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Critical Care

Severely bleeding trauma patients are a small proportion of the major trauma population but account for 40 % of all trauma deaths. Healthcare resource use and costs are likely to be substantial but have not been fully quantified. Knowledge of costs is essential for developing targeted cost reduction strategies, informing health policy, and ensuring the cost-effectiveness of interventions.  
ccforum.com
over 4 years ago
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15

Prothrombin complex concentrate for reversal of vitamin K antagonist treatment in bleeding and non-bleeding patients | Cochrane

Prothrombin complex concentrate (PCC) is a drug that contains a source of proteins involved in the human blood clotting process. Patients medicated with vitamin K antagonists (blood thinning drug) have low blood levels of these important blood clotting proteins. Therefore these patients will be at increased risk of spontaneous and traumatic bleeding events. Also, when these patients experience a bleeding event, this will lead to progressive loss of these important blood clotting proteins. This process causes a vicious circle, thereby increasing risks of illness and death.  
cochrane.org
over 4 years ago
Www.bmj
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15

Peri-procedural management of patients taking oral anticoagulants

The use of oral anticoagulants is becoming increasingly common. For many years warfarin was the main oral anticoagulant available, but therapeutic options have expanded with the introduction of oral direct thrombin (dabigatran) and factor Xa inhibitors (apixaban, rivaroxaban, and edoxaban). Management of patients taking any oral anticoagulant in the peri-procedural period poses a challenge to medical and surgical providers because of the competing risks of thrombosis and hemorrhage. Bridging therapy has been used to minimize time without anticoagulation when warfarin is interrupted for invasive procedures, but validated strategies based on high quality data are lacking. Existing data suggest that the use of bridging therapy may increase the risk of bleeding for some patients without reducing the risk of thrombosis. Clinical trials are currently under way to answer these questions. Because the half lives and time to anticoagulant activity of newer oral anticoagulants are shorter than for warfarin, bridging therapy is not thought to be necessary with these agents. Peri-procedural management of patients taking these agents is complicated by the lack of demonstrated reversal agents in emergency situations, although specific antidotes are being developed and tested. Existing guidelines for peri-procedural management of patients on oral anticoagulants highlight the importance of individualized patient decision making and suggest strategies to minimize complications. From a patient’s perspective, given the uncertainties surrounding optimal management, explicit discussions regarding risks and benefits of treatment options and demonstration of effective communication among medical and surgical providers are essential.  
feeds.bmj.com
over 4 years ago
Www.bmj
0
9

Peri-procedural management of patients taking oral anticoagulants

The use of oral anticoagulants is becoming increasingly common. For many years warfarin was the main oral anticoagulant available, but therapeutic options have expanded with the introduction of oral direct thrombin (dabigatran) and factor Xa inhibitors (apixaban, rivaroxaban, and edoxaban). Management of patients taking any oral anticoagulant in the peri-procedural period poses a challenge to medical and surgical providers because of the competing risks of thrombosis and hemorrhage. Bridging therapy has been used to minimize time without anticoagulation when warfarin is interrupted for invasive procedures, but validated strategies based on high quality data are lacking. Existing data suggest that the use of bridging therapy may increase the risk of bleeding for some patients without reducing the risk of thrombosis. Clinical trials are currently under way to answer these questions. Because the half lives and time to anticoagulant activity of newer oral anticoagulants are shorter than for warfarin, bridging therapy is not thought to be necessary with these agents. Peri-procedural management of patients taking these agents is complicated by the lack of demonstrated reversal agents in emergency situations, although specific antidotes are being developed and tested. Existing guidelines for peri-procedural management of patients on oral anticoagulants highlight the importance of individualized patient decision making and suggest strategies to minimize complications. From a patient’s perspective, given the uncertainties surrounding optimal management, explicit discussions regarding risks and benefits of treatment options and demonstration of effective communication among medical and surgical providers are essential.  
feeds.bmj.com
over 4 years ago
Www.bmj
0
7

