Abnormal Preprocedural International Normalized Ratio and Platelet Counts Are Not Associated With Increased Bleeding Complications After Ultrasound-Guided Thoracentesis

2011 ◽  
Vol 197 (1) ◽  
pp. W164-W168 ◽  
Author(s):  
Maitray D. Patel ◽  
Sahil D. Joshi
Keyword(s):  
International Normalized Ratio ◽  
Bleeding Complications ◽  
Ultrasound Guided ◽  
Platelet Counts

scholarly journals Prevalence, patterns, and factors associated with bleeding tendencies in dengue

2015 ◽  
Vol 9 (01) ◽  
pp. 105-110 ◽  
Author(s):  
Emmanuel Bhaskar ◽  
Gopalan Sowmya ◽  
Swathy Moorthy ◽  
Varun Sundar
Keyword(s):  
Platelet Count ◽  
Bleeding Risk ◽  
International Normalized Ratio ◽  
Drug Intake ◽  
Bleeding Complications ◽  
Study Cohort ◽  
Severe Thrombocytopenia ◽  
Factors Associated ◽  
Platelet Counts ◽  
Anti Platelet Drug

Introduction: The pattern of bleeding tendencies in dengue and its corellation with platelet count and other factors requires clarification. Methodology: A retrospective study on bleeding tendencies in adults with dengue and platelet counts of less than 100,000 per mm3 was conducted. Factors associated with bleeding were analyzed. The study cohort were grouped as dengue with severe thrombocytopenia when platelet count was < 50,000/mm3 and as dengue with moderate thrombocytopenia if platelet count was 50,000–100,000/mm3 Results: A total of 638 patients formed the study cohort. A 24.1% prevalence of bleeding tendencies was observed. Prior anti-platelet drug intake, platelet count of < 70,000/mm3, international normalized ratio > 2.0, and partial thromboplastin time > 60 seconds were associated with bleeding. Esophagogastroduodenoscopy was found to identify structural gastroduodenal lesions when dengue was complicated by hematemesis or melena. Conclusions: The results of this study suggest that bleeding complications in dengue can occur at platelet counts of up to 70,000/mm3, and that prior anti-platelet drug intake increases bleeding risk. Evaluation of hematemesis or melena in dengue with esophagogastroduodenoscopy is beneficial.

Determination and Treatment of Disorders of Primary Haemostasis

1999 ◽  
Vol 19 (04) ◽  
pp. 168-175 ◽  
Author(s):  
M. Weippert-Kretschmer ◽  
V. Kretschmer
Keyword(s):  
Platelet Function ◽  
Bleeding Risk ◽  
Bleeding Complications ◽  
Bleeding Tendency ◽  
Platelet Counts ◽  
Platelet Function Disorders ◽  
Perioperative Bleeding ◽  
Before And After ◽  
Low Sensitivity

SummaryPerioperative bleeding complications due to disorders of primary haemostasis are often underestimated. Routine determination of primary haemostasis is still problematic. The in vivo bleeding time (BT) shows low sensitivity and high variability. In this contribution the results and experiences with the IVBT having been obtained in various studies and during 10 years of routine use are reported. Patients and Methods: Blood donors before and after ASA ingestion, patients with thrombocytopenia as well as congenital and acquired platelet function disorders. Monitoring of desmopressin efficacy. IVBT with Thrombostat 4000 (tests with CaCl2 = TST-CaCl2 and ADP = TST-ADP) and PFA-100 (test cartridges with epinephrine = PFA-EPI and ADP = PFA-ADP). Results and Conclusions: IVBT becomes abnormal with platelet counts <100,000/μl. With platelet counts <50,000/μl the results are mostly outside the methodical range. IVBT proved clearly superior to BT in von Willebrand syndrome (vWS). All 16 patients with vWS were detected by PFA-EPI, whereas with BT 7 of 10 patients with moderate and 1 of 6 patients with mild forms of vWS were spotted. The majority of acquired and congenital platelet function disorders with relevant bleeding tendency were detectable by IVBT. Sometimes diagnostic problems arose in case of storage pool defect. Four to 12 h after ingestion of a single dose of 100 mg ASA the TST-CaCl2 became abnormal in all cases, the PFA-EPI only in 80%. However, the ASA sensitivity of TST-CaCl2 proved even too high when looking for perioperative bleeding complications in an urological study. Therefore, the lower ASS sensitivity of the PFA-100 seems to be rather advantageous for the estimation of a real bleeding risk. The good efficacy of desmopressin in the majority of cases with mild thrombocytopenia, congenital and acquired platelet function disorders and even ASS-induced platelet dysfunction could be proven by means of the IVBT. Thus IVBT may help to increase the reliability of the therapy. However, the IVBT with the PFA-100 is not yet fully developed. Nevertheless, routine use can be recommended when special methodical guidelines are followed.

