• 임상간호연구
• /
• 제17권1호
• /
• pp.35-45
• /
• 2011

Purpose: The purpose of this study was to identify the effect of exercise therapy on low back pain, self-urination disorder, bleeding, and hematoma in Percutaneous Coronary Intervention (PCI) patients. Methods: A total of 64 PCI patients were recruited from C hospital located in C city, from June until August of 2010. The patients were divided into two groups as the exercise and control group. Thirty-two participants in the exercise group took bedrest for two hours after PCI, and then received excise therapy. The other 32 participants in the control group took the usual 8-hour bedrest with intermittent back care by the unit nurses. Results: In the relieving effect of low back pain, exercise group reported pain reduced faster than the control group. On the other hand, there were no significant differences between the two groups in alleviant of self-urination disorder, bleeding, and hematoma. Conclusion: Exercise therapy for reducing patients' low back pain showed to be an effective nursing intervention. Since there was no bleeding or hematoma after PCI in the exercise group, this study provided the ground suggesting that it might be possible to reduce the bedrest time after PCI without increased risk of bleeding or hematoma.

• 성인간호학회지
• /
• 제25권4호
• /
• pp.400-408
• /
• 2013

Purpose: This study was conducted to examine the effects of bed side exercising on back pain and bleeding during absolute bed rest in patients who had received transcatheter arterial chemoembolization (TACE). Methods: A nonequivalent control group pretest-posttest design was used. A total 46 patients were sampled from a gastrointestinal unit of a urban general hospital in Seoul. The control group received 8 hours of bed rest and conservative care. The experimental group received 8 hours of bed rest and bed side exercising every one hour from the time having absolute bed rest for 3 hours after TACE. Results: The experimental group with bed side exercising experienced significantly less back pain compared to the control group. There was no significant difference in the incidence of bleeding complications between two groups. Conclusion: The results indicate that a bed side exercising is associated with a reduction of back pain and with no increased risk of bleeding complications in patients after TACE.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제15권1호
• /
• pp.25-29
• /
• 2015

Factor XI deficiency (Hemophilia C) is a very rare autosomal recessive bleeding disorder. Patients with factor XI deficiency do not typically show any spontaneous bleeding or specific symptoms. Sometimes those who have this disorder are identified during special situations such as trauma or surgery. Orthognathic surgery is particularly associated with a high bleeding risk. Therefore, great care must be taken when treating patients with bleeding disorders such as factor XI deficiency. There are a few reports that address the management of patients with bleeding disorders during orthognathic surgery. The current report describes a patient with factor XI deficiency who underwent Le Fort I osteotomy together with bilateral sagittal split osteotomy. The patient's condition was assessed using both rotation thromboelastometry ($ROTEM^{TM}$) and noninvasive measurements of total hemoglobin (SpHb) using Masimo Radical 7 (Masimo Co. CA, USA).

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• 제6권1호
• /
• pp.10-16
• /
• 2003

목 적: 아스피린을 비롯한 NSAID의 사용이 위장관 출혈 등 여러 가지 위 장관합병증의 위험성을 증가시키는 것은 이미 잘 알려진 사실이다. 소아에서 염증성 질환이나 해열제로 사용하는 통상용량의 아스피린보다 10분의 1정도의 소용량을 사용하는 경우가 종종 있으나, 이와 연관된 위 장관 출혈의 위험성에 대한 연구는 거의 없다. 이에 저자들은 Kawasaki병으로 아스피린을 사용한 소아들을 대상으로 소용량 아스피린의 장기적 사용에 의한 위 장관 출혈의 위험성을 평가하고자 하였다. 방 법: 1995년부터 2001년 5월까지 을지병원 소아과에서 Kawasaki병으로 진단받고 입원 치료하였던 소아가운데, 임상 기록을 확인하고 보호자와 전화통화를 하여 위장관 출혈 여부를 확인할 수 있었던 소아 100명을 대상으로 하였다. 위 장관 출혈 여부는 환아의 임상 기록을 확인하고, 보호자와 직접 전화 인터뷰를 하여 소용량 아스피린 투여시 육안적 토혈, 혈변의 유무를 물어서 확인하였다. 결 과: 모두 100명의 환아가 연구 대상에 포함되었으며, 남아 63명, 여아 37명으로 이들이 아스피린 투약을 시작할 때 연령은 4~118개월이었으며, 약 75%의 환아가 3세 미만이었다. 아스피린 투약기간은 0.5~17개월로 나타났으며, 약 70%의 환아가 2~3개월 간의 투약을 시행하였다. 한 명의 환아에서 육안적 혈변이 발생하였는데, 환아는 투약 당시 18개월된 여아로 투약 1개월경 하루 한번 씩 약 1주일간 육안적 혈변을 보았으나, 복통이나 다른 증상은 동반되지 않았다. 혈변은 씨메티딘을 약 1주일간 사용한 후 호전되었으며, 이후 씨메티딘을 사용하지 않으며, 아스피린 투약을 약 3개월 가량 더 지속하였으나 더 이상의 출혈은 없었다. 100명의 환아가 총 341.5개월 동안 아스피린을 투여하였으며, 이 가운데 한 명만이 육안적 장출혈을 보여, 이를 100명의 환아가 일년동안 소용량 아스피린을 먹은 것으로 환산하면 3.5회/100명/1년의 비율로 장출혈이 발생하는 것을 의미하게 된다. 결 론: 소아에서 소용량 아스피린의 장기적 사용은 안전하나, 위 장관 출혈의 위험성을 높일 수 있으므로 해당 환아에 대한 세심한 추적관찰이 필요하며, 위 장관 출혈의 위험성을 감소시켜주기 위한 다양한 노력이 병행되어야 할 것이다.

