Objective To analyze the impact of ivaroxaban on hidden blood loss and blood transfusion rate after primary total knee arthroplasty (TKA) by comparing with the use of low molecular weight heparin. Methods Between December 2009 and January 2011, the clinical data from 90 patients undergoing primary TKA were retrospectively analyzed. At 12 hours after operation, 45 patients were given ivaroxaban (10 mg/d) in the trial group and low molecular weight heparin injection (0.4 mL/d) in the control group for 14 days, respectively. There was no significant difference in gender, age, disease duration, or range of motion between 2 groups (P gt; 0.05). Results The operation time was (92.32 ± 23.13) minutes in the trial group and (89.81 ± 18.65) minutes in the control group, showing no significant difference (t=0.26, P=0.79). The hidden blood loss was (40.18 ± 14.85) g/L in the trial group and (34.04 ± 12.96) g/L in the control group, showing significant difference (t=2.09, P=0.00); the dominant blood loss was (30.60 ± 2.89) g/L and (28.85 ± 8.10) g/L respectively, showing no significant difference (t= 1.37, P=0.17). The blood transfusion rate was 73.33% (33/45) in the trial group and 55.56% (25/45) in the control group, showing no sigificant difference (χ2=3.10, P=0.08); the transfusion volume was (1.44 ± 1.09) U and (1.06 ± 1.17) U respectively, showing no significant difference (t=1.58, P=0.11). Stress ulcer occurred in 1 case of the trial group; symptomatic deep vein thrombosis of lower extremity and asymptomatic muscular venous thrombosis developed in 1 case and 4 cases of the control group respectively. Conclusion Ivaroxaban has effect on the hidden blood loss after primary TKA, which may increase postoperative blood loss and blood transfusion rate. The changes in hemoglobin should be monitored during the anticoagulant therapy, and the blood volume should be added promptly.
Objective To compare the efficacy of 6-epsilon-aminocaproic acid （EACA） with aprotinin on reducing postoperative bleeding in cardiac valve replacement procedures, and to investigate its influence on the possible thromboembolism and the renal function. Methods Seventy-nine patients who underwent cardiac valve replacement were randomly divided into two groups： EACA group （n = 39） and aprotinin group （n = 40）, which were given EACA and aprotinin separately in operations. The volumes of drainage to body surface area （BSA）, blood transfusion were recorded during 24 h after operations. The concentrations of serum D-dimer and α2-antiplasmin （a2- AP） were measured before, during operation and at 72h post-operatively. The serum creatinine levels before operation and at the 72 h after operation were also measured. Results The volume ratio of drainage to BSA in EACA group was significantly higher than that in the aprotinin group at 24 h after operation （P = 0. 019）. However, there was no significant difference in the volumes of blood transfusion between two groups （P〉0. 05）. Also no statistical difference in the concentrations of D-dimer and a2-AP were found between two groups whether preoperatively or at 72h post-operatively （P= 0. 960,0. 485）, D-dimer and a2-AP of the aprotinin group were higher than those in the EACA group after aortic off-clamping （P = 0. 001,0. 000）. There was no statistically difference of △CrCl72 in both groups （P〉0. 05）. No patient with thrombosis or thromboembolism was detected in two groups.Conclusion Although the efficacy of EACA in reducing postoperative bleeding in cardiac valve replacement can not compare favorably with that of aprotinin, the blood transfusion volume would not increase when EACA is used introoperatively. Proper usage of EACA will not cause thrombosis and renal damage.
Objective To evaluate the hemostatic effect of selective artery embolization in treatment for traumatic hepatic rupture bleeding. Methods The clinical data of 63 patients with traumatic hepatic rupture treated in this hospital from Jan. 2004 to Jun. 2011 were analyzed retrospectively. With Seldinger technique， a catheter was introduced into the liver artery via the right femoral artery for angiography. Once the bleeding site was identified， microcatheter was placed into the hemorrhagic vessels to control the bleeding with polyvinyl alcohol or gelatin sponges. Results The hepatic arteriography was successfully performed in 63 cases， the results showed hepatic left-artery bleeding in 8 cases， hepatic right-artery bleeding in 39 cases， and hepatic left- and right-artery bleeding in 10 cases. Fifty-seven cases received selective arterial embolization and successful hemostasia， including one embolization in 36 cases， two embolizations in 11 cases， and more than two embolizations in 10 cases. Six patients without obvious hemorrhage didn’t receive selective arterial embolization. There was no bleeding again case and no dead case. The hemoglobin and hematocrit returned to normal in one week after embolization. No hemorrhage or other complications happened during follow-up for 0.5 to 1 year. Conclusion The selective arterial embolization is an effective， safe and minimally invasive method for hemostasia of patients with traumatic hepatic rupture.