Risk of intracranial haemorrhage linked to co-treatment with antidepressants and NSAIDs

The linked paper by Shin and colleagues (doi:10.1136/bmj.h3517) offers important new evidence about the relation between antidepressant drugs, non-steroidal anti-inflammatory drugs (NSAIDs), and the incidence of intracranial haemorrhage.1 Although NSAIDs and antidepressants are both associated with an increased risk of gastrointestinal bleeding, previous evidence has not shown clear links between intracranial haemorrhage and either type of drug when used alone. The new study, however, set out to define the risk of such bleeds when the two classes of drugs are combined, and the results give some cause for concern. In a retrospective population cohort study of more than four million people in Korea, the authors found that the combination of antidepressants and NSAIDs was associated with a substantially increased risk of intracranial haemorrhage, compared with antidepressant treatment alone.  
feeds.bmj.com
over 4 years ago
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Post tonsillectomy hemorrhage

Tonsillectomy is one of the most common procedures performed in children. Post op hemorrhage is either primary (within 24 hours) or secondary/delayed ≥24 hours. Primary hemorrhage is more rare and is seen in 0.2-2% of cases. Secondary hemorrhage is a bit more common, especially in the Emergency Department as kids have been home for several days. rates vary, but estimates settle around 3%. It most commonly occurs between 5-10 days post-op, with the median 6th POD. The cause is separation of the eschar – which may be precipitated by dehydration, vomiting or rarely infection. Most stop on their own, but rarely they can lead to calamitous bleeding and airway compromise – so it is obviously a good idea to take them seriously.  
pemcincinnati.com
over 4 years ago
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13

Fresh frozen plasma for patients undergoing surgery on the heart or blood vessels | Cochrane

Fresh frozen plasma is obtained from whole blood from blood donors. It contains a number of factors that help blood to clot. The risk of bleeding in open heart surgery or surgery on the main blood vessels in the body is high. Fresh frozen plasma is sometimes administered to these patients to reduce bleeding. It can be administered prophylactically (to prevent bleeding) or therapeutically (to treat bleeding). However, there are risks of side effects from fresh frozen plasma, such as severe allergic reactions or breathing problems.  
cochrane.org
over 4 years ago
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9

Routine compared with selective ultrasound in early pregnancy | Cochrane

Ultrasound is an electronic technology that uses the reflection of pulses of high-frequency sound to produce an image. Ultrasound may be used in a variety of circumstances during pregnancy. It has been assumed that the routine use of ultrasound in early pregnancy will result in the earlier detection of problems and improved management of pregnancy complications when compared with selective use for specific indications such as after clinical complications (e.g. bleeding in early pregnancy), or where there are concerns about fetal growth.  
cochrane.org
over 4 years ago
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Which therapies are the most effective to prevent the progression of autosomal dominant polycystic kidney disease? | Cochrane

Current clinical care for people who have autosomal dominant polycystic kidney disease (ADPKD) focuses on controlling future risks for need for dialysis and symptom management, mainly pain and bleeding. Newly discovered molecules that may slow kidney cyst growth has recently switched attention from care and treatment toward preventing disease progression and symptom control.  
cochrane.org
over 4 years ago
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10

New oral anticoagulants: dosing and monitoring

The two reports on the risk of gastrointestinal bleeding with new oral anticoagulants come as no surprise given the dosing regimens that have been adopted.1 2  
feeds.bmj.com
over 4 years ago
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0

Critical Care

Severely bleeding trauma patients are a small proportion of the major trauma population but account for 40 % of all trauma deaths. Healthcare resource use and costs are likely to be substantial but have not been fully quantified. Knowledge of costs is essential for developing targeted cost reduction strategies, informing health policy, and ensuring the cost-effectiveness of interventions.  
ccforum.com
over 4 years ago
Healio safe image
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Triple therapy has similar outcomes, more bleeding than dual therapy in older patients