• 대한영상의학회지
• /
• 제83권5호
• /
• pp.1121-1127
• /
• 2022

임신 중 심부자궁내막증의 증상은 대부분 호전되는 것으로 알려져 있다. 그러나 심부자궁내막증과 관련하여 자궁동맥의 가성동맥류, 난소 또는 자궁동맥의 파열 및 탈락막화가 진행된 병변에 의한 복강내 출혈과 같은 심각한 산과적 합병증이 임신후반기에 드물게 보고되었다. 특히, 심부자궁내막증에 발생한 탈락막화가 진행될 경우 파열 및 출혈로 인한 심각한 모체/태아의 합병증이 발생할 수 있어 정확한 진단을 하고 임신 중 상태를 집중 감시하는 것이 필요하다. 그러나 이러한 경우는 매우 드물어 잘 알려져 있지 않으며, 저자들이 아는 한, 현재까지 보고된 심부자궁내막증에 의한 대량출혈은 모두 복강내출혈이 발생한 경우였다. 저자들은 임신 중 직장질부위 심부자궁내막증의 탈락막화가 진행되고 커지면서 질강내로 노출된 병변과 임신 후반기 병변에서 자연히 발생한 대량 질출혈의 증례를 보고하고자 한다.

• 한국임상약학회지
• /
• 제28권3호
• /
• pp.250-253
• /
• 2018

When stenting is applied to treat myocardial infarction, antiplatelet agents are administered to prevent thrombosis, which increases the risk of bleeding. Patients with myocardial infarction are also more likely to have osteoarthritis simultaneously, because both diseases occur frequently in elderly patients. Patients with osteoarthritis often use analgesics, especially nonsteroidal anti-inflammatory drugs (NSAIDs); hence, patients with both diseases use analgesics and antiplatelet agents simultaneously. The risk of bleeding increases with the use of antiplatelet agents and this is further increased when NSAIDs are added. We would like to report a case that reflects this situation. A 60-year-old man underwent stenting after ST-elevation myocardial infarction, and was treated with aspirin and clopidogrel. This patient also received a pelubiprofen prescription from another physician to treat osteoarthritis. After the patient took pelubiprofen twice, he found a bruise on his wrist and reported it to the pharmacist. It is unlikely that this is rare in community pharmacies, so pharmacists should pay careful attention to the concomitant administration of analgesics to patients receiving antiplatelet agents and should provide appropriate education to patients.

• Journal of Korean Neurosurgical Society
• /
• 제58권3호
• /
• pp.262-270
• /
• 2015

Objective : Long-term oral anticoagulation or antiplatelet therapy has been used with increasing frequency in the elderly. These patients are at increased risk of morbidity and mortality from expansion of intracranial hemorrhage. We conducted a single-center retrospective case control study to evaluate risk factors associated with outcomes and to identify the differences in outcome in traumatic brain injury between preinjury anticoagulation use and without anticoagulation. Methods : A retrospective study of patients who underwent craniotomy or craniectomy for acute traumatic cerebral hemorrhage, between January 2005 and December 2014 was performed. Results : A consecutive series of 50 patients were evaluated. The factors significantly differed between the two groups were initial Prothrombin Time-International Normalized Ratio, initial platelet count, initial Glasgow Coma Scale score, and postoperative intracranial bleeding. Mean Glasgow Outcome Scale (GOS) score were similar between the two groups. In the patient with low-energy trauma only, no significant differences in GOS score, postoperative bleeding and many other factors were observed. The contributing factors to postoperative bleeding was preinjury anticoagulation and its adjusted odds ratio was 12 [adjusted odds ratio (OR), 12.242; p=0.0070]. The contributing factors to low GOS scores, which mean unfavorable neurological outcomes, were age (adjusted OR, 1.073; p=0.039) and Rotterdam scale score for CT scans (adjusted OR, 3.123; p=0.0020). Conclusion : Preinjury anticoagulation therapy contributed significantly to the occurrence of postoperative bleeding. However, preinjury anticoagulation therapy in the patients with low-energy trauma did not contribute to the poor clinical outcomes or total hospital stay. Careful attention should be given to older patients and severity of hemorrhage on initial brain CT.

