Cases reported "Postoperative Hemorrhage"

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1/38. Excessive bleeding on extracorporeal membrane oxygenation after surgical repair of type I truncus arteriosus: A case report.

    Severe bleeding remains the most common complication of extracorporeal membrane oxygenation (ECMO) following surgical repair of congenital heart defects. We present a case of excessive hemorrhage within the first hours on ECMO support after repair of a type I truncus arteriosus. Bleeding control was achieved by surgical repair following failure of conventional interventions to control hemorrhage despite normalization of laboratory coagulation parameters. Aspects associated with bleeding and bleeding control during extracorporeal circulation after cardiac surgery are discussed.
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ranking = 1
keywords = coagulation
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2/38. Bleeding after intermittent or continuous r-hirudin during CVVH.

    OBJECTIVE: To demonstrate bleeding complications encountered in patients after cardiac surgery on continuous venovenous haemofiltration (CVVH) treated with continuous versus intermittent r-hirudin for heparin-induced thrombocytopenia (HIT) type II. DESIGN: Case description. SETTING: Cardiothoracic intensive care unit at a university hospital. patients: 5 consecutive patients with proven HIT type II on CVVH after major cardiac surgery. INTERVENTIONS: Recombinant hirudin (r-hirudin) was given continuously at a dose of 0.01 mg/kg per h in three patients or in repeated bolus administration of 0.05 mg/kg in two patients. MEASUREMENTS AND RESULTS: Since the ecarin clotting time assay was not available at that time to monitor hirudin effects on coagulation, the activated partial thromboplastin time (normal range 26-38 s, target range 50-60 s) was used. The continuously treated patients suffered from major bleeding complications. Therefore, the regimen was changed to repeated bolus administration, reducing the incidence of bleeding complications probably due to a threefold diminished cumulative hirudin dose per day in comparison to continuous administration. CONCLUSIONS: If ecarin clotting time, the most suitable monitor for hirudin activation, is not available, we would prefer to give r-hirudin in repeated boluses to avoid major bleeding complications in cardiac surgery patients on CVVH.
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keywords = coagulation
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3/38. Recombinant hirudin anticoagulation for aortic valve replacement in heparin-induced thrombocytopenia.

    PURPOSE: To report the case of a patient with HIT that received a prolonged infusion of r-hirudin (lepirudin; Refludan; Hoechst, france) before, during and after cardiopulmonary bypass (CPB) for aortic surgery. Although administration of r-hirudin for CPB anticoagulation has previously been reported, many questions persist concerning the best therapeutic regimen for CPB anticoagulation as well as the time of onset and the doses for postoperative anticoagulation. CLINICAL FEATURES: A 65-yr-old man was admitted for surgery of aortic stenosis after an episode of acute pulmonary edema complicated by deep venous thrombosis in the context of documented HIT. The patient received r-hirudin for 13 dy before surgery at doses (0.4 mg x kg(-1) bolus followed by 0.15 mg x kg(-1) x hr(-1) continuous infusion) that maintained activated partial thromboplastin time (aPTT) ratios between 2 and 2.5. Anticoagulation for CPB was performed with r-hirudin given as 0.1 mg x kg(-1) i.v. bolus and 0.2 mg kg(-1) in the CPB priming volume. Anticoagulation during CPB was monitored with the whole blood activated coagulation time and ecarin clotting time (ECT) performed in the operating room with values corresponding to r-hirudin concentrations >5 microg x ml(-1) during CPB. Anticoagulation during CPB was uneventful. Two bleeding episodes, related to the r-hirudin regimen and necessitating allogeneic blood transfusion, occurred after surgery. CONCLUSION: This case report confirms previous experience of the use of r-hirudin for anticoagulation during CPB and provides additional information in the context of prolonged r-hirudin infusion before and after CPB.
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ranking = 12
keywords = coagulation
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4/38. Left to right extracardial shunt to control hemorrhage of ascending aorta and left ventricle: a report of 3 cases.

    Presented in this paper are 3 cases of hemorrhage of ascending aorta and left ventricle after open heart surgery treated by extracardial bypass in our hospital from Oct. 1994 to Dec. 1995. Remained aneurysmal wall enclosing conduit graft was used as a sac bypassed to right atrium to form a extracardial left-to-right shunt in order to control bleeding and the results turned out to be satisfactory. The bypass and hemodynamically ignorable shunt can close spontaneously without complications with recovery of coagulation system. The technique may find wide application in clinical practice.
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keywords = coagulation
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5/38. Percutaneous vascular surgical closure of the brachial artery.

    For the first time, a suture mediated closure device was used to obtain hemostasis after a catheterization procedure was performed via the brachial artery approach. Two successive catheterization procedures, using the right and left brachial arteries, were performed in a patient, contraindicated for a procedure through the femoral approach. In both cases the closures were successful and without complications. An aggressive anticoagulation regimen could safely be prescribed to this patient because of the percutaneous surgical achievement of hemostasis. This technique should provide interesting clinical benefits in selected patients undergoing catheterization via the brachial approach.
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ranking = 1
keywords = coagulation
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6/38. hemorrhage after the preoperative use of complementary and alternative medicines.

