is increasing evidence base in both congenital and acquired bleeding disorders. We present a clinical narrative of the antifibrinolytic system and associated drugs to accompany the pharmacy review by Chaplin et al, with the aim of highlighting the evolution of TXA use in bleeding disorders over recent decades.

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