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The improvement in left ventricular assist device (LVAD) technology and scarcity of donor hearts have increased dramatically the population of the LVAD‐supported patients and the probability of those patients to present to the emergency department with expected and non‐expected device‐related and patient–device interaction complications. The ageing of the LVAD‐supported patients, mainly those supported with the 'destination therapy' indication, increases the risk for those patients to suffer from other co‐morbidities common in the older population. In this second part of the trilogy on the management of LVAD‐supported patients for the non‐LVAD specialist healthcare provider, definitions and structured approach to the LVAD‐supported patient presenting to the emergency department with bleeding, neurological event, pump thrombosis, chest pain, syncope, and other events are presented. The very challenging issue of declaring death in an LVAD‐supported patient, as the circulation is artificially preserved by the device despite no other signs of life, is also discussed in detail. [ABSTRACT FROM AUTHOR]

Haemophilia and inherited bleeding disorders in newborns and their carrier mothers pose unique challenges. The pattern of bleeding and the causes and risk factors for bleeding are decidedly different than an older child or an adult with haemophilia/inherited bleeding disorder. This document outlines the needs for further research and education, summarizes the state of the art background information and provides guidance regarding research, education and access to care issues in this population. [ABSTRACT FROM AUTHOR]

Manufactured sand (MS) has been started utilizing as an alternative in constructions due to the escalated demand for river sand (RS). The microfine aggregate (MFA) is a salient constituent in manufactured sand, which is a crushed reactive form of parent rocks having particles less than 0.075 mm. This paper presents the effects of varying microfine aggregate levels on bleeding, plastic shrinkage cracking (PSC) and compressive strength of MS made concrete. Two types of MS were utilized: MS from Hornblende‐Gneiss rock (MH) and MS from Charnockite rock (MC) and the MFA level was ranged from 0% to 12% at 3% increments and the reference concrete was prepared with RS alone. With the MFA levels, the bleeding of MS concretes was reduced where, at 0% MFA level the maximum bleeding rates were observed for MC (1.63 kg/m2) and MH (0.84 kg/m2) concretes. PSC results were analyzed from an image processing technique, which revealed an increasing trend of mean and maximum crack widths, crack length and crack area with the MFA levels. At 0% MFA, the mean crack width of MC (0.19 mm) and MH (0.17 mm) concretes manifested marginally similar to RS concrete (0.17 mm). The decreasing bleeding with the MFA levels can be attributed to the increasing severity to PSC. Moreover, the optimum 28 days compressive strength of MC (57.5 MPa) and MH (56.1 MPa) concretes was achieved at 3% MFA level which are higher than RS concrete (51.5 MPa). Consequently, the MFA level should be limited to 3% for better plastic and hardened performance of MS made concrete. [ABSTRACT FROM AUTHOR]

Cryobiopsy is an emerging tool in the diagnosis of peripheral pulmonary lesions (PPL) and becoming an important tool in the toolbox. Anecdotally the data on cryobiopsy use in the lung was extrapolated from the use of transbronchial cryobiopsy (TBCB) in Interstitial Lung disease (ILD). Similar to ILD data, cryobiopsy in PPL also provided larger tissue compared to forceps biopsies. Yet, unlike TBCB in ILD, the safety profile for cryobiopsy in PPL seems much more favourable, yet the number of publications on cryobiopsy in PPL remains sparse. Some PPL, both malignant and non‐malignant are considered to be of a high bleeding risk due to vascularity of the tumour and/or inflammation of the blood vessels and surrounding tissue. The use of cryobiopsy and the risk of bleeding in this type of PPL have not been described. This paper describes four patients with PPL, undergoing cryobiopsy with radial EBUS for suspected lung cancer, and later diagnosed to have a PPL, deemed to be of a high bleeding risk. The use of cryobiopsy with radial ultrasonic examination for the vasculature of the PPL, bronchial blocker use, and airway protection as well as an expert team preserved the safety of the procedure. [ABSTRACT FROM AUTHOR]

Introduction: In the era of electronic medical records, pen‐and‐paper‐based physician‐administered bleeding assessment tools (BAT) remain under‐utilized in the clinical setting, as they are noted to be time‐consuming. Aim: The current study reviews the use of an electronic self‐administered bleeding assessment tool (eBAT) prospectively in a paediatric haematology clinic and in comparison with a physician administered BAT (pBAT). Materials and Methods: This was reviewed and approved in the current form because the aims statement includes the method regarding comparison of 2 groups. So no additional section required. Results: A total of 94 BAT response pairs were available for analysis. The median time required for patients or parents to complete the eBAT was 8 min, with less than a third of the patients requiring over 10 min. The median bleeding scores noted in this study were 4 for both the BATs, with strong positive correlation between the eBAT and the physician administered bleeding questionnaire. The eBAT had a sensitivity of 93.8% (95% CI 82.8%–98.7%), a specificity of 34.8% (95% CI 21.4%–50.3%), a positive predictive value (PV) of 60.0% (95% CI 54.5%–65.2%) and a negative PV of 84.2% (95% CI 62.5%–94.5%) for identifying a bleeding disorder. Conclusions: Findings indicate that eBAT is a valid and time‐efficient screening tool for evaluating patients' bleeding symptoms, which can improve clinical applicability of BATs by reducing time for bleeding history review. [ABSTRACT FROM AUTHOR]