    The preoperative use of certain complementary and alternative medicines may predispose surgical patients to an acquired coagulation disorder resulting in excessive bleeding. Many herbs and dietary supplements inhibit platelet adhesion and aggregation or contain coumarins. We report the case of a patient undergoing breast surgery at the University of colorado health Sciences Center Denver, Colo, who had extensive postoperative bleeding requiring surgical re-exploration. Preoperatively the patient consumed vitamin e and several herbs with potential to alter the hemostatic process combined with the drugs quinine sulfate and sertraline hydrochloride. These combinations of alternative and conventional drugs may have contributed to inhibition of coagulation.
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ranking = 22.734437261965
keywords = coagulation disorder, coagulation
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7/38. Surreptitious bleeding in surgery: a major challenge in coagulation.

    Apart from inadequate surgical haemostasis, postoperative bleeding can be related to acquired disorders of platelet number, platelet function or coagulation proteins (e.g. vitamin k deficiency, DIC or liver injury). We highlight our experience with three patients who suffered life-threatening bleeding in the postoperative setting. The three patients - a 47-year-old man and 70- and 74-year-old women -- all had negative histories for excessive bleeding with prior surgeries, and all had normal preoperative PT and aPTT tests. Surgeries were resection of ischaemic bowel, cholecystectomy and coronary artery bypass grafting. All patients experienced unexpected bleeding within the first few postoperative days requiring multiple red cell transfusions and surgical re-explorations. Evaluations within the first 4--7 days after surgery revealed that these three patients had developed prolonged aPTT due to demonstrable factor viii antibodies initially at low titre. One patient was treated with high doses human factor viii, corticosteroids, intravenous gammaglobulin and plasma exchanges. The inhibitor was no longer demonstrable after 6 weeks of such therapy, and he has remained in remission without therapy. The second patient was initially treated with high-dose human factor viii infusions. Five months later, prednisone and 6-mercaptopurine were begun for worsening inhibitor titre and diffuse purpura and subcutaneous haematomas. The factor inhibitor remitted, but the patient died from liver failure related to post-transfusion hepatitis. The third patient was initially managed with high-dose human factor viii. Two months later, worsening inhibitor titre and tongue haematoma was treated with activated prothrombin complex, corticosteroids and cyclophosphamide. Eight years later, she is on no therapy, demonstrates a mild bleeding tendency and has a stable low-titre inhibitor. There have been a few case reports of inhibitors to coagulation factors including factor viii becoming manifest in the postoperative setting but surgery has not been widely recognized as an underlying cause for acquired haemophilia. This paper speculates on pathogenesis and reviews treatment options. This syndrome is remarkable for its abrupt onset in the first few postoperative days and for its substantial morbidity. The problem is potentially reversible with immunosuppressive therapy. Clinicians should be aware of this syndrome, considering acquired haemophilia in patients with unexpected postoperative bleeding.
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ranking = 6
keywords = coagulation
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8/38. Management of the oral and maxillofacial surgery patient with thrombocytopenia.

    patients with disorders of coagulation and bleeding can be among the most challenging surgical patients to manage. Intraoperative or postoperative bleeding can contribute to life-threatening complications in even the most "benign" surgical procedures. An adequate number and function of platelets play a critical role in the coagulation pathway. A thorough understanding of platelet physiology and platelet disorders is therefore essential in the management of the thrombocytopathic oral and maxillofacial surgery patient. A careful preoperative evaluation will help the surgeon treat these patients and help prevent potentially catastrophic intraoperative or postoperative bleeding.
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ranking = 2
keywords = coagulation
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9/38. Distant wounded glioma syndrome: report of two cases.

    OBJECTIVE AND IMPORTANCE: We describe two cases of distant wounded glioma syndrome complicating surgical resection of multifocal glioblastoma multiforme. This clinical entity was previously described as a local phenomenon resulting in postoperative hemorrhaging within the cavity of partially resected tumors. These cases are unique, in that the postoperative hemorrhaging occurred within distant tumor nodules after gross total resection of the primary lesion. CLINICAL PRESENTATION AND INTERVENTION: Two middle-aged men without known risk factors for postoperative hemorrhaging presented with multifocal glioblastoma multiforme. Each underwent surgical resection of the deficit-producing lesion and developed hemorrhage at distant tumor sites that were not directly manipulated during the surgical procedures. The distant hemorrhage caused new neurological deficits, with severe morbidity. CONCLUSION: We postulate that distant wounded glioma syndrome is a distinct clinical entity that causes remote postoperative hemorrhaging and that tumor-induced coagulopathy triggered by surgery seems to create a hypocoagulable state that is most concentrated within brain tissue. Because of their rich vascularity, these distant tumor nodules are more susceptible to hemorrhage, resulting from coagulation changes after tumor resection, than are other sites. They also exhibit increased blood flow after resection of a large mass, because of autoregulatory dysfunction induced by peritumoral edema, increasing the likelihood of hemorrhage at these sites.
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ranking = 1
keywords = coagulation
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10/38. Severe hemorrhage complicating tension-free vaginal tape (TVT): a case report.

    A 59-year-old non-obese woman with genuine stress incontinence underwent an uneventful TVT procedure. Postoperatively a hemorrhage in the space of Retzius became more and more prominent, and a secondary laparotomy was performed. Large clots as well as the TVT tape were removed. No active bleeding was found. She recovered uneventfully but needed 10 units of blood. A coagulation defect could not be diagnosed.
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ranking = 1
keywords = coagulation
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