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Fulltext Interventions for treating post-extraction bleeding

Kumbargere Nagraj S, Prashanti E, Aggarwal H, Lingappa A, Muthu MS, Kiran Kumar Krishanappa S, et al.

Cochrane Database Syst Rev, 2018 Mar 04;3(3):CD011930.
PMID: 29502332 DOI: 10.1002/14651858.CD011930.pub3

BACKGROUND: Post-extraction bleeding (PEB) is a recognised, frequently encountered complication in dental practice, which is defined as bleeding that continues beyond 8 to 12 hours after dental extraction. The incidence of post-extraction bleeding varies from 0% to 26%. If post-extraction bleeding is not managed, complications can range from soft tissue haematomas to severe blood loss. Local causes of bleeding include soft tissue and bone bleeding. Systemic causes include platelet problems, coagulation disorders or excessive fibrinolysis, and inherited or acquired problems (medication induced). There is a wide array of techniques suggested for the treatment of post-extraction bleeding, which include interventions aimed at both local and systemic causes. This is an update of a review published in June 2016.
OBJECTIVES: To assess the effects of interventions for treating different types of post-extraction bleeding.
SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 24 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 12), MEDLINE Ovid (1946 to 24 January 2018), Embase Ovid (1 May 2015 to 24 January 2018) and CINAHL EBSCO (1937 to 24 January 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. We searched the reference lists of relevant systematic reviews.
SELECTION CRITERIA: We considered randomised controlled trials (RCTs) that evaluated any intervention for treating PEB, with male or female participants of any age, regardless of type of teeth (anterior or posterior, mandibular or maxillary). Trials could compare one type of intervention with another, with placebo, or with no treatment.
DATA COLLECTION AND ANALYSIS: Three pairs of review authors independently screened search records. We obtained full papers for potentially relevant trials. If data had been extracted, we would have followed the methods described in the Cochrane Handbook for Systematic Reviews of Interventions for the statistical analysis.
MAIN RESULTS: We did not find any randomised controlled trial suitable for inclusion in this review.
AUTHORS' CONCLUSIONS: We were unable to identify any reports of randomised controlled trials that evaluated the effects of different interventions for the treatment of post-extraction bleeding. In view of the lack of reliable evidence on this topic, clinicians must use their clinical experience to determine the most appropriate means of treating this condition, depending on patient-related factors. There is a need for well designed and appropriately conducted clinical trials on this topic, which conform to the CONSORT statement (www.consort-statement.org/).

Matched MeSH terms: Oral Hemorrhage/therapy*; Postoperative Hemorrhage/therapy*
Fulltext Management of bleeding pseudoaneurysm of gastroduodenal artery secondary to chronic pancreatitis

Leow VM, Siam F, Kannan S, Sari Baharudin M, Raman K, Singh H

Med J Malaysia, 2013 Jun;68(3):271-2.
PMID: 23749023 MyJurnal

A bleeding pseudoaneurysm of the peripancreatic artery can present with massive upper gastrointestinal hemorrhage. History of pancreatitis and urgent imaging are crucial in the making of the diagnosis. Here, we report a patient with alcoholic chronic pancreatitis presented with ruptured pseudoaneurysm of gastroduodenal artery (GDA). He was treated with percutaneous angiographic embolisation.

Matched MeSH terms: Gastrointestinal Hemorrhage/therapy
Fulltext Treatment of bleeding gastroesophageal varices

Kyaw K, Raj SM

Med J Malaysia, 1993 Sep;48(3):377-8.
PMID: 8183158
Matched MeSH terms: Gastrointestinal Hemorrhage/therapy*
Interventions for treating post-extraction bleeding

Sumanth KN, Prashanti E, Aggarwal H, Kumar P, Lingappa A, Muthu MS, et al.