Focus question: What is the efficacy of a chlorhexidine (CHX) mouthwash (MW) containing sodium fluoride (NaF) compared to a CHX − MW alone on the parameters of plaque, gingivitis and discoloration? Material and Methods: MEDLINE‐PubMed, Cochrane‐CENTRAL, and EMBASE were searched for papers from inception to December 2017. The inclusion criteria were (randomized) controlled clinical trials conducted in human subjects with good general health and without removable prosthesis. Papers evaluating the effect of a MW containing CHX + NaF compared to a CHX alone were included. From the eligible studies, data were extracted, a descriptive analysis was performed and a meta‐analysis when feasible. Results: Independent screening of 412 unique papers resulted in 9 eligible publications presenting 10 clinical trials comparing the effect of CHX + NaF to CHX − MW and provided 13 comparisons. Five evaluated the MW as an adjunct to brushing and 8 were non‐brushing comparisons of which 4 used an experimental gingivitis model. No significant difference was observed for plaque score reduction in the brushing studies the end scores (diffM; −0.04, P = .36; 95%CI: [−0.13, 0.05]) nor the differences (diffM; 0.11, P = .33; 95%CI: [−0.12, 0.24]). In the descriptive analysis, none of the experiments demonstrated a statistical significant difference regarding Gingival Index (GI), Bleeding Score and Discoloration Scores. For the GI, a meta‐analysis of the difference of Means was not significant when included experimental gingivitis model studies end scores (0.01, P = .78; 95%CI: [−0.08, 0.11]) and the difference (0.01, P = .81; 9 5%CI: [−0.08, 0.10]) either for the end scores of brushing studies (diffM; −0.01, P = .82; 95%CI: [−0.10, 0.08]). Conclusion: From this study, it can be concluded that NaF and CHX may be present in the same MW without reducing CHX efficacy with respect to plaque and gingivitis scores. Moreover, no difference in the development of tooth discoloration was observed. [ABSTRACT FROM AUTHOR]

Patients with liver disease often develop complex changes in their haemostatic system. Frequently observed changes include thrombocytopaenia and altered plasma levels of most of the proteins involved in haemostasis. Although liver disease was historically classified as a haemostasis‐related bleeding disorder, it has now been well established that the antihaemostatic changes that promote bleeding are compensated for by prohaemostatic changes. Conventional coagulation tests however do not accurately reflect these prohaemostatic changes, resulting in an underestimation of haemostatic potential. Novel coagulation tests, such as viscoelastic tests (VETs) and thrombin generation assays (TGAs) better reflect the net result of the haemostatic changes in patients with liver disease, and demonstrate a new, "rebalanced" haemostatic status. Although rebalanced, this haemostatic status is more fragile than in patients without liver disease. Patients with liver disease are therefore not only at risk of bleeding but also at risk of thrombosis. Notably, however, many haemostatic complications in liver disease are not related to the haemostatic failure. It is, therefore, crucial to identify the cause of the bleed or thrombotic complication in order to provide adequate treatment. In this paper, we will elaborate on the haemostatic changes that occur in liver disease, reflect on laboratory and clinical studies over the last few years, and explore the pathophysiologies of bleeding and thrombosis in this specific patient group. [ABSTRACT FROM AUTHOR]

Aim: The aim of this review was to systematically review the literature on the adjunctive effect of oral irrigation in addition to toothbrushing on plaque and clinical parameters of periodontal inflammation. Material and Methods: Papers in the MEDLINE-PubMed and Cochrane Central register of Controlled Trials (CENTRAL) databases up to January 2008 were searched to identify appropriate studies. Clinical parameters of periodontal inflammation such as plaque, bleeding, gingivitis and pocket depth, were selected as outcome variables. Results: Independent screening of the titles and abstracts of 809 PubMed and 105 Cochrane papers resulted in seven publications that met the eligibility criteria. Mean values and standard deviations were collected by data extraction. Descriptive comparisons with brushing alone or regular oral hygiene are presented. Conclusion: As an adjunct to brushing, the oral irrigator does not have a beneficial effect in reducing visible plaque. However, there is a positive trend in favour of oral irrigation improving gingivial health over regular oral hygiene or toothbrushing only. [ABSTRACT FROM AUTHOR]

Background A balanced transfusion of red blood cells, fresh frozen plasma (FFP) and platelets are recommended for massively bleeding trauma patients. Fibrinogen concentrates could potentially lessen or replace the need for FFP and/or platelet transfusions. Aim To provide a review of the literature covering the application of fibrinogen concentrates in trauma care. Methods PubMed and Cochrane database search: fibrinogen and (concentrate or trauma), not congenital, published between 2000 and 2012. Results Six papers were identified. None were randomized controlled trials. The main conclusion of these papers was that administration of fibrinogen sometimes together with prothrombin complex concentrate might improve haemostasis in trauma patients resuscitated with synthetic colloids. Data regarding the effect of fibrinogen concentrate together with a more physiological resuscitation fluid, i.e. FFP, or as the only intervention in bleeding trauma patients is lacking. Conclusions Evidence for the use of fibrinogen concentrate to trauma patients with massive bleeding is sparse, of poor quality and confined to patients resuscitated with synthetic colloids. Well-designed prospective, randomized, double-blinded studies evaluating the effect of fibrinogen concentrate, as the only intervention, are urgently needed. [ABSTRACT FROM AUTHOR]

Aims: Over decades, left ventricular assist device (LVAD) technology has transitioned from less durable bulky pumps to smaller continuous‐flow pumps which have substantially improved long‐term outcomes and quality of life. Contemporary LVAD therapy is beleaguered by haemocompatibility‐related adverse events including thrombosis, stroke and bleeding. A fully magnetically levitated pump, the HeartMate 3 (HM3, Abbott, USA) LVAD, has been shown to be superior to the older HeartMate II (HMII, Abbott, USA) pump by improving haemocompatibility. Experience with the HM3 LVAD suggests near elimination of de‐novo pump thrombosis, a marked reduction in stroke rates, and only a modest decrease in bleeding complications. Since the advent of continuous‐flow LVAD therapy, patients have been prescribed a combination of aspirin and anticoagulation therapy on the presumption that platelet activation and perturbations to the haemostatic axis determine their necessity. Observational studies in patients implanted with the HM3 LVAD who suffer bleeding have suggested a signal of reduced subsequent bleeding events with withdrawal of aspirin. The notion of whether antiplatelet therapy can be avoided in an effort to reduce bleeding complications has now been advanced. Methods: To evaluate this hypothesis and its clinical benefits, the Antiplatelet Removal and Hemocompatibility Events with the HeartMate 3 Pump (ARIES HM3) has been introduced as the first‐ever international prospective, randomized, double‐blind and placebo‐controlled, non‐inferiority trial in a patient population implanted with a LVAD. Conclusion: This paper reviews the biological and clinical role of aspirin (100 mg) with LVADs and discusses the rationale and design of the ARIES HM3 trial. [ABSTRACT FROM AUTHOR]

