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Query: UMLS:C0019079 (hemoptysis)
 6,129 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report the clinical experience of a large Haemophilia Centre and Haemostasis Unit in reversing oral anticoagulation (OAC) using clotting factor concentrates. This is a retrospective study extending over 2 years (January 1996-December 1997). Reversal was performed using a combination of factor IX and factor VII concentrates administered by intravenous infusion. in a dose varying between 12 i.u./kg and 50 i.u./kg. We identified 20 episodes of OAC reversal in 18 patients, with a prevalence of 10 reversal episodes/1000 OAC patients/year. The median age was 77 years old (range 53-92 years). Indications for OAC reversal were divided into major bleeds (muscle haematoma [9], haematuria [3], subarachnoid haemorrhage [1], oesophageal bleeding [1], haemoptysis [1], haemarthrosis [1]); minor bleeds (extensive bruising [9], epistaxis [3], oral cavity bleeding [1]); and emergency invasive investigation (2). Pre-reversal, the international normalized ration (INR) was greater than 6.0 in 15/18 patients. Post-infusion. there was an immediate reduction in the INR towards normal (mean 1.3; range 1.1-2.3). There were no thrombotic complications or other adverse effects. The median use of factor 9 A concentrate was 2300 units/patient (range 570-4195), at a cost of 645 Pounds/patient and for factor VII concentrate 2200 units/patient (range 815-3630), at a cost of 664 Pounds/patient. Clotting factor concentrates provide a safe, rapid and effective means for OAC reversal and although expensive it is the treatment of choice in the over anticoagulated, bleeding patient.
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PMID:Clinical experience with the use of clotting factor concentrates in oral anticoagulation reversal. 995 82

Major hemoptysis a potentially life-threatening condition in pulmonology and can originate from both identifiable and unidentifiable sites. Identifiable bleeding sites can be controlled locally by iced saline, vasopressors, laser, electrocautery and balloon tamponade. Bleeding from an unidentifiable source, on the other hand, is much more difficult to control as the bleeding site is not accessible by the bronchoscope. Tranexamic acid (TA), a synthetic anti-fibrinolytic agent, is approved for treatment or prophylaxis of bleeding episodes in hemophilia or following major operative procedures via intravenous or oral routes. Its efficacy in controlling bleeding from mucosal tissue led us to apply it to patients with pulmonary bleeding. Six patients with significant hemoptysis, two who bled during bronchoscopy biopsy and four with spontaneous bleeding (lung cancer, diffuse alveolar hemorrhage, idiopathic pulmonary bleeding, metastatic thyroid carcinoma) were treated with TA. For the two who bled during bronchoscopy, we used a bolus of 500mg/5mL through the bronchoscope working channel, while the latter four received aerosolized TA 500mg/5ml 3-4 times a day. In all cases, the bleeding stopped with the first dose of TA, and the treatment was well tolerated without adverse events. While limited due to the small number of patients, these data show that TA administered either as a bolus through the bronchoscope or via inhalation seems to be effective in controlling severe hemoptysis from both identifiable and unidentifiable bleeding sites. Further clinical studies are needed to evaluate the use of the TA in this set-up.
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PMID:Pulmonary hemorrhage: A novel mode of therapy. 1925 6

Massive hemoptysis is a common complication in patients with cystic fibrosis (CF) and is associated with significant morbidity and mortality. Conventional treatment with antibiotic therapy and early bronchial artery embolization (BAE) is usually successful in achieving hemostasis in the majority of patients. Recombinant activated factor VII (rFVIIa), originally developed for use in patients with hemophilia, has emerged as a general hemostatic agent that is potentially useful in the management of many life-threatening bleeding conditions. In this article, we present four patients with CF lung disease and massive hemoptysis who were treated successfully with rFVIIa. We suggest that in patients with CF who present with massive hemoptysis, the use of rFVIIa can be considered in patients with refractory hemoptysis despite conventional therapy or as a temporizing therapy when BAE is not immediately available.
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PMID:Recombinant activated factor VII for massive hemoptysis in patients with cystic fibrosis. 1958 9

The authors present the case of a 72-year-old patient who presented with severe dyspnoea, scant haemoptysis, pronounced desaturation and bilateral haematomas on the upper limbs. Chest radiography showed bilateral infiltrates mainly in the lower lobes. The patient's prothrombin time, and platelet count were normal. However, the activated partial thromboplastin time showed a prolongation that was not reversed on a correction study. Factor VIII (FVIII) levels were very low and evidence of FVIII inhibitor was found. The patient had started taking ivabradine 2 months earlier, and the diagnosis of idiosyncratic acquired haemophilia was established. The patient was treated with volume expansion therapy, high levels of oxygen, multiple transfusions, methylprednisolone, desmopressine and rituximab. On the 3rd day, the patient showed progressive amelioration of his dyspnoea, oxygen needs and chest infiltrates. On the 7th day, the patient was discharged.
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PMID:Acquired haemophilia secondary to ivabradine presenting with acute respiratory distress syndrome. 2260 98