Risk factors for bleeding in pediatric post-cardiotomy patients requiring ECLS

Perfusion ◽  
2009 ◽  
Vol 24 (3) ◽  
pp. 191-197 ◽  
Author(s):  
Kathryn Nardell ◽  
Gail M Annich ◽  
Jennifer C Hirsch ◽  
Cathe Fahrner ◽  
Pat Brownlee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Loss ◽  
Blood Product ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Bleeding Complications ◽  
Excessive Bleeding ◽  
Surgical Exploration ◽  
Platelet Counts ◽  
Protamine Administration

Background/Objective: There is limited literature documenting bleeding patterns in pediatric post-cardiotomy patients on extracorporeal life support (ECLS). This retrospective review details bleeding complications and identifies risk factors for bleeding in these patients. Methods: Records from 145 patients were reviewed. Patients were divided into excessive (E) and non-excessive (NE) bleeding groups based on blood loss. Results: Excessive bleeding occurred predominantly from 0-6h. Longer CPB duration (NE=174±8min; E=212±16; p=0.02) and lower platelet counts (NE=104.8±50K; E=84.3±41K; p=0.01) were associated with excessive bleeding during the first 6h (p=0.005). Use of intraoperative protamine with normal platelets was associated with decreased bleeding from 7-12h post-ECLS (p=0.002). Most mediastinal exploration occurred >49h post-ECLS, with decreased bleeding post-exploration in E patients. Conclusions: The majority of pediatric post-cardiotomy ECLS bleeding occurs early after support initiation. Longer CPB time and thrombocytopenia increased bleeding 0-6h post-ECLS. Since early bleeding may be coagulopathic in origin, an approach to minimize bleeding includes protamine administration and aggressive blood product replacement with target platelet counts of 100-120K. Surgical exploration should follow if additional hemostasis is necessary.

Bleeding risk and complications associated with percutaneous ultrasound-guided liver biopsy in cats

2018 ◽  
Vol 21 (6) ◽  
pp. 529-536 ◽  
Author(s):  
Michelle Pavlick ◽  
Cynthia RL Webster ◽  
Dominique G Penninck
Keyword(s):  
Liver Biopsy ◽  
Vitamin K ◽  
Major Bleeding ◽  
Bleeding Risk ◽  
Bleeding Complications ◽  
P Value ◽  
Safe Procedure ◽  
Ultrasound Guided ◽  
Coagulation Parameters ◽  
Ultrasound Findings

Objectives Liver biopsy is necessary for a diagnosis of liver disease; however, post-biopsy bleeding is a concern. The aim of this study was to describe the extent of bleeding and the occurrence of complications after percutaneous ultrasound-guided liver biopsy (PUGLB) in cats. Methods The medical records of 30 cats that had a PUGLB were retrospectively reviewed. Using human guidelines, bleeding was classified as minor or major when the absolute change in packed cell volume (ΔPCV) was <0 and >−6% or ≤-6%, respectively. Complications were defined as physiologic compromise necessitating an intervention, or death. The relationship between ΔPCV and the occurrence of complications and the signalment, initial PCV, coagulation parameters, serum liver enzymes and bilirubin, number of biopsies, histological diagnosis, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration were assessed using Fisher’s exact test, ANOVA and Pearson’s correlation coefficient, with a P value <0.05 considered significant. Results All cats had a decrease in PCV after biopsy. The mean ΔPCV was −6.9% ± 4.1%. Minor and major bleeding occurred in 13/30 (43.3%) and 17/30 (56.7%) cats, respectively, and non-lethal bleeding complications occurred in 5/30 (16.7%). Cats with complications had a lower pre-biopsy PCV ( P <0.003). Major bleeding was more likely with a diagnosis of hepatic lipidosis ( P = 0.03). There was no correlation between ΔPCV or complications and signalment, coagulation parameters, serum parameters, number of biopsies, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration. Conclusions and relevance PUGLB is a relatively safe procedure in cats, although many cats have a subclinical decrease in PCV. As conventional coagulation tests did not predict complications or the magnitude of ΔPCV, there is a need for more sensitive indicators of bleeding risk in cats undergoing PUGLB.