The phenomena associated with the consolidation of fresh concrete (bleeding and plastic settlement) are commonly considered significant for the bond performance of reinforcement. However, rules to take care of such influence for design are not consistent amongst design recommendations and may lead to notable differences. With this respect, two failure modes generally govern the bond failure, namely the spalling of the concrete cover (also called splitting failure) and the pull‐out of the reinforcement. In this paper, a detailed investigation is presented on the influence of bleeding and plastic settlement on both failures modes, in an effort to understand their conceptual differences and to clarify how shall consistent design recommendations be formulated. Such investigation is based on a comprehensive experimental programme, comprising 137 pull‐out tests on specimens with different casting conditions, embedment lengths, loading arrangements and concrete covers. On the basis of the test results, the phenomenological differences between pull‐out and spalling failures are clarified, as well as the main influencing phenomena (particularly the potential presence of cracks and voids under the reinforcement and the mechanical properties of concrete). On this basis, a physically‐consistent approach is presented to consider the casting conditions on the bond performance and failure modes. [ABSTRACT FROM AUTHOR]

Objective The purpose of this review was to systematically evaluate the effects of an alcohol vehicle solution ( V- Sol) compared with an essential-oils mouthwash ( EOMW) and if available with a water-based control ( WC) on plaque, gingival inflammation parameters and extrinsic tooth staining. Materials and Methods The Pub Med- MEDLINE, Cochrane- CENTRAL and EMBASE databases were searched. Where appropriate, a meta-analysis was performed, and difference of means ( DIFFM) as calculated. Results In total, 971 unique papers were found of which five met the eligibility criteria. The DIFFM of the meta-analysis of four 6-month studies showed that the EOMW provided significantly better plaque control ( DIFFM = 0.39, P < 0.00001) and gingival inflammation reduction as measured by the Löe and Silness Index ( DIFFM = 0.36, P = 0.00001) as compared to the V- Sol. Regarding extrinsic tooth staining, a small but significant difference ( DIFFM = −0.08, P = 0.03) was observed. Conclusion Limited data, but with a low risk of bias, were available to assess the potential benefit of the alcohol-containing V- Sol. 'High'- and 'moderate'-quality data were available for the analysis of plaque and gingivitis, respectively. Within these limitations, EOMW appears to provide a significant oral health benefit during the 6 months of use. The data retrieved for this review suggest that the essential oils produce an effect on plaque and gingivitis that extends beyond the V- Sol. Furthermore, the V- Sol proved to be no different from a WC. [ABSTRACT FROM AUTHOR]

It is well known that control specimens used to assess the concrete strength of new structures have different casting and curing conditions than those of actual structures. Notably, after pouring of the concrete and before its hardening, a number of phenomena such as concrete bleeding and plastic settlement occur, influencing the in‐situ strength with respect to that of small and homogeneous control specimens (cubes or cylinders). In addition, the development of these phenomena and their structural implications are influenced by the presence of reinforcing bars, disturbing the settlement and bleeding of fresh concrete. In this paper, these aspects, with particular emphasis on the effective structural strength, are investigated by means of a testing program performed with refined measurement techniques such as tomography and Digital Image Correlation. On that basis, consistent design rules are derived to correct the strength of control specimens in order to calculate the resistance of a structural concrete member. [ABSTRACT FROM AUTHOR]

All patients with liver cirrhosis and portal hypertension should be stratified by risk groups to individualize different therapeutic strategies to increase the effectiveness of treatment. In this regard, the development of primary prophylaxis of variceal bleeding and its management according to the severity of portal hypertension may be promising. This paper is to describe the modern principles of primary prophylaxis of esophageal variceal bleeding in patients with liver cirrhosis. The PubMed and EMbase databases, Web of Science, Google Scholar, and the Cochrane Database of Systematic Reviews were used to search for relevant publications from 1999 to 2019. The results suggested that depending on the severity of portal hypertension, patients with cirrhosis should be divided into those who need preprimary prophylaxis, which aims to prevent the formation of esophageal varices, and those who require measures that aim to prevent esophageal variceal bleeding. In subclinical portal hypertension, therapy should be etiological and pathogenetic. Cirrhosis with clinically significant portal hypertension should receive nonselective β‐blockers if they have small esophageal varices and risk factors for variceal bleeding. Nonselective β‐blockers are the first‐line drugs for the primary prevention of bleeding from medium to large‐sized esophageal varices. Endoscopic band ligation is indicated for the patients who are intolerant to nonselective β‐blockers or in the case of contraindications to pharmacological therapy. In summary, the stratification of cirrhotic patients by the severity of portal hypertension and an individual approach to the choice of treatment may increase the effectiveness of therapy as well as improve survival rate of these patients. [ABSTRACT FROM AUTHOR]

Introduction A balanced transfusion of red blood cells, fresh frozen plasma and platelets are recommended for massively bleeding trauma patients. Fibrinogen concentrates could potentially lessen or replace the need for fresh frozen plasma and/or platelet transfusions. Objective To provide a review of the literature covering the application of fibrinogen concentrates in trauma care. Methods PubMed and Cochrane database search, 'fibrinogen' and ('concentrate' or 'trauma'), not 'congenital', 10 years. Results Only four papers were identified. None were randomized controlled trials. The main conclusion of these papers was that administration of fibrinogen sometimes together with prothrombin complex concentrate might improve haemostasis in trauma patients resuscitated with synthetic colloids. Conclusion Evidence for the use of fibrinogen concentrate to trauma patients with massive bleeding is lacking. Well-designed prospective, randomized, double-blinded studies evaluating the effect of fibrinogen concentrate, as the only intervention, are urgently needed. [ABSTRACT FROM AUTHOR]

Objective: To review the literature concerning hexetidinecontaining mouthwash as a monotherapy or as an adjunct to oral hygiene in the prevention of plaque accumulation and gingival inflammation. Materials and methods: PubMed-MEDLINE and the Cochrane-CENTRAL were searched through January 2010 to identify appropriate studies. The primary outcome measurements were plaque accumulation and gingivitis parameters. Results: Independent screening of titles and abstracts of 168 papers resulted in six publications that met the eligibility criteria. Mean values and standard deviations were obtained by data extraction. Descriptive comparisons are presented for hexetidine mouthwash and control mouthwashes (chlorhexidine and placebo). Conclusions: Considering the potential benefits in the light of the observed side effects, hexetidine appears to be a poor alternative to chlorhexidine. [ABSTRACT FROM AUTHOR]

