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Special Issue "New Insights in Bleeding: From Diagnosis to Therapy"

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Surgery".

Deadline for manuscript submissions: closed (31 July 2023) | Viewed by 7120

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Special Issue Editor

Dr. Rita Carlotta Santoro

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Guest Editor

Centre for Haemorrhagic and Bleeding Diseases, “Pugliese Ciaccio” Hospital, 88100 Catanzaro, Italy
Interests: hemophilia; von willebrand disease; congenital hemorrhagic diseases; hypofibrinogenemia and dysfibrinogenemia; rare coagulation defects; replacement therapy; non-replacement therapy for hemophili

Special Issue Information

Dear Colleagues,

The term haemorrhage or bleeding refers to the sudden and intense leakage of blood from the blood vessels. Bleedings are distinguished according to the type of vessel involved, arterial or venous, and their location, external and internal. Their severity depends on the location of the bleeding, the amount of blood flowed and the accompanying symptoms, and it can lead to hemorrhagic shock and death if untreated. Bleeding is a common event, not only in patients with Congenital Hemorrhagic Disorders, and it can be caused by several accidents or conditions. Possible causes include:

Traumatic bleeding: an injury can cause traumatic bleeding. Common types of traumatic injuries include: abrasions that do not penetrate under the skin; hematoma or bruises; lacerations or incisions; injuries from objects such as needles or knives; crush injuries; gunshot wounds;

Medical Conditions: some medical conditions can cause bleeding. Haemorrhage due to a medical condition is less common than traumatic bleeding. Conditions that can cause it include: haematological disease; liver disease; menorrhagia; heavy or prolonged menstrual bleeding; thrombocytopenia; vitamin K deficiency; bowel obstruction; congestive heart failure; tumours; severe hypothermia;

Drugs: some medications can increase the risk of bleeding or even cause it. Drugs that may be responsible include: anticoagulants, antiplatelet agents; anti-inflammatories; antibiotics; radiotherapy; chemotherapy.

In addition, knowledge of bleeding causes plays a pivotal role in the choice of therapeutic options. Haemorrhages may be self-limiting, stopped by external pressure, or require IR or surgery to control. Medical management, surgery or endovascular treatment are the main strategies that can be adopted in case of bleeding. The total time needed to stop the haemorrhage critically affects outcomes. Endovascular treatment options are minimally invasive, cost-effective, and life-saving. A variety of embolization techniques and embolic agents have been described. Imaging should be performed before radiologic or operative intervention in patients who respond at least partially to resuscitation. Patients with ongoing hemodynamic instability that does not respond at least partially to adequate resuscitation may require immediate intervention.

This issue highlights recent advances in diagnostic and therapeutic options for bleeding.

We welcome articles providing new insights into the diagnosis and treatment of bleedings. We will be pleased to evaluate your interventional or observational studies evaluating the safety, effectiveness, and efficacy of new diagnostic tools and therapeutic options in bleeding patients.

Dr. Rita Carlotta Santoro
Guest Editor

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Keywords

bleeding
replacement therapy
endovascular treatments
anticoagulation and adverse hemorrhagic events
reverse therapy
acquired haemorrhagic disorders
bleedings in pregnancy

Published Papers (5 papers)

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Research

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15 pages, 5347 KiB

Open AccessArticle

Transcatheter Arterial Embolization (TAE) in the Management of Bleeding in the COVID-19 Patient

and

Medicina 2023, 59(6), 1062; https://doi.org/10.3390/medicina59061062 - 01 Jun 2023

