Complications of stress bleeding prophylaxis

Reactions ◽  
1989 ◽  
Vol 262 (1) ◽  
pp. 3-3
Keyword(s):  
Bleeding Prophylaxis ◽  
Stress Bleeding

T1040 Stress Bleeding Prophylaxis in Critically Ill Patients: Survey of the Clinical Practice

2008 ◽  
Vol 134 (4) ◽  
pp. A-470
Author(s):  
Stefanie Zierhut ◽  
Sylvia Siebig ◽  
Tanja Bruennler ◽  
Falitsa Mandraka ◽  
Felix Rockmann ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Bleeding Prophylaxis ◽  
Stress Bleeding

Acute stress bleeding prophylaxis with sucralfate versus ranitidine and incidence of secondary pneumonia in intensive care unit patients

1995 ◽  
Vol 21 (3) ◽  
pp. 287-287 ◽  
Author(s):  
N. A. Mustafa ◽  
G. Aktürk ◽  
I. Özen ◽  
I. Köksal ◽  
N. Erciyes ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acute Stress ◽  
Bleeding Prophylaxis ◽  
Stress Bleeding

scholarly journals Gastrointestinal bleeding prophylaxis for critically ill patients: a clinical practice guideline

BMJ ◽  
2020 ◽  
pp. l6722 ◽  
Author(s):  
Zhikang Ye ◽  
Annika Reintam Blaser ◽  
Lyubov Lytvyn ◽  
Ying Wang ◽  
Gordon H Guyatt ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Gastrointestinal Bleeding ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Risk Of Bleeding ◽  
Weak Recommendation ◽  
Guideline Panel ◽  
Bleeding Prophylaxis

AbstractClinical questionWhat is the role of gastrointestinal bleeding prophylaxis (stress ulcer prophylaxis) in critically ill patients? This guideline was prompted by the publication of a new large randomised controlled trial.Current practiceGastric acid suppression with proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) is commonly done to prevent gastrointestinal bleeding in critically ill patients. Existing guidelines vary in their recommendations of which population to treat and which agent to use.RecommendationsThis guideline panel makes a weak recommendation for using gastrointestinal bleeding prophylaxis in critically ill patients at high risk (>4%) of clinically important gastrointestinal bleeding, and a weak recommendation for not using prophylaxis in patients at lower risk of clinically important bleeding (≤4%). The panel identified risk categories based on evidence, with variable certainty regarding risk factors. The panel suggests using a PPI rather than a H2RA (weak recommendation) and recommends against using sucralfate (strong recommendation).How this guideline was createdA guideline panel including patients, clinicians, and methodologists produced these recommendations using standards for trustworthy guidelines and the GRADE approach. The recommendations are based on a linked systematic review and network meta-analysis. A weak recommendation means that both options are reasonable.The evidenceThe linked systematic review and network meta-analysis estimated the benefit and harm of these medications in 12 660 critically ill patients in 72 trials. Both PPIs and H2RAs reduce the risk of clinically important bleeding. The effect is larger in patients at higher bleeding risk (those with a coagulopathy, chronic liver disease, or receiving mechanical ventilation but not enteral nutrition or two or more of mechanical ventilation with enteral nutrition, acute kidney injury, sepsis, and shock) (moderate certainty). PPIs and H2RAs might increase the risk of pneumonia (low certainty). They probably do not have an effect on mortality (moderate certainty), length of hospital stay, or any other important outcomes. PPIs probably reduce the risk of bleeding more than H2RAs (moderate certainty).Understanding the recommendationIn most critically ill patients, the reduction in clinically important gastrointestinal bleeding from gastric acid suppressants is closely balanced with the possibility of pneumonia. Clinicians should consider individual patient values, risk of bleeding, and other factors such as medication availability when deciding whether to use gastrointestinal bleeding prophylaxis. Visual overviews provide the relative and absolute benefits and harms of the options in multilayered evidence summaries and decision aids available on MAGICapp.