Objective: To review the literature on whether a hand-held triangular woodstick, as compared with no adjunct or other interdental cleaning device in addition to daily toothbrushing, can improve clinical parameters of gingival inflammation. Material and Methods: MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched through February 2008 to identify appropriate studies. Plaque and gingivitis were selected as outcome variables. Results: Independent screening of the titles and abstracts of 181 MEDLINE and 65 CENTRAL papers yielded seven publications with eight clinical experiments that met the eligibility criteria. The improvement in gingival health, as observed in seven studies, represents a significant incremental benefit realized by the use of triangular woodsticks. None of the studies that scored plaque demonstrated any significant advantage to the use of woodsticks, as opposed to alternative methods, in gingivitis patients. Conclusion: Evidence from controlled trials, most of which were also randomized, shows that woodsticks do not have an additional effect on visible interdental plaque or gingival index, but do, however, provide an improvement in interdental gingival inflammation by reducing the bleeding tendency. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Infections in infantile hemangiomas (IHs) are generally limited, and only few cases have been reported. The rapid expansion of an ulcerated IH should raise concern for possible complications to monitor and provide immediate therapeutic interventions. This case highlights the importance of prompt treatment in large segmental IHs to prevent ulceration and related complications, including bleeding and superinfection. IH is a benign tumor proliferating during early infancy. While many IHs spontaneously resolve, complications like ulceration, bleeding, and potential damage to vital organs can occur, leading to pain, infection, and scarring. A 6‐month‐old girl with a previously treated IH on her left leg developed a Klebsiella‐infected ulcer at the site. The ulcer resulted from non‐standard treatments used before admission. Upon hospitalization, she was initially treated with cefepime and propranolol, but a week later, the wound culture revealed Klebsiella pneumoniae, prompting a switch to piperacillin/tazobactam. After successfully managing the infection and bleeding, the child was discharged in good condition with orders to continue treatment with propranolol for at least a year. This case highlights the potential of IHs to become infected even with uncommon germs such as Klebsiella and the importance of receiving appropriate medical care to prevent further complications. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Vigilant monitoring for postoperative complications, including bleeding and dysrhythmia, is crucial in patients with craniosynostosis syndromes like Crouzon syndrome undergoing craniofacial surgery, with a thorough evaluation, including coagulation tests, assisting in diagnosing underlying conditions such as von Willebrand disease subtype 1 to inform appropriate management strategies. Crouzon syndrome is a rare genetic disorder affecting craniofacial structures. Its etiology is the premature fusion of cranial sutures. The LeFort III advancement surgery is a commonly used approach to correct malformations related to midface hypoplasia. Complications following surgical treatment of craniosynostosis and craniofacial syndromes can include both intracranial and extracranial problems. Reporting of this syndrome and the surgery complications, in addition to consideration of other differential diagnoses, can help improve the treatment plan and surgery outcomes. The aim of the article is to report a 14‐year‐old female with Crouzon syndrome who underwent the modified LeFort III osteotomy and developed unexpected massive bleeding during the surgery. Post‐surgery, she experienced complications including dysrhythmia, hypothermia, and cyanosis. Treatment included fluid therapy, blood transfusions, and antibiotic therapy for suspected septic shock. Differential diagnosis was disseminated intravascular coagulation but was ruled out. Post‐discharge, coagulation tests suggested von Willebrand disease subtype 1 as the diagnosis. Excessive bleeding during surgery for craniosynostosis syndromes is a significant and concerning issue in the surgical management of Crouzon syndrome. For patients with von Willebrand disease who are candidates for elective surgeries, von Willebrand factor concentrates or recombinant von Willebrand factor can be used. [ABSTRACT FROM AUTHOR]

Objective: To test the efficacy of a dentifrice containing baking soda (BS), compared with dentifrice without BS for controlling plaque and gingivitis. Materials and methods: MEDLINE‐PubMed and Cochrane‐CENTRAL were searched. The inclusion criteria were randomized controlled clinical trials including healthy participants aged 18 years or older. Studies were selected that compared the effect of toothbrushing with a dentifrice with and without BS on the clinical parameters of plaque and gingivitis. Data were extracted from the selected studies, and a meta‐analysis was performed. Results: The search retrieved 21 eligible publications. Among these papers, 43 comparisons were provided, with 23 involving a single‐use design and 20 being evaluations with a follow‐up. Negative controls were found, or positive controls for which various active ingredients had been used. The included studies showed a moderate overall potential risk of bias and considerable heterogeneity. The meta‐analysis of plaque scores from the single‐brushing experiments showed that BS dentifrice (BS‐DF) was associated with significantly better outcomes than the negative control dentifrices (DiffM −0.20; P < 0.0001; 95% CI: [−0.27; −0.12]) or the positive control dentifrices (DiffM −0.18; P < 0.0001; 95% CI: [−0.24; −0.12]). This finding was only confirmed in studies that used a follow‐up design as compared to a negative control (DiffM −0.19; P = 0.01; 95% CI: [−0.34; −0.04]). The indices of gingival bleeding also improved when the comparison was a negative control (DiffM −0.08; P = 0.02; 95% CI: [−0.16; −0.01] and (DiffM −0.13; P < 0.001; 95% CI: [−0.18; −0.08]. However, for the gingival index scores, the meta‐analysis did not reveal any significant differences. Conclusion: BS‐DF showed promising results with respect to plaque removal in single‐use studies. However, the finding was partially substantiated in follow‐up studies. Studies that assessed bleeding scores indicated that a small reduction can be expected from BS, relative to a control product. [ABSTRACT FROM AUTHOR]

Aim The aim of this systematic review was to evaluate the efficacy of anti-plaque chemical formulations for managing gingivitis, in 6-month, home-use, randomised clinical trials ( RCTs). Material and Methods A protocol was designed, including inclusion and exclusion criteria to identify RCTs assessing gingival and/or bleeding indices. Electronic and hand-searches identified relevant papers, which were screened and evaluated for inclusion. Full-papers were retrieved and relevant information was extracted (also plaque indices), including quality and risk of bias. Mean treatment effects were calculated to obtain weighted mean differences ( WMD) and 95% confidence intervals. Results After the process of screening and selection, 87 articles with 133 comparisons, were included in the review. The additional effects of the tested products were statistically significant in terms of Löe & Silness gingival index (46 comparisons, WMD −0.217), modified gingival index ( n = 23, −0.415), gingivitis severity index ( n = 26, −14.939%) or bleeding index ( n = 23, −7.626%), with significant heterogeneity. For plaque, additional effects were found for Turesky (66 studies, WMD −0.475), Silness & Löe ( n = 26, −0.109), and plaque severity ( n = 12, −23.4%) indices, with significant heterogeneity. Conclusion Within the limitations of the present study, formulations with specific agents for chemical plaque control provide statistically significant improvements in terms of gingival, bleeding and plaque indices. [ABSTRACT FROM AUTHOR]