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

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.

A Restrictive Platelet Transfusion Policy Allowing Long-Term Support of Outpatients With Severe Aplastic Anemia

Blood ◽  
1999 ◽  
Vol 93 (9) ◽  
pp. 3124-3126 ◽  
Author(s):  
Markus Sagmeister ◽  
Lic Oec ◽  
Jürg Gmür
Keyword(s):  
Aplastic Anemia ◽  
Platelet Transfusion ◽  
Severe Aplastic Anemia ◽  
Bleeding Complications ◽  
Outpatient Basis ◽  
Platelet Counts ◽  
The Mean ◽  
Restrictive Policy ◽  
Platelet Transfusions

Abstract The threshold for prophylactic platelet transfusions in patients with hypoplastic thrombopenia generally recommended in the standard literature is 20,000 platelets/μL. A more restrictive transfusion policy may be indicated in patients with chronic severe aplastic anemia (SAA) in need of long-term platelet support. We evaluated the feasibility and safety of a policy with low thresholds for prophylactic transfusions (≤5,000 platelets/μL in stable patients; 6,000 to 10,000 platelets/μL in cases with fever and/or hemorrhagic signs) combined with progressive lengthening of transfusion intervals (up to at least 7 days irrespective of the interim course of platelet counts). The study was based on a retrospective analysis of a total of 18,706 patient days with platelet counts ≤10,000/μL in patients with chronic SAA treated (for more than 3 months) on an outpatient basis. Altogether, 1,135 platelet transfusions were given, 88% at counts ≤10,000/μL and 57% at counts ≤5,000/μL. The mean transfusion interval was 10 days. During the period of observation, three major nonlethal bleeding complications occurred, which could be well controlled. We conclude that the restrictive policy with low transfusion thresholds and prolonged transfusion intervals proved feasible and safe in chronic SAA patients.

Thrombopoietin Receptor Agonists in Patients with Chronic Liver Disease

2020 ◽  
Vol 46 (06) ◽  
pp. 682-692
Author(s):  
Saro Khemichian ◽  
Norah A. Terrault
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Invasive Procedure ◽  
Bleeding Risk ◽  
Chronic Liver ◽  
Bleeding Complications ◽  
Invasive Procedures ◽  
Platelet Counts ◽  
Receptor Agonists ◽  
Platelet Transfusions

AbstractThrombocytopenia is one of the most common hematologic complications in cirrhosis. Despite limited data linking platelet count and bleeding risk in patients with cirrhosis, the use of platelets transfusions for invasive procedures has been a common practice. Recently, thrombopoietin (TPO) receptor agonists have been approved for use in patients with chronic liver disease (CLD) undergoing invasive procedures. The aim of this study was to review current literature on bleeding risk in patients with cirrhosis and the use of platelet transfusions and TPO receptor agonists in the context of invasive procedures. PubMed search was conducted to find articles relating to cirrhosis, thrombocytopenia, and new novel treatments for this condition. Search terms included CLD, cirrhosis, thrombocytopenia, bleeding, thrombosis, coagulopathy, hemostasis, and TPO receptor agonists. Romiplostim, eltrombopag, avatrombopag, and lusutrombopag are approved TPO receptor agonists, with avatrombopag and lusutrombopag specifically approved for use in patients with CLD undergoing invasive procedures. In patients with platelet counts < 50,000/mm3, avatrombopag and lusutrombopag increased the platelet counts above this threshold in the majority of treated patients and reduced the frequency of platelet transfusions. At the approved doses, incidence of thrombosis was not increased and therapies were well tolerated. Studies were not powered to assess whether risk of bleeding complications was reduced and the fundamental question of whether correction of thrombocytopenia is warranted in patients undergoing invasive procedures remains unanswered. The use of TPO receptor agonists has resulted in less requirement for platelet transfusions. In patients with cirrhosis undergoing invasive procedures for whom platelet transfusion is planned, TPO receptor agonists are an alternative and avoid the risks associated with transfusions. However, there is need for a thoughtful approach to manage bleeding risk in patients with cirrhosis undergoing procedures, with the consideration of a comprehensive hemostatic profile, the severity of portal hypertension, and the complexity of the invasive procedure to guide decisions regarding transfusions or use of TPO receptor agonists.