Cochrane Database Syst Rev, 2016 Jun 10.
PMID: 27285450 DOI: 10.1002/14651858.CD011930.pub2

BACKGROUND: Post-extraction bleeding (PEB) is a recognised, frequently encountered complication in dental practice, which is defined as bleeding that continues beyond 8 to 12 hours after dental extraction. The incidence of post-extraction bleeding varies from 0% to 26%. If post-extraction bleeding is not managed, complications can range from soft tissue haematomas to severe blood loss. Local causes of bleeding include soft tissue and bone bleeding. Systemic causes include platelet problems, coagulation disorders or excessive fibrinolysis, and inherited or acquired problems (medication induced). There is a wide array of techniques suggested for the treatment of post-extraction bleeding, which include interventions aimed at both local and systemic causes.
OBJECTIVES: To assess the effects of interventions for treating different types of post-extraction bleeding.
SEARCH METHODS: We searched the following electronic databases: The Cochrane Oral Health Group Trials Register (to 22 March 2016); The Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2016, Issue 2); MEDLINE via OVID (1946 to 22 March 2016); CINAHL via EBSCO (1937 to 22 March 2016). Due to the ongoing Cochrane project to search EMBASE and add retrieved clinical trials to CENTRAL, we searched only the last 11 months of EMBASE via OVID (1 May 2015 to 22 March 2016). We placed no further restrictions on the language or date of publication. We searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov), and the WHO Clinical Trials Registry Platform for ongoing trials (http://apps.who.int/trialsearch/default.aspx). We also checked the reference lists of excluded trials.
SELECTION CRITERIA: We considered randomised controlled trials (RCTs) that evaluated any intervention for treating PEB, with male or female participants of any age, regardless of type of teeth (anterior or posterior, mandibular or maxillary). Trials could compare one type of intervention with another, with placebo, or with no treatment.
DATA COLLECTION AND ANALYSIS: Three pairs of review authors independently screened search records. We obtained full papers for potentially relevant trials. If data had been extracted, we would have followed the methods described in the Cochrane Handbook for Systematic Reviews of Interventions for the statistical analysis.
MAIN RESULTS: We did not find any randomised controlled trial suitable for inclusion in this review.
AUTHORS' CONCLUSIONS: We were unable to identify any reports of randomised controlled trials that evaluated the effects of different interventions for the treatment of post-extraction bleeding. In view of the lack of reliable evidence on this topic, clinicians must use their clinical experience to determine the most appropriate means of treating this condition, depending on patient-related factors. There is a need for well designed and appropriately conducted clinical trials on this topic, which conform to the CONSORT statement (www.consort-statement.org/).

Matched MeSH terms: Hemorrhage/therapy*
Fulltext Brief Consent Methods Enable Rapid Enrollment in Acute Stroke Trial: Results From the TICH-2 Randomized Controlled Trial

Law ZK, Appleton JP, Scutt P, Roberts I, Al-Shahi Salman R, England TJ, et al.

Stroke, 2022 Apr;53(4):1141-1148.
PMID: 34847710 DOI: 10.1161/STROKEAHA.121.035191

BACKGROUND: Seeking consent rapidly in acute stroke trials is crucial as interventions are time sensitive. We explored the association between consent pathways and time to enrollment in the TICH-2 (Tranexamic Acid in Intracerebral Haemorrhage-2) randomized controlled trial.
METHODS: Consent was provided by patients or by a relative or an independent doctor in incapacitated patients, using a 1-stage (full written consent) or 2-stage (initial brief consent followed by full written consent post-randomization) approach. The computed tomography-to-randomization time according to consent pathways was compared using the Kruskal-Wallis test. Multivariable logistic regression was performed to identify variables associated with onset-to-randomization time of ≤3 hours.
RESULTS: Of 2325 patients, 817 (35%) gave self-consent using 1-stage (557; 68%) or 2-stage consent (260; 32%). For 1507 (65%), consent was provided by a relative (1 stage, 996 [66%]; 2 stage, 323 [21%]) or a doctor (all 2-stage, 188 [12%]). One patient did not record prerandomization consent, with written consent obtained subsequently. The median (interquartile range) computed tomography-to-randomization time was 55 (38-93) minutes for doctor consent, 55 (37-95) minutes for 2-stage patient, 69 (43-110) minutes for 2-stage relative, 75 (48-124) minutes for 1-stage patient, and 90 (56-155) minutes for 1-stage relative consents (P<0.001). Two-stage consent was associated with onset-to-randomization time of ≤3 hours compared with 1-stage consent (adjusted odds ratio, 1.9 [95% CI, 1.5-2.4]). Doctor consent increased the odds (adjusted odds ratio, 2.3 [1.5-3.5]) while relative consent reduced the odds of randomization ≤3 hours (adjusted odds ratio, 0.10 [0.03-0.34]) compared with patient consent. Only 2 of 771 patients (0.3%) in the 2-stage pathways withdrew consent when full consent was sought later. Two-stage consent process did not result in higher withdrawal rates or loss to follow-up.
CONCLUSIONS: The use of initial brief consent was associated with shorter times to enrollment, while maintaining good participant retention. Seeking written consent from relatives was associated with significant delays.
REGISTRATION: URL: https://www.isrctn.com; Unique identifier: ISRCTN93732214.