Objective To systematically review the literature to compare the efficacy of triclosan ( Tcs) and stannous fluoride ( Sn F) dentifrices on parameters of gingivitis and plaque scores. Materials and Methods Medline, EMBASE and Cochrane Central Register of Controlled Trials were searched up to March 2013 to identify appropriate studies. Studies regarding self-performed manual brushing by adults with a minimum 4 weeks of follow-up were included. Primary outcomes were parameters of gingivitis. Secondary outcome was plaque score. Results Of 55 publications, 11 met the eligibility criteria. Additionally, four unpublished papers were added after contacting the manufacturers of the leading brands. In total, 15 studies [10 medium term and five long term (>6 months)] were processed for data analysis. There was no difference in gingival index (or its modification) between the two types of dentifrice [DiffM-0.04, 95% confidence interval CI (−0.11; 0.04); P = 0.34]. The change in the average gingival bleeding score was significantly in favour of Sn F [DiffM0.02, 95% CI (0.01; 0.02); P < 0.00001]. Plaque scores demonstrated a statistical significant difference in favour of Tcs, according to Quigley-Hein Plaque Index ( Q& H PI; DiffM-0.29, 95% CI [−0.45; −0.13]; P = 0.0004), but there was no difference according to Rustogi Modified Navy Plaque Index ( RMNPI) [DiffM-0.09, 95% CI (−0.01; 0.18); P = 0.07]. Long-term results supported these findings. Conclusions In the context of inconclusive results for the primary outcome variable of gingival health, it can be concluded that there was a minor and most likely clinically insignificant difference between Tcs- and Sn F-containing dentifrices. Meta-analysis of plaque score reduction was also inconclusive; whereas Tcs was more effective when assessed by the Q& H PI, it was not when scored with the RMNPI. [ABSTRACT FROM AUTHOR]

Six years have passed since the first International Consensus Conference on Laparoscopic Liver Resection was held. This comparatively new surgical technique has evolved since then and is rapidly being adopted worldwide. We compared the theoretical differences between open and laparoscopic liver resection, using right hepatectomy as an example. We also searched the Cochrane Library using the keyword “laparoscopic liver resection.” The papers retrieved through the search were reviewed, categorized, and applied to the clinical questions that will be discussed at the 2nd Consensus Conference. The laparoscopic hepatectomy procedure is more difficult to master than the open hepatectomy procedure because of the movement restrictions imposed upon us when we operate from outside the body cavity. However, good visibility of the operative field around the liver, which is located beneath the costal arch, and the magnifying provide for neat transection of the hepatic parenchyma. Another theoretical advantage is that pneumoperitoneum pressure reduces hemorrhage from the hepatic vein. The literature search turned up 67 papers, 23 of which we excluded, leaving only 44. Two randomized controlled trials (RCTs) are underway, but their results are yet to be published. Most of the studies (n = 15) concerned short‐term results, with some addressing long‐term results (n = 7), cost (n = 6), energy devices (n = 4), and so on. Laparoscopic hepatectomy is theoretically superior to open hepatectomy in terms of good visibility of the operative field due to the magnifying effect and reduced hemorrhage from the hepatic vein due to pneumoperitoneum pressure. However, there is as yet no evidence from previous studies to back this up in terms of short‐term and long‐term results. The 2nd International Consensus Conference on Laparoscopic Liver Resection will arrive at a consensus on the basis of the best available evidence, with video presentations focusing on surgical techniques and the publication of guidelines for the standardization of procedures based on the experience of experts. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this review was to describe systematically the effects of hydrogen peroxide mouthwashes as an adjunct to daily oral hygiene or as a mono-therapy in the prevention of plaque accumulation and gingival inflammation. Materials and methods: PubMed-MEDLINE and the Cochrane-CENTRAL were searched up to December 2009 to identify appropriate papers. The primary outcome measures included plaque accumulation and parameters of gingivitis. Results: Independent screening of titles and abstracts of 229 articles resulted in 10 publications that met the criteria for eligibility. Descriptive comparisons are presented for hydrogen peroxide mouthwash as compared with control mouthwashes or no oral hygiene. Mean values and standard deviations were obtained by data extraction. Based on a quality assessment, three studies, of which one evaluated H2O2 over a period of 6 months, were considered to represent a low risk of bias. This 6-month study showed a positive effect of the use of H2O2 on the modified gingival index. Conclusions: The results of the studies included in this review showed that H2O2 mouthwashes do not consistently prevent plaque accumulation when used as a short-term mono-therapy. When used as a long-term adjunct to daily oral hygiene, the results of one study indicate that oxygenating mouthwashes reduce gingival redness. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to assess systematically the adjunctive effect of both flossing and toothbrushing versus toothbrushing alone on plaque and gingivitis. Materials: The MEDLINE and Cochrane Central register of Controlled Trials (CENTRAL) databases were searched through December 2007 to identify appropriate studies. The variables of plaque and gingivitis were selected as outcomes. Results: Independent screening of titles and abstracts of 1166 MEDLINE–Pubmed and 187 Cochrane papers resulted in 11 publications that met the eligibility criteria. Mean values and SD were collected by data extraction. Descriptive comparisons are presented for brushing alone or brushing and flossing. A greater part of the studies did not show a benefit for floss on plaque and clinical parameters of gingivitis. A meta-analysis was performed for the plaque index and gingival index. Conclusions: The dental professional should determine, on an individual patient basis, whether high-quality flossing is an achievable goal. In light of the results of this comprehensive literature search and critical analysis, it is concluded that a routine instruction to use floss is not supported by scientific evidence. [ABSTRACT FROM AUTHOR]