Self-management of oral anticoagulation in children with congenital heart disease

2001 ◽  
Vol 11 (3) ◽  
pp. 269-276 ◽  
Author(s):  
Thomas D. Christensen ◽  
Jørn Attermann ◽  
Vibeke E. Hjortdal ◽  
Marianne Maegaard ◽  
J. Michael Hasenkam
Keyword(s):  
Cardiac Disease ◽  
Oral Anticoagulation ◽  
Congenital Heart ◽  
International Normalized Ratio ◽  
Self Management ◽  
Bleeding Complications ◽  
Conventional Management ◽  
Quality Of Treatment ◽  
Congenital Cardiac Disease

Objective: The concept of self – management of oral anticoagulation has been shown to entail better quality of treatment than conventional management when assessed in selected adults. We have extended the concept of self – management to include children with congenital cardiac disease, hypothesizing self-management of oral anticoagulation is also possible in this subset of patients. Our aim was to assess the quality of self-management. Methods: We trained 14 children aged from 2.2 to 15.6 years, with a mean age of 9.7 years, and their parents, in domiciliary analysis of the International Normalized Ratio and necessary adjustment of dosage of coumarin. The curriculum for training lasted for 27 weeks, and the patients and their parents were followed for a period of up to 31 months by weekly measurement of the values obtained for the International Normalized Ratio. Results: The patients were observed over a mean of 547 days, with a range from 214 to 953 days. The patients were within the therapeutic targetted range of the International Normalized Ratio for a median of 65.5% of the time, with a range from 17.6 % to 90.4 %. None of the patients experienced thromboembolic or bleeding complications requiring doctoral intervention. All the patients and their parents expressed full satisfaction with the treatment. Conclusion: Selfmanagement of oral anticoagulation provides a good quality of treatment, which is feasible and safe in selected children with congenital cardiac disease.

The Role of Platelets in the Pathogenesis of Thrombosis and Hemorrhage in Patients with Thrombocytosis

1977 ◽  
Vol 38 (04) ◽  
pp. 1085-1096 ◽  
Author(s):  
Peter N. Walsh ◽  
Scott Murphy ◽  
William E. Barry
Keyword(s):  
Platelet Function ◽  
Bleeding Complications ◽  
Platelet Counts ◽  
Normal Platelet ◽  
Coagulant Activity ◽  
Hemorrhagic Complications ◽  
Myeloproliferative Diseases ◽  
Thrombotic Complications ◽  
Preliminary Study

SummarySome patients with thrombocytosis due to myeloproliferative diseases or other etiologies experience thromboembolic complications and others may bleed excessively. It seems unlikely that elevations in platelet count per se are a direct cause either of thrombosis or of hemorrhage. In an effort to ascertain whether variations in platelet function might determine whether an individual patient experiences thrombotic or hemorrhagic complications we have evaluated platelet function in 22patients with thrombocytosis due to a variety of etiologies. The results of platelet counts, bleeding time determinations, and studies of platelet aggregation were similar in patients with thrombosis, in patients with bleeding and in patients with neither complication. Therefore, detailed studies of platelet coagulant activities were carried out in 8patients. The results of platelet coagulant activity assays were normal in all 3patients with thrombocytosis and neither thrombotic nor bleeding complications and an additional 3patients with myeloproliferative diseases, normal platelet counts and no thrombohemorrhagic complications. In 2patients with thrombotic complications significant elevation of platelet coagulant activities concerned with the early phases of intrinsic coagulation were observed whereas in 2patients with severe hemorrhagic complications deficiences of either contact forming activity or collagen-induced coagulant activities were evident. This preliminary study suggests the possibility that variations in platelet coagulant activities concerned with the early stages of intrinsic coagulation may determine whether patients with thrombocytosis will experience bleeding or thrombotic complications.

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