Cited by 5 | Viewed by 1224

Abstract

Background and Objectives: Increasing attention is being paid to the coagulation disorders associated with SARS-CoV-2 infection. Bleeding accounts for 3–6% of COVID-19 patient deaths, and is often a forgotten part of the disease. The bleeding risk is enhanced by several factors, including spontaneous heparin-induced thrombocytopenia, thrombocytopenia, the hyperfibrinolytic state, the consumption of coagulation factors, and thromboprophylaxis with anticoagulants. This study aims to assess the efficacy and safety of TAE in the management of bleeding in COVID-19 patients. Materials and Methods: This multicenter retrospective study analyzes data from COVID-19 patients subjected to transcatheter arterial embolization for the management of bleeding from February 2020 to January 2023. Results: Transcatheter arterial embolization was performed in 73 COVID-19 patients for acute non-neurovascular bleeding during the study interval (February 2020–January 2023). Coagulopathy was observed in forty-four (60.3%) patients. The primary cause of bleeding was spontaneous soft tissue hematoma (63%). A 100% technical success rate was recorded; six cases of rebleeding resulted in a 91.8% clinical success rate. No cases of non-target embolization were observed. Complications were recorded in 13 (17.8%) patients. The efficacy and safety endpoints did not differ significantly between the coagulopathy and non-coagulopathy groups. Conclusions: Transcatheter Arterial Embolization (TAE) is an effective, safe and potentially life-saving option for the management of acute non-neurovascular bleeding in COVID-19 patients. This approach is effective and safe even in the subgroup of COVID-19 patients with coagulopathy. Full article

(This article belongs to the Special Issue New Insights in Bleeding: From Diagnosis to Therapy)

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10 pages, 306 KiB

Open AccessArticle

Risk Factors for Bleeding Varicose Veins in Patients with Chronic Venous Disease

Umberto Marcello Bracale

Michele Andreucci

and

Raffaele Serra

Medicina 2023, 59(6), 1034; https://doi.org/10.3390/medicina59061034 - 27 May 2023

Cited by 6 | Viewed by 1271

Abstract

Background and Objectives: Chronic venous disease (CVD) is a widespread clinical condition that is very common in western countries in the adult general population with a wide range of clinical manifestations, such as varicose veins (VVs) that in certain circumstances may complicate with rupture and subsequent bleeding that may even be fatal. The aim of this study is to evaluate risk factors for bleeding VVs. Materials and Methods: This is a retrospective study conducted in patients with CVD complicating with bleeding of VVs over a 4-year period (2019–2022). A random sample, for the same 4-year period and with a 3:1 ratio, was selected from other CVD patients without VVs bleeding that served as the control group. Results: From a global population of 1048 patients with CVD over a 4-year period, a total of 33 patients (3.15%) with VVs bleeding were selected. A group of 99 patients without VVs bleeding were randomly selected from the total population of 1048 patients with CVD. Findings of this study showed that advanced clinical stage of CVD (i.e., C4b stage), advanced age, living alone, suffering from cardiovascular co-morbidity (i.e., hypertension and CHF), assuming certain drugs that act on blood coagulation (i.e., aspirin, anticoagulants), assuming psychotropic medication, having particular venous reflux patterns (i.e., below-knee GSV reflux, non-saphenous veins reflux, Cockett’s perforators reflux), and not having been assessed and treated previously for CVD (i.e., with VADs, CT, or surgery) may predispose a high risk for bleeding VVs. Conclusions: Bleeding VVs may be a life-threatening complications of CVD patients, and monitoring risk factors found in this study and others that, hopefully, may be discovered in the future through further focused research will help to reduce the impact of this problem in this patient population. Full article

(This article belongs to the Special Issue New Insights in Bleeding: From Diagnosis to Therapy)

18 pages, 3353 KiB

Open AccessArticle

Efficacy and Safety of Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs) in Transcatheter Arterial Embolization (TAE) of Acute Non-Neurovascular Bleeding: A Multicenter Retrospective Cohort Study

and

Medicina 2023, 59(4), 710; https://doi.org/10.3390/medicina59040710 - 04 Apr 2023