Objective: To review the literature concerning cetylpyridinium chloride (CPC) containing mouth rinses as effective adjuncts to toothbrushing in the prevention of plaque accumulation and gingival inflammation. Materials and methods: Medline and the Cochrane Central Register of Controlled Trials were searched up to January 2008 to identify appropriate studies. The primary outcome measurements were plaque accumulation and gingivitis. Results: Independent screening of titles and abstracts of 3250 papers resulted in eight publications that met the criteria of eligibility. Mean values and standard deviations were obtained by data extraction. Descriptive comparisons are presented for brushing only or brushing and rinsing. Meta-analyses were performed when possible. Conclusions: The existing evidence supports that CPC containing mouth rinses, when used as adjuncts to either supervised or unsupervised oral hygiene, provide a small but significant additional benefit in reducing plaque accumulation and gingival inflammation. [ABSTRACT FROM AUTHOR]

Background and Aims: To construct a bleeding events prediction model of nonvalvular atrial fibrillation (NVAF) patients receiving rivaroxaban. Methods: We conducted a retrospective cohort study in patients with NVAF who received rivaroxaban from June 2017 to March 2019. Demographic information and clinical characteristics were obtained from the electronic medical system. Univariate analysis was used to find the primary predictive factors of bleeding events in patients receiving rivaroxaban. Multiple analysis was conducted to screen the primary independent predictive factors selected from the univariate analysis. Finally, the independent influencing factors were applied to build a prediction model by using R software; then, a nomogram was established according to the selected variables visually, and the sensitivity and specificity of the model was evaluated. Results: Twelve primary predictive factors were selected by univariate analysis from 46 variables, and multivariate analysis showed that older age, higher prothrombin time (PT) values, history of heart failure and stroke were independent risk factors of bleeding events. The area under curve (AUC) for this novel nomogram model was 0.828 (95% CI: 0.763–0.894). The mean AUC over 10‐fold stratified cross‐validation was 0.787, and subgroup analysis validation also showed a satisfied AUC. In addition, the decision curve analysis showed that the PT in combination with CHA2DS2‐VASc and HASBLED was more practical and accurate for predicting bleeding events than using CHA2DS2‐VASc and HASBLED alone. Conclusions: PT in combination with CHA2DS2‐VASc and HASBLED could be considered as a more practical and accurate method for predicting bleeding events in patients taking rivaroxaban. [ABSTRACT FROM AUTHOR]

After several institutions recommended salpingectomy as opposed to tubal ligation, we attempted to perform meta‐analysis to compare operative properties and rates of postoperative wound infections. There are no temporal or linguistic limitations to our search in PubMed, Cochrane Library and Embase. The search was carried out in September 2023. The database search identified 401 potential studies and five studies were included in the meta‐analysis. Our study involved a comparison of salpingectomy with tube ligating in female patients who wanted to be sterilized. Our trial included at least one result of the wound and haemorrhage. The articles that did not qualify for inclusion or did not submit data, and those who did not answer questions were excluded. Abstracts and full‐text articles were assessed independently by two authors using blinding. Conflicting decisions were settled by consensus. The Cochrane‐recommended ROBINS‐I instrument has been applied to evaluate the risk of bias in clinical trials and to establish the quality of inclusion. Two authors separately evaluated the risk of bias for each trial; differences were settled by consensus. There were no statistically significant differences in the rate of postoperative wound infections among those who had received salpingectomy or tubal ligation (OR, 0.46; 95% CI, 0.18–1.20 p = 0.11). In the three trials, the risk of bleeding following the ligation of the fallopian tubes was lower than that of the salpingectomy group (OR, 1.25; 95% CI, 1.21–1.30 p < 0.0001). From this information we have come to the conclusion that it is possible to give preference to tubal ligation for reduction of bleeding in suitable circumstances, and that the findings currently do not provide sufficient evidence for a reduction in the risk of postoperative wound infection. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Gargano J, Holzman C, Senagore P, Reuss M, Pathak D, Williams M, Fisher R. Evidence of placental haemorrhage and preterm delivery. BJOG 2010;117:445–455. Objective To evaluate evidence of placental haemorrhage (PH) obtained through maternal interviews, patient charts and placental pathology examinations as potential indicators of a ‘bleeding pathway’ to preterm delivery (PTD). Design Prospective cohort. Setting Fifty-two clinics in five communities in Michigan, USA (1998–2004). Population A subset ( n = 996) of cohort participants with complete placental pathology data. Methods First-trimester bleeding and placental abruption were ascertained by mid-trimester interviews and chart review, respectively. Disc-impacting blood clot was defined as a gross placental examination finding of a blood clot impacting adjacent tissue. Microscopic haemorrhage was defined as ‘high’ (top quintile) scores on an aggregate measure of placental pathology findings suggestive of atypical maternal vessel haemorrhage. These four PH indicators were compared with one another and with risk of PTD assessed by logistic regression analyses. Main outcome measures Preterm delivery and PTD subtypes (i.e. <35 weeks, 35–36 weeks; spontaneous, medically indicated) compared with term deliveries. Results Placental abruption cases had 2.3-fold to 5.5-fold increased odds of the other three PH indicators. Disc-impacting blood clots and microscopic haemorrhage were associated with one another (odds ratio [OR] = 4.6), but not with first-trimester bleeding. In a multivariable model that included all four PH indicators and confounders, risk of PTD < 35 weeks was elevated with first-trimester bleeding (OR = 1.9 [1.0, 3.4]), placental abruption (OR = 5.2 [1.7, 16.2]), disc-impacting blood clots (OR = 2.3 [1.0, 5.0]) and microscopic haemorrhage (OR = 2.4 [1.4, 4.2]). Conclusions Multiple clinical and subclinical PH indicators are associated with PTD, particularly early PTD. [ABSTRACT FROM AUTHOR]

Background: Only a few dental procedures have been reported to cause life-threatening bleeding. All of these cases followed surgical intervention. Material and Methods: In this paper, we report a case of severe bleeding following non-surgical periodontal procedures in a patient treated with a dual anti-platelet regimen post-coronary stent insertion. Results: Her medical history included ischaemic heart disease, hypertension and diabetes mellitus. Haemostasis was achieved at the conclusion of the non-surgical periodontal treatment. However, several hours later, the patient arrived at the emergency room and was diagnosed with hypovolemic shock. Conclusion: This case should raise the clinician's awareness of bleeding complications in non-surgical procedures as well as the risk for bleeding when a dual anti-platelet regimen is administered. The importance of patient monitoring and the use of local haemostatic agents is demonstrated in these cases. [ABSTRACT FROM AUTHOR]