Plasma angiotensin II levels in hypoxic and hypovolemic stress in unanesthetized rabbits

1976 ◽  
Vol 41 (4) ◽  
pp. 462-465 ◽  
Author(s):  
R. M. Zakheim ◽  
A. Molteni ◽  
L. Mattioli ◽  
M. Park
Keyword(s):  
Angiotensin Ii ◽  
Plasma Levels ◽  
Chronic Hypoxia ◽  
Normal Values ◽  
Acute Hypoxia ◽  
Temporary Increase ◽  
Hypoxic Stress ◽  
Renin Angiotensin Aldosterone System ◽  
Plasma Angiotensin ◽  
Stress Bleeding

Plasma levels of angiotensin II were determined by radioimmunoassay in unanesthetized white rabbits exposed to acute hypoxia (FIO2 10% for 10 min),chronic hypoxia (0.5 atm up to 16 days), or hypovolemic stress (bleeding 20ml/kg). Angiotensin II levels significantly decreased after 10 min of acutehypoxia in normal rabbits and significantly increased when the same procedure was applied to animals previously exposed to hypoxia by 6–8 days of permanence in the hypobaric chamber or sodium deprivation. Chronic hypoxia resulted in a temporary increase of angiotensin II already evident on the 3rd day, but maximal at the 9th day with return to normal values within 16 days.Hypovolemic stress resulted in the expected rise of angiotensin II levels 10 min postbleeding both in normal and acclimatized rabbits. The responseof the renin-angiotensin-aldosterone system to hypoxic and hypovolemic stress is different. The direction and magnitude of the response to hypoxia depends on the underlying state of activation of the system and the cardiovascular condition of the animal at the time of hypoxic stress.

scholarly journals Practical Guidance of the GTH Haemophilia Board on the Use of Emicizumab in Patients with Haemophilia A

2020 ◽  
Vol 40 (05) ◽  
pp. 561-571
Author(s):  
Katharina Holstein ◽  
Manuela Albisetti ◽  
Christoph Bidlingmaier ◽  
Susan Halimeh ◽  
Sabine Heine ◽  
...  
Keyword(s):  
Tolerance Induction ◽  
Haemophilia A ◽  
Immune Tolerance Induction ◽  
Activated Prothrombin Complex Concentrate ◽  
Limited Experience ◽  
Bleeding Prophylaxis ◽  
Post Marketing ◽  
Practical Guidance ◽  
General Aspects ◽  
Treatment Surgery

AbstractEmicizumab has been approved for bleeding prophylaxis in patients with haemophilia A (PWHAs) with or without inhibitors. Because of substantial differences between factor VIII (FVIII) and Emicizumab, the ‘Ständige Kommission Hämophilie’ of the German, Austrian, Swiss Society for Thrombosis and Haemostasis Research (GTH) established a practical guidance for the use of Emicizumab in PWHAs. A systematic literature research was conducted in PubMed. Based on this and on personal experience, this practical guidance has been developed. Each single statement has been discussed among members of the ‘Ständige Kommission Hämophilie’ and revised accordingly. The final set of recommendations has been approved by all authors analogous to the Delphi method. This practical guidance is provided for physicians treating PWHAs with regard to general aspects, patient education, bleeding treatment, surgery, use of Emicizumab in previously untreated patients (PUPs), patients with newly diagnosed inhibitors and elderly patients. Patients should be treated in expert centres and adequate laboratory tests to monitor Emicizumab levels, FVIII replacement and inhibitors should be available. Early experience of immune tolerance induction protocols integrating Emicizumab is reviewed, and the limited experience in PUPs and very young children is described. So far, no thromboembolic complications have been reported with the concomitant use of FVIII or recombinant activated FVII for bleeding treatment or surgery. Activated prothrombin complex concentrate doses of >100 U/kg for >24 hours should be avoided whenever possible because of the high risk of thrombosis and/or thrombotic microangiopathy. In conclusion, this study is designed to support haemophilia physicians using Emicizumab in physicians treating hemophilia and using (PWHAs). With further post-marketing experience and trials, regular updates are necessary.

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