Matched MeSH terms: Cerebral Hemorrhage/therapy
Fulltext Jejunal diverticulosis as the obscure cause of overt gastrointestinal bleeding

Nyin LY, Zainun AR, Tee HP

Med J Malaysia, 2011 Aug;66(3):257-8.
PMID: 22111453 MyJurnal

Jejunal diverticulosis is a rare gastrointestinal condition manifested as benign outpouching from the jejunal wall. It is usually asymptomatic, but may present as obscure gastrointestinal bleeding. This condition is often found incidentally in the imaging work-up of patients with other gastrointestinal conditions. We present a case of jejunal diverticulosis in a 65-year-old gentleman with obscure overt gastrointestinal bleed.

Matched MeSH terms: Gastrointestinal Hemorrhage/therapy
Abnormal per rectal bleed

Singh AH

Scott Med J, 2011 Feb;56(1):59.
PMID: 21515535 DOI: 10.1258/smj.2010.010026

A 3-year old girl presented to our A&E with a complaint of an acute event of per rectal bleed. The parent had given a history of a visit to a nearby waterfall one day ago. Upon admission she developed hypotension and had a fainting episode due to the excessive passing of blood per rectum. The case report shows how the appropriate investigations were carried out and the twist behind the cause.

Matched MeSH terms: Hemorrhage/therapy
Puerperal uterine inversion: a report of four cases

Achanna S, Mohamed Z, Krishnan M

J Obstet Gynaecol Res, 2006 Jun;32(3):341-5.
PMID: 16764627

Acute puerperal uterine inversion is a life-threatening and unpredictable obstetric emergency. If overlooked, it could lead to a maternal death. Although the precise cause is unknown, it is postulated to be caused by the mismanagement of the third stage of labor with premature traction of the umbilical cord and fundal pressure before placental separation. At the Ipoh General Hospital in Malaysia there were 31 394 deliveries and four acute uterine inversions occurring from 1 January 2002 to 30 June 2005. The four patients were between 25 and 36 years of age and their parities were between two and three. When manual repositioning of the uterus failed, successful correction was accomplished by the O'Sullivan's hydrostatic method. One case had to undergo subtotal hysterectomy after repositioning because of massive hemorrhage secondary to placenta accreta. Early diagnosis, immediate treatment of shock, and replacement are essential.

Matched MeSH terms: Postpartum Hemorrhage/therapy*
Acute puerperal inversion of the uterus--an obstetric emergency

Rachagan SP, Sivanesaratnam V, Kok KP, Raman S

Aust N Z J Obstet Gynaecol, 1988 Feb;28(1):29-32.
PMID: 3214380

Over a 17-year period, 15 patients with acute puerperal inversion of the uterus were managed at the University Hospital, Kuala Lumpur, an incidence of 1 in 4,836 deliveries. Injudicious traction on the umbilical cord before the uterus was well contracted, was probably the most important causative factor. Haemorrhage was more severe when removal of the placenta was done prior to correction of the inversion. Either the hydrostatic method or manual replacement were used but more often a combination of both techniques was found necessary. With careful management of the third stage of labour, this complication can be avoided.

Matched MeSH terms: Uterine Hemorrhage/therapy
Transarterial angioembolization versus surgery after failed endoscopic therapy for non-variceal upper gastrointestinal bleeding

Jailani RF, Kosai NR, Yaacob NY, Jarmin R, Sutton P, Harunarrashid H, et al.

Clin Ter, 2014;165(6):294-8.
PMID: 25524184 DOI: 10.7417/CT.2014.1771

BACKGROUND AND OBJECTIVE: To compare the outcome of transarterial angioembolization (TAE) and surgery with endoscopically unmanageable non-variceal hemorrhage of the upper gastrointestinal tract.

MATERIALS AND METHODS: A case note review of all patients treated for non-variceal upper gastrointestinal bleeding from January 2006 till January 2012 was performed.