Phosphomannose isomerase (PMI) deficiency (CDG-Ib) is a newly recognized disorder of mannose and glycoprotein metabolism. PMI deficiency manifests itself mainly as a gastrointestinal disorder with protein-losing enteropathy and life-threatening intestinal bleeding. Hypoglycaemia is an additional prominent symptom. In contrast to phosphomannomutase deficiency (CDG-Ia), there are no neurological symptoms. PMI deficiency blocks the endogenous mannose formation from glucose. Exogenous oral mannose supply bypasses the enzymatic block and leads to the disappearance of all symptoms in the patient. The striking ultrastructural abnormalities of the rough endoplasmatic reticulum of the duodenal epithelial cells completely normalize and the hypoglycosylation disappears, as evidenced by the normal isoelectric focusing pattern of serum transferrin, the standard diagnostic procedure for recognition of CDG. This paper includes a detailed description of the clinical symptomatology of the first-ever diagnosed and treated patient with PMI deficiency and a 5-y follow-up study of mannose therapy. [ABSTRACT FROM AUTHOR]

Summary. This paper describes the molecular defect of the second case of Bernard–Soulier syndrome, initially reported in 1957. Analysis of the patient's platelets by flow cytometry and Western blotting failed to detect surface expression of any of the four subunits of the glycoprotein (GP)Ib–V–IX complex and revealed small amounts of intracellular GPIbα, GPIbβ and GPV but no GPIX. DNA sequencing revealed a novel missense mutation in the GPIX gene which replaced Leu (CTG) by Pro (CCG) at position 7 of the signal peptide. This mutation is, to date, the only known example of a leader sequence defect in Bernard–Soulier syndrome. The change occurred in a prototypic alpha-helical hydrophobic core region, typically enriched in leucine and devoid of proline residues. Co-transfection of GPIXPro7 with normal GPIbα and GPIbβ into Chinese hamster ovary cells reproduced the platelet phenotype, resulting in no detectable GPIX, low intracellular levels of GPIbα and GPIbβ, and an absence of surface expression. This mutation presumably leads to an abnormal conformation and, hence, incorrect insertion of GPIX into the endoplasmic reticulum and/or to defective signal peptide cleavage, both of which are required for correct transport to the cell membrane. This provides further evidence for a critical role of GPIX in controlling biosynthesis of the GPIb–IX complex. [ABSTRACT FROM AUTHOR]

Aims: Clinical trials have found differences in bleeding locations between direct oral anticoagulants (DOAC) and vitamin K antagonists (VKA). The present study was performed to investigate these differences in real life using reports of adverse drug reactions registered in the World Health Organization's pharmacovigilance database, VigiBase®. Methods: All bleeding registered between 1 January 2008 and 31 December 2021 in adults were included. The main objective was to compare bleeding locations reported with DOAC with those with VKA. As a secondary objective, we performed the same comparison with Xa vs. thrombin inhibitors. Results were presented as reporting odds ratios (RORs) adjusted on age, gender, origin of reports and co‐medications with their 95% confidence interval. Results: During this 14‐year period, 142 228 instances of bleeding were registered with oral anticoagulants, including 39 570 with VKA and 102 658 with DOAC. Mean time to event was lower with DOAC (7.6 months) than with VKA (29.9 months) (P <.001). Significant differences in bleeding locations were found in the reports with less cerebral, urologic and nasal bleeding, more gynaecologic bleeding with DOAC than with VKA, without any significant differences in digestive and cutaneous locations. A higher risk of bleeding reports was found with Xa inhibitors vs. dabigatran whatever the locations (except digestive bleeding). Conclusion: This real‐life study shows that the differences in bleeding locations between DOAC and VKA are not limited to the brain or gastrointestinal tracts. Significant differences were also found between Xa and thrombin inhibitors. [ABSTRACT FROM AUTHOR]

Patients with chronic liver disease (CLD) and cirrhosis present a rebalanced hemostatic system in the three phases of haemostasis. This balance is however unstable and can easily tip towards bleeding or thrombosis. Management of both spontaneous bleeding and bleeding during invasive procedures remains a challenge in this patient population. Transfusion of blood products can result in circulatory overload and thereby worsen portal hypertension. As an alternative to fresh frozen plasma (FFP), prothrombin complex concentrates (PCC) may have merit in patients with liver disease because of their low volume. The impact of PCC in in‐vitro spiking experiments of cirrhotic plasma is promising, but also warrants cautious use in light of thromboembolic risk. The majority of existing studies carried‐out in CLD patients are retrospective or do not have an adequate control arm. A prospective study (the PROTON trial) was set up in 2013 to investigate the utility of PCC in patients undergoing liver transplantation. However, the study has never recruited the planned number of patients. Robust data on PCC safety in CLD is also required. The limited existing evidence does not seem to indicate an excessive thromboembolic risk. Currently, the utilisation of PCC in CLD cannot be routinely recommended but can provide an option for carefully selected cases in which other measures were not sufficient to control bleeding and after delicately weighing risks and benefits. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) associates with higher Alzheimer's disease (AD) and vascular dementia risks but the clinical implications have been scarcely investigated. We examined the association between AD or vascular dementia and adverse outcomes in AF patients. Methods: Cohort study between January 2000 and 2017. AF patients were divided into two groups according to vascular dementia or AD, and balanced using propensity score matching (PSM). During 4‐years of follow‐up, incident intracranial hemorrhages (ICH), the composite of ischemic stroke/transient ischemic attack (TIA), hospitalizations, and all‐cause deaths, were recorded. Results: Two thousand three hundred seventy‐seven AF patients with dementia (1225 with vascular dementia, and 1152 with AD) were identified. Following a PSM, 615 patients were included in each cohort (i.e., 1:1) and all variables were well‐matched. After PSM, 22 (3.6%) patients with vascular dementia and 55 (8.1%) patients with AD had incident ICH during follow‐up (hazard ratio [HR]: 2.22, 95% confidence interval [CI]: 1.33−3.70, log‐rank p = 0.002). Overall, 237 (38.5%) patients with vascular dementia and 193 (31.4%) patients with AD, developed an ischemic stroke/TIA. The risk of ischemic stroke/TIA was 1.32‐fold higher in vascular dementia (HR: 1.32, 95% CI: 1.09−1.59, log‐rank p = 0.003). The risk of rehospitalization (HR: 1.14, 95% CI: 1.01−1.31), and mortality (HR: 1.25, 95% CI: 1.01−1.58) were also higher among AF patients with vascular dementia compared to AD. Conclusions: The two forms of dementia in AF patients are associated with different prognosis, with AD being associated with a higher risk of ICH, and vascular dementia with a higher risk of stroke/TIA, hospitalization, and mortality. [ABSTRACT FROM AUTHOR]