ObjectiveTo evaluate the clinical efficiency of balloon occlusion of the lower abdominal aorta in blood loss control during resections of pelvic or sacral tumor. MethodsFrom April 2006 to April 2010, 24 patients diagnosed as pelvic or sacral tumor in this hospital were collected. Balloon occlusion of the lower abdominal aorta to control blood loss was used in these cases. Balloon catheters were placed via femoral artery to occlude the abdominal aorta before operation. Resections of pelvic or sacral tumors were performed after occlusion of abdominal aorta, duration no longer than 60 min per occlusion, if repeated occlusions needed, 10－15 min release in between. Results Average operative time was 153 min (range 40－245 min) and average blood loss was 310 ml (range 200－650 ml) in this series, and the procedure helped in clearly identifying the surgical margin, neurovascular structures, and adjacent organs. The blood pressure were stable in all the cases. No postoperative renal function impairment was found in all the cases, no side injuries to adjacent organs was identified. One case complicated with thrombosis in iliac artery at same puncture side was successfully treated with catheter thrombectomy. ConclusionIntraoperative abdominal aorta balloon occluding in pelvic and sacral tumor surgical operation could reduce blood loss, and improve the safety of operation.
ObjectiveTo evaluate the efficiency of the spot-welding electrocoagulation with needle-knife to prevent bleeding after endoscopic sphincterotomy (EST). MethodsThe clinical data of 187 patients underwent EST from August 2009 to October 2009 were retrospectively analyzed, study group （n=102) were treated with spotwelding electrocoagulation with needleknife and 110 000 noradrenaline washing, control group (n=85) were treated with 110 000 noradrenaline washing alone. The bleeding and complications after EST were observed. ResultsThe differences of gender, age, primary diseases, cormorbidities, nutritional status, and immune function were not significant between two groups (Pgt;0.05). The bleeding after EST happened 4 cases (4.70%) in the control group and none in the study group. The bleeding rate of the study group was significantly lower than that of the control group (Plt;0.05). The bleeding cases in the control group were controlled successfully by spotwelding electrocoagulation with needleknife under endoscopy. Cholangitis occurred in 5 cases altogether, 1 case in each group deteriorated promptly and died of multiple organ failure syndrome, another 3 cases, 2 in the study group, 1 in the control group, were cured by PTCD and antibiotics. Biliary tract hemorrhage occurred one case in each group, which one died in the study group. Pancreatitis occurred 1 case in the study group and 2 cases in the control group, all of which were salvaged by conservative therapy. The incidences of complications were not significantly different between two groups (Pgt;0.05). ConclusionsThe spotwelding electrocoagulation with needleknife can significantly reduce the bleeding rate after EST. It is an effective, safe, and easy technique, especially to rural areas.
Objective To systematically review the effect of discontinuous warfarin on the risk of postoperative bleeding complications after tooth extractions. Methods PubMed, EMbase, The Cochrane Library (Issue 9, 2016), CNKI, VIP, WanFang Data, China Food and Drug Administration and the ADR supervision system of FDA were electronically searched to collect randomized controlled trials (RCTs) and cohort studies about the effect of discontinuous warfarin on risk of postoperative bleeding complications after tooth extractions in patients until September 30th, 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 8 studies were included, involving 3 RCTs and 5 cohort studies. The results of meta-analysis showed that: there was no significant difference between the discontinuous or reduced warfarin group and the continuous warfarin group (RCTs: RR=0.86, 95%CI 0.49 to 1.51,P=0.60; cohort studies: RR=0.67, 95%CI 0.45 to 1.01,P=0.06). Conclusions Current evidence indicates that there is no statistically significant correlation between whether discontinuous warfarin and the risk of postoperative bleeding complications after tooth extractions. Due to the limited quantity and quality of included studies, the above conclusions are needed to be further verified by more high quality studies.