RESULTS: Fifty-four of 667 patients with non-variceal bleeding did not respond to endoscopic treatment. Nine of the 54 patients had incomplete data, leaving 45 patients in the study; 24 had angiography and another 21 had surgery. The two groups were broadly similar in terms of relevant clinical variables. Nineteen of 24 having angiography had embolisation. Re-bleeding recurred in 8 patients (33%) in the TAE group and 6 patients (28.6%) in the surgery group (p = 0.28). There was no statistically significant difference in post procedural complications (81% vs 62.5%, p = 0.17), 30-day mortality (33% vs 29.1%, p = 0.17 ) units of blood transfused (12.24 vs 8.92, p = 0.177) and mean hospital stay (30.7 vs 22.9 days, p = 0.281) observed in patients undergoing surgery as compared to TAE.

CONCLUSIONS: TAE and surgery have similar outcomes in patients with endoscopically unmanageable non-variceal upper gastrointestinal haemorrhage.

Matched MeSH terms: Gastrointestinal Hemorrhage/therapy*
Fulltext Massive lower gastrointestinal bleeding secondary to colonic mucormycosis

Anand J, Ghazala K, Chong VH

Med J Malaysia, 2011 Aug;66(3):266-7.
PMID: 22111457

Lower gastrointestinal bleeding is usually due to haemorrhoids, diverticular disease, or colorectal cancer. Infective causes of gastrointestinal bleeding are rare. A 70-year-old lady was admitted with septic shock secondary to community acquired pneumonia. She later developed massive lower gastrointestinal bleeding secondary to colonic mucormycosis. Her condition deteriorated rapidly and she died of septicemia. Mucormycosis of the colon is extremely rare and is still associated with a high mortality.

Matched MeSH terms: Gastrointestinal Hemorrhage/therapy
Fulltext Arteriovenous malformation of the stomach: a rare cause of upper gastrointestinal bleeding

Latar NH, Phang KS, Yaakub JA, Muhammad R

Med J Malaysia, 2011 Jun;66(2):142-3.
PMID: 22106696 MyJurnal

Haemorrhage arising from gastric arteriovenous malformation (AVM) is rare and normally occurs in the elderly. Bleeding gastric AVM presenting in the younger age group is even rarer. We report a case of a 14 year old boy who presented with recurrent episodes of haematemesis. He subsequently underwent a proximal gastrectomy and the histological examination confirmed a gastric AVM. After reviewing the literature we believe this is the youngest ever reported case of bleeding gastric AVM reported in English literature.

Matched MeSH terms: Gastrointestinal Hemorrhage/therapy
Fulltext Intravitreal injection of recombinant tissue plasminogen activator and pneumatic displacement of submacular haemorrhage

Fadhilah M, Mimiwati Z, Fong KC

Med J Malaysia, 2010 Dec;65(4):271-2.
PMID: 21901943

We report a case of a patient with hypertension and ischaemic heart disease on anti-platelet treatment, who developed uniocular profound visual loss from a submacular haemorrhage secondary to valsalva retinopathy. He was treated with a combination of intravitreal recombinant tissue plasminogen activator (rtPA) and sulphur hexafluoride (SF6) gas followed by strict prone positioning. He demonstrated significant displacement of the haemorrhage and improvement of vision postoperatively.

Matched MeSH terms: Retinal Hemorrhage/therapy*
Fulltext A study into the characteristics and outcome of variceal bleeding in a tertiary hospital in Southeast Asia

Yew BS, Ong WC, Chow WC, Lui HF

Med J Malaysia, 2007 Aug;62(3):201-5.
PMID: 18246907

This retrospective study evaluated patients admitted to the Department of Gastroenterology, Singapore General Hospital for variceal bleeding in the year 2004. Improvement in outcome of variceal bleeding has been reported in the West. There is no regional data on this condition. This study aims to determine the characteristics and outcome of variceal bleeding in a tertiary hospital in Southeast Asia. Twenty-two patients were eligible. The main aetiologies of liver cirrhosis were chronic hepatitis B (38%) and alcohol (33%). Child's A, B and C were 29%, 48% and 24% respectively. Nineteen patients (86%) had bleeding oesophageal varices (band ligation performed). The remaining three patients (14%) had bleeding gastric varices (N-butyl-2-cyanoacrylate injection performed). Detailed description of certain endoscopic findings was absent in up to 18 patients (82%). All patients received antibiotics and vasoactive drug. In-hospital mortality and rebleeding were 9% and 18% respectively. We conclude that the relatively low in-hospital mortality and rebleeding rates in our series are most probably due to the smaller proportion of patients with severe liver dysfunction and management which adhered to recommendations. Documentation of endoscopic findings needs to be improved to facilitate the continuation of care.