• 한국임상약학회지
• /
• 제26권3호
• /
• pp.195-200
• /
• 2016

Background: Venous thromboembolism (VTE) is a common and life-threating condition in cancer patients. Low molecular weight heparins (LMWH), such as dalteparin, are recommended in the treatment of VTE. Also, rivaroxaban, an orally administered direct factor Xa inhibitor, was approved for the treatment of VTE. It showed similar efficacy to standard therapy (LMWH or warfarin) and was associated with significantly lower rates of major bleedings. However, in the real world, bleeding has been reported to occur frequently in cancer patient receiving rivaroxaban. The goal of this research was to analyze bleeding risks between rivaroxaban and dalteparin for treatment of VTE in cancer patients. Methods: Medical records of oncology patients who were treated with rivaroxaban or dalteparin for VTE from July 2012 to June 2014 were retrospectively reviewed. Data collected were as follows: age, sex, weight, height, cancer types and stages, ECOG (eastern cooperative oncology group) PS (performance score), VTE types, concurrently used medications, study drug information (dose and duration of therapy), INR (international normalized ratio), PT (prothrombin time), and platelet counts. Bleeding was classified into major bleedings, clinically relevant non-major bleedings, and minor bleedings. Results: A total of 399 patients were included in the study. Of these patients, 246 were treated with rivaroxaban and 153 with dalteparin. Bleeding rates were significantly higher in the rivaroxaban group than in the dalteparin group (adjusted odds ratio (AOR) 2.09, 95% CI 1.22-3.60) after adjusting for confounders. In addition, rivaroxaban remained independently associated with 1.78-fold (95% CI 1.14-2.76) shorter time to bleeding compared to dalteparin after adjusting other factors known to be associated with poor outcomes. Conclusion: This study suggested that rivaroxaban was associated with an increased risk of bleedings in cancer patients.

• Archives of Plastic Surgery
• /
• 제47권1호
• /
• pp.54-61
• /
• 2020

Background Conventional methods of external bleeding for congested fingertip replants exhibit notable problems, including uncontrollable bleeding and unpredictable survival of the replant. We have added a local injection of heparin calcium to the routine use of systemic heparinization for inducing external bleeding. We retrospectively examined patients who underwent external bleeding using our method. Methods Local subcutaneous injections of heparin calcium were made in 15 congested replants in addition to systemic heparinization. Each injection ranged from 500 to 5,000 U. The average duration of the injections was 4.1 days. Surgical outcomes were analyzed and compared with a control group of patients who underwent external bleeding without heparin calcium. Results The overall survival rate was 93.3%, which was higher than that of the control group (83.3%), but the difference was not statistically significant (P=0.569). The survival rate for subzones I and II by the Ishikawa subzone classification was 100%, whereas it was 87.5% in subzones III and IV. No statistically significant difference was observed. The rate of partial necrosis was 0% in subzones I and II, whereas it was significantly higher (66.7%) in subzones III and IV (P=0.015). The mean total blood loss via external bleeding was 588 g in 10 fingers. No patients required blood transfusion. Conclusions Congestion of a replanted fingertip can be successfully managed without blood transfusion by our method. Although complete relief from congestion in replants in subzones I and II is achievable, there is a higher risk of partial necrosis in subzones III and IV.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제40권
• /
• pp.39.1-39.7
• /
• 2018

Background: Patients with chronic ITP (idiopathic thrombocytopenia) frequently do not require comprehensive medication for daily life. Usually, it had been regarded that postoperative bleeding after a simple or surgical extraction is easily controlled by simple local measures even in patients with ITP. This lack of regular medication usage can sometimes lead practitioners or patients to underestimate the potential life-threatening risk of ITP. There had been no report on postoperative hemorrhage in a patient with ITP related to dental implant surgery. Case presentation: This report presented a life-threatening postoperative hemorrhage after dental implant surgery in an adult with chronic ITP and subsequent emergency management after severe bleeding and airway compromise. Conclusion: The presented case emphasizes the thorough hematological evaluation of the patients even for patients who do not take any specific medications for asymptomatic, chronic ITP.