Objective [WTBZ]To assess the impact of dual antiplatelet therapy using aspirin and clopidogrel on postoperative bleeding and blood transfusion early after coronary artery bypass grafting (CABG). Methods [WTBZ]In this randomized controlled trial, 249 patients were randomly assigned to 2 groups after coronary artery bypass grafting from December 2007 to December 2008. Daily clopidogrel (75 mg) and aspirin (100 mg) were initiated in 124 patients (group AC) while aspirin (100 mg) alone was administered to 125 patients (group A). Antiplatelet therapy was initiated within 48h postoperatively. Demographic, operative, and postoperative data were compared between the two groups. Chest tube drainage and quantity of blood products used in both groups were recorded. The effects of the antiplatelet regimen on chest tube drainage were compared using a linear regression model. Results [WTBZ]No statistical difference of demographic, operative, and preoperative data was observed between the two groups （Pgt;0.05）. Chest tube drainage after patients received ntiplatelet agents was not significantly different between group A and group AC（495.00±270.89 ml vs. 489.25±316.68ml，t=0.146, P=0.884）. No statistical difference of cases of transfusion(81 cases vs. 91 cases，χ2=1.937, P=0.164) or quantity of red cells (2.51±2.88 U vs. 2.25±2.87 U, t=0.690, P=0.491) and plasma (195.45±300.88 ml vs. 223.01±238.68 ml,t=0.759, P=0.449) transfused was found between group A and group AC. No perioperative mortality, reexploration or extrathoracic bleeding occurred in either group. Early postoperative use of dual antiplatelet therapy was not associated with increased bleeding after coronary artery bypass grafting on multivariable analysis（r=2.297，95%CI:-64.526,69.121，P=0.946）. Conclusionpresent study suggests that according to a predefined administration protocol, dual antiplatelet therapy of aspirin and clopidogrel can safely be administered in the early postoperative period in CABG patients, without increasing the risk of bleeding complications.
ObjectiveTo investigate the current situation of randomized controlled trials (RCTs) of thrombin like enzyme research and the ability to provide a reliable basis for the clinical practice. MethodsRCTs identified from four Chinese databases up to the year 2012 were assessed according to international standard, including SinoMed (1978-2012), CNKI (1979-2012), Wanfang Data (1986-2012), and VIP (1989-2012). ResultsA total of 2358 articles were searched and 53 RCTs were identified. The results showed that the quality of these articles was not high enough to meet the needs of clinical practice in China. ConclusionIn China, current quantity and quality of RCTs of thrombin like enzyme can not meet the need of clinical practice. In order to improve the prevention and treatment of hemorrhagic diseases, and surgical bleeding, especially for patients lacking clotting factor, more high-quality RCTs are required.
Several unusual manifestations such as white bile draining in common bile duct (14 cases) and casual massive bleeding (2 cases ) during and following hepatobiliary and pancreatic operations is reported. These manifestations were in fact signs of hepatic insufficiency. The manners of manifestations of hepatic insufficiency and their treatment are discussed, with a stress that liver-protective treatment and nutritional support are the fundamental modalities.
Objective To assess the efficacy of finasteride in treating perioperative bleeding in patients undergoing transurethral resection of the prostate (TURP). Methods We searched MEDLINE (1966 to 2005), EMBase (1984 to 2004), CBM (1980 to 2005), The Cochrane Library (Issue 4, 2005) and relevant journals to identify cl inical trials involving finasteride in patients undergoing TURP. We also checked the references in the reports of each included trial. The qual ity of randomized controlled trials (RCTs) was assessed according to the methods recommended by The Cochrane Collaboration, and the qual ity of non-RCTs was assessed based on the methods recommended by Jiang-ping Liu, Stroup and Hailey. Two reviewers extracted data independently and data analyses were conducted with The Cochrane Collaboration’ s RevMan 4.2. Result We included 4 RCTs and 1 non-RCT. The qual ity of 3 RCTs was graded C and the other one was graded B. The quality of the non-RCT was relatively high. Meta-analyses showed that with comparable age, international prostate symptom score, prostate specific antigen, preoperative volume of prostate and excision volume between the two groups (Pgt;0.05), the perioperative bleeding volume (WMD –85.44, 95%CI –117.31 to –53.58), the bleeding volume per gram of resected prostate tissue (WMD –3.5, 95%CI –6.34 to –0.58) and hemoglobin reduction (WMD –1.61, 95%CI –1.96 to –1.26) of the finasteride group were significantly smaller than those of the control group. Conclusion The evidence currently available indicates that preoperative use of finasteride may reduce bleeding in patients undergoing TURP.