Older patients with atrial fibrillation who received triple therapy consisting of aspirin, clopidogrel and warfarin at discharge after PCI for acute MI had a similar risk for major adverse cardiac events at 2 years, but higher rates of major bleeding compared with patients who received aspirin and clopidogrel only. Researchers analyzed 4,959 patients aged 65 years or older from the Acute  
healio.com
over 4 years ago
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Anti-VEGF for prevention of postoperative vitreous cavity haemorrhage after vitrectomy for proliferative diabetic retinopathy | Cochrane

Review question Does anti-vascular endothelial growth factor (anti-VEGF) reduce the occurrence of posterior vitreous cavity haemorrhage (POVCH) after vitrectomy surgery for proliferative diabetic retinopathy?  
cochrane.org
over 4 years ago
Sinaiem dark
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epistaxis-management-go-beyond-the-dad-bod

Earlier this year at a conference, I met a vendor from the makers of Rapid Rhino who compared the device to the Dad Bod: it’s old and not sexy like this, but it gets the job done and everyone has them (or used them) at some point in their careers. In fact, it even looks like a Dad Bod when soaked in NS and inflated. That’s an odd analogy, I thought to myself.  
sinaiem.org
over 4 years ago
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7

Interventions for preventing and treating kidney disease in Henoch-Schönlein Purpura | Cochrane

Henoch-Schönlein Purpura (HSP) causes inflammation of small blood vessels in children and affects approximately 20/100,000 children annually. Symptoms and signs include a purpuric skin rash (which comprises small spots and larger bruises), abdominal pain, gastrointestinal bleeding, joint pain and swelling, facial swelling and evidence of kidney disease with blood and protein in the urine. Kidney disease occurs in about one third of children with HSP. In the majority this is mild (small amounts of blood in the urine only) and resolves completely but a few children have persistent kidney disease that can progress to kidney failure.  
cochrane.org
over 4 years ago
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15

Clinical Case 119: Trauma & the Sensitive New Age Ultrasound - Broome Docs

Trauma ultrasound stabbing pneumothorax bleeding CXR  
broomedocs.com
over 4 years ago
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1

Bleeding in the brain in a Newborn (post meningitis )

Prepare for USMLE,UK,CANADIAN,AUSTRALIAN, NURSING & OTHER MEDICAL BOARD examinations around the globe with us.Understand the basics, concepts and how to answ...  
youtube.com
over 4 years ago
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Dabigatran Reversal Agent – Idarucizumab |

Thanks to Rob MacSweeney‘s fantastic Critical Care Reviews I learned of Idarucizumab, a monoclonal antibody fragment that binds the (pesky) anticoagulant dabigatran. Two industry-supported studies this week show rapid, complete reversal of anticoagulation in healthy volunteers(1) and patients who were either bleeding or undergoing procedures(2). The dose given to patients was 5g intravenously.  
resus.me
over 4 years ago
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2

Combined use of antidepressants and NSAIDs: NNT for intracranial haemorrhage

Mercer and colleagues’ editorial says that the new found risk of intracranial haemorrhage in the first 30 days of combined non-steroidal anti-inflammatory drug (NSAID) and antidepressant use in Korea has implications for GPs and primary care teams.1 They think guidelines are poor at informing therapeutic decisions in patients with multimorbidity, with evidence based decisions difficult to make because …  
feeds.bmj.com
over 4 years ago
Preview
0
7

Combined use of antidepressants and NSAIDs: NNT for intracranial haemorrhage

Mercer and colleagues’ editorial says that the new found risk of intracranial haemorrhage in the first 30 days of combined non-steroidal anti-inflammatory drug (NSAID) and antidepressant use in Korea has implications for GPs and primary care teams.1 They think guidelines are poor at informing therapeutic decisions in patients with multimorbidity, with evidence based decisions difficult to make because …  
feeds.bmj.com
over 4 years ago