Matched MeSH terms: Gastrointestinal Hemorrhage/therapy
Massive dissecting intramural duodenal haematoma following endoscopic haemostasis of a bleeding duodenal ulcer

Lukman MR, Jasmi AY, Niza SS

Asian J Surg, 2006 Apr;29(2):98-100.
PMID: 16644511

Intramural duodenal haematoma is a rare injury of the duodenum. Most reported cases are secondary to blunt trauma to the abdomen. Such injury following endoscopic intervention is even rarer, and there are no definite guidelines for its management. We report a case where endoscopic haemostasis of a bleeding duodenal ulcer resulted in a massive dissecting intramural duodenal haematoma with gastric outlet obstruction and obstructive jaundice.

Matched MeSH terms: Peptic Ulcer Hemorrhage/therapy*
Superselective coil embolization in gastrointestinal haemorrhage: early experience

Nawawi O, Young N, So S

Australas Radiol, 2006 Feb;50(1):21-6.
PMID: 16499722

This is a retrospective study to evaluate our early experience of using selective microcoil embolization in patients who had gastrointestinal (GI) haemorrhage. From December 2002 to December 2003, six patients with GI haemorrhage (upper GI, n = 1; lower GI, n = 5) underwent superselective microcoil embolization. Microcatheters were used to carry out embolizations in branches of the superior mesenteric artery. Microcoils were used in five patients and a combination of microcoils and embolospheres was used in one patient. Technical success (bleeding target devascularization) was achieved in all patients who showed active bleeding at the time of angiography. Two patients had recurrent bleeding within 24 h of embolization, of which one (16.7%) died. The other patient did not require active intervention as bleeding was minimal and resolved with conservative management. Satisfactory clinical success (no rebleeding after 30 days) was achieved in five patients. No clinical signs and symptoms of bowel ischaemia occurred in these patients. Follow-up colonoscopy carried out in two patients did not show any signs of ischaemia in the affected bowel segments. Superselective microcoil embolization is an effective and safe method of controlling and arresting bleeding in GI haemorrhage.

Matched MeSH terms: Gastrointestinal Hemorrhage/therapy*
Locally produced bovine bone sponge as a haemostatic agent

Ang CY, Samsudin AR, Karima AM, Nizam A

Med J Malaysia, 2004 May;59 Suppl B:149-50.
PMID: 15468862

The aim of this study was to evaluate the morphological and biological properties of a locally produced "Bovine Bone Sponge" for use in dentistry. Bovine bone sponge was prepared from local calf bone. Endotoxin level and surface properties were investigated. The pore size and water uptake ability were measured and results were compared with the commercial haemostatic agent. The material was tested for its haemostatic property and its inhibition of alveolar bone resorption in a sheep model following dental extraction. Results revealed a significant difference in haemostatic effect, and a shorter bleeding time and a lower rate of alveolar bone resorption in bovine bone sponge compare to a commercial haemostatic agent.

Matched MeSH terms: Hemorrhage/therapy*
Advances in portal hypertension

McCormick A, Qasim A

Med J Malaysia, 2005 Jul;60 Suppl B:6-11.
PMID: 16108165
Matched MeSH terms: Gastrointestinal Hemorrhage/therapy*
Clinical outcomes of mesh exposure/extrusion: presentation, timing and management

Lo TS, Tan YL, Cortes EF, Wu PY, Pue LB, Al-Kharabsheh A

Aust N Z J Obstet Gynaecol, 2015 Jun;55(3):284-90.
PMID: 26044791 DOI: 10.1111/ajo.12340

The Food and Drug Administration has recently highlighted an increase in reported complications associated with the use of transvaginal mesh.

Matched MeSH terms: Uterine Hemorrhage/therapy
An unusual cause of antepartum haemorrhage

Soh EB, Lim JM

Aust N Z J Obstet Gynaecol, 1999 Aug;39(3):389-90.
PMID: 10554965

This is a rare case of antepartum haemorrhage arising from the nonpregnant uterus in a woman with uterine didelphys. The bleeding and subsequent passage of a decidual cast did not have any adverse effect on the ongoing pregnancy.

Matched MeSH terms: Uterine Hemorrhage/therapy

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