Cited by 7 | Viewed by 1252

Abstract

Background and Objectives: Transcatheter arterial embolization (TAE) is part of the daily practice of most interventional radiologists worldwide. The ideal liquid embolic agent is far from being identified. Non-adhesive liquid embolic agents (NALEA) harden from the outside to the inside, resulting in deep penetration, known as “magma-like” progression, which permits a more distal embolization with good control of the embolic material. This multicenter retrospective cohort study aims to assess the efficacy, feasibility and safety of transcatheter arterial embolization (TAE) with ethylene-vinyl alcohol (EVOH)-based NALEAs (Onyx and Squid) in acute bleeding outside of the neurovascular area. Materials and Methods: This study is a multicenter analysis of retrospectively collected data of consecutive patients who had undergone, from January 2015 to December 2022, transcatheter arterial embolization with non-adhesive EVOH-based agents in the setting of acute non-neurovascular bleeding. Results: Fifty-three patients underwent transcatheter arterial embolization for acute non-neurovascular bleeding. Eight (15.1%) procedures were performed in patients with coagulopathy. The most used concentration of EVOH-based NALEAs was 34 (i.e., 8%), with a mean dose of 0.5 (±0.3) mL. The mean CT-to-groin time, the mean procedure time, the mean CT-to-embolization time and the mean fluoroscopy time were 22.9 (±12.4) min, 27.5 (±7) min, 50.3 (±13.1) min and 7.5 (±2.8) min, respectively. Technical success was achieved in all cases with a 96.2% clinical success rate. Complications were recorded in six (11.3%) patients. No statistically significant differences were observed between the group of patients with coagulopathy and the group of patients without coagulopathy in terms of efficacy and safety endpoints. Conclusions: Transcatheter arterial embolization (TAE) performed with non-adhesive EVOH-based embolic agents is an effective, feasible and safe strategy for the management of acute non-neurovascular bleeding, even in the subgroup of patients with coagulopathy. Full article

(This article belongs to the Special Issue New Insights in Bleeding: From Diagnosis to Therapy)

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Review

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11 pages, 317 KiB

Open AccessReview

Acquired Hemophilia A: Bleeding Pattern and Hemostatic Therapeutic Strategies

Renato Marino

Medicina 2023, 59(10), 1739; https://doi.org/10.3390/medicina59101739 - 28 Sep 2023

Viewed by 557

Abstract

Acquired Hemophilia A (AHA) is a rare autoimmune disorder characterized by the onset of a sudden and unexpected bleeding episode in a patient with no personal or family history of bleeding diathesis, and with a typical laboratory feature, i.e., a prolonged activated partial thromboplastin time that is not otherwise explained. This bleeding disorder is caused by autoantibodies directed against the coagulation factor VIII (FVIII). AHA is idiopathic in 50% of cases and is secondary to well-defined diseases in the remaining 50%. AHA affects elderly patients although it has also been observed in the post-partum period. Bleeding manifestations are heterogeneous, ranging from mild to life-threatening bleeds involving limbs and organs. Severe bleeding with a significant decrease in hemoglobin levels must be promptly and adequately treated in order to avoid a worsening of the hemorrhages and their complications. According to international recommendations, the bypass agents (i.e., activated prothrombin complex concentrate and activated recombinant factor VII) and the replacement therapy with recombinant porcine FVIII are considered as the first-line therapy for bleeding control, due to their proven clinical efficacy. Plasma-derived or recombinant FVIII concentrates could be used as second-line treatments. Emicizumab may represent a valid and interesting therapeutic option for prophylaxis of bleeding recurrences. Full article

(This article belongs to the Special Issue New Insights in Bleeding: From Diagnosis to Therapy)

12 pages, 623 KiB

Open AccessReview

Isolated Prolongation of Activated Partial Thromboplastin Time: Not Just Bleeding Risk!

Rita Carlotta Santoro

Angelo Claudio Molinari

Marzia Leotta

and

Tiziano Martini

Medicina 2023, 59(6), 1169; https://doi.org/10.3390/medicina59061169 - 17 Jun 2023

Cited by 1 | Viewed by 2322

Abstract

Activated partial thromboplastin time (aPTT) is a fundamental screening test for coagulation disturbances. An increased aPTT ratio is quite common in clinical practice. How the detection of prolonged activated aPTT with a normal prothrombin time is interpreted is therefore very important. In daily practice, the detection of this abnormality often leads to delayed surgery and emotional stress for patients and their families and may be associated with increased costs due to re-testing and coagulation factor assessment. An isolated, prolonged aPTT is seen in (a) patients with congenital or acquired deficiencies of specific coagulation factors, (b) patients receiving treatment with anticoagulants, mainly heparin, and (c) individuals/patients with circulating anticoagulants. We summarize here what may cause an isolated prolonged aPTT and evaluate the preanalytical interferences. The identification of the cause of an isolated prolonged aPTT is of the utmost importance in ensuring the correct diagnostic workup and therapeutic choices. Full article

(This article belongs to the Special Issue New Insights in Bleeding: From Diagnosis to Therapy)

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Special Issue "New Insights in Bleeding: From Diagnosis to Therapy"

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