Bleeding disorders in women are an underestimated problem that deserves increased attention. About 9%–14% of females have menorrhagia and, amongst them, there is a significant over-representation of von Willebrand disease (VWD), with a prevalence of 13% in this group as compared with about 1% in the general population. The bleeding disorder has not been diagnosed in most of these women and they may therefore be withheld from treatment with desmopressin, which is effective in most cases of VWD and also in platelet dysfunctions and mild factor VIII deficiency. This paper is a review of the haemostatic use of desmopressin with special reference to women’s bleeding disorders, the mechanisms of action, modes of administration, clinical indications, dosage recommendations, and hospital or home treatment. Desmopressin stimulates endogenous release of FVIII and von Willebrand factor (VWF), it increases platelet adhesiveness and shortens bleeding time. It can be given as intravenous or subcutaneous injection, but the intranasal spray is probably the most practical mode of administration for females with bleeding disorders as it is simple to administer and suitable for home treatment. The spray has been used successfully in connection with menorrhagia and other bleeding symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Individual variability of rivaroxaban was observed in clinical application. This study aimed to identify genetic variants associated with the variability of pharmacodynamics and bleeding risk of rivaroxbaban in patients with nonvalvular atrial fibrillation (NVAF). Materials and Methods: From June 2017, and July 2019, this study enrolled 257 patients with NVAF receiving rivaroxaban. Pharmacodynamics was assessed by determining anti‐Factor Xa (anti‐FXa) level 3 h after rivaroxaban administration as peak concentration. Whole‐exome sequencing was performed to detected single nucleotide polymorphisms (SNPs). This study was registered (NCT03161496). Results: The bleeding events within 12 months were significantly related to the peak anti‐FXa level (p =.027). SUSD3 rs76292544 was associated with 12‐month bleeding events (odds ratio [OR]: 4.20, 95% confidence interval [CI]: 2.17–8.14, p = 6.43×10−5). Five SNPs including NCMAP rs4553122 (p = 2.29×10−5), PRF1 rs885821 (p = 7.02×10−5), PRKAG2 rs12703159 (p = 7.97×10−5), PRKAG2 rs13224758 (p = 8.70×10−5), and POU2F3 rs2298579 (p = 8.24×10−5) were associated with peak anti‐FXa level. Genetic variants of 52 SNPs from 36 genes including GOT2 rs14221 and MMP13 rs640198 were potentially related to 12‐month bleeding events caused by rivaroxaban's efficacy. Conclusions: Peak anti‐FXa level was associated with risk of bleeding events in patients with NVAF receiving rivaroxaban. SUSD3 rs76292544 was suggestively associated with 12‐month bleeding events and five SNPs (NCMAP rs4553122, PRF1 rs885821, PRKAG2 rs12703159, rs13224758 and POU2F3 rs2298579) were suggestively associated with peak anti‐FXa level. [ABSTRACT FROM AUTHOR]

Intranasal, subcutaneous, or intravenous desmopressin can be utilized to release von Willebrand Factor and Factor VIII into circulation, enhance platelet adhesion and shorten bleeding time. Due to these properties, desmopressin can be effective in controlling bleeding in mild hemophilia A, certain subtypes of von Willebrand disease and in acute bleeding from uremia, end stage renal disease, and liver disease. Its use, however, can be complicated by hyponatremia and rarely arterial thrombotic events. While desmopressin has also been used as a prophylactic blood sparing agent in orthopedic, renal, and hepatic procedures, clinical studies have shown limited benefit in these settings. The purpose of this article is to review the evidence for desmopressin in primary hematologic disorders, discuss its mechanism of action and evaluate its utility as a hemostatic and blood sparing product in various bleeding conditions. [ABSTRACT FROM AUTHOR]

This meta‐analysis aimed to investigate the effect of the genotype on the pharmacokinetics and bleeding events of direct oral anticoagulants (DOACs) and comprehensively searched electronic databases. Weighted mean difference (WMD) was used to assess the kinetic indicators, odds ratio, and 95% confidence interval (CI) were used to calculate the clinical outcomes. Thirteen articles with 1543 participants were finally included in this study. The peak concentration (Cmax) and area under the plasma concentration–time curve from time 0 to infinity of individuals with the ABCB1 rs 1045642 CT + TT were higher than that of the CC (WMD = −31.9, 95% CI [−49.94, −12.24], P =.02; WMD = −79.97, 95%CI [−152.38 to −7.56], P =.03, I2 = 0). The Cmax of individuals with mutated genes in ABCB1 2677–3435 is higher than that the wild type (WMD = −19.20, 95%CI [36.62 to −1.79], P =.03, I2 = 0). Carriers of the CYP3A5 rs776746 GG genotype had a higher Cmax than the GA gene (WMD = −51.22, 95%CI [−92.26 to −10.19], P =.01, I2 = 0). Bleeding events were more common in the CES1 rs 2244613 AA + AC than in the CC (odds ratio, 2.62, 95%CI [1.06, 6.47], P =.04; I2 = 0). The Cmax of DOACs was affected by individuals with ABCB1 rs 1045642, ABCB1 2677‐343, and cytochrome P450 3A5 rs 776746. Carriers of the ABCB1 rs 1045642 affected the change of area under the plasma concentration–time curve from time 0 to infinity of DOACs. Bleeding events were affected by CES1 rs 2244613. [ABSTRACT FROM AUTHOR]

Introduction: The patient‐administered bleeding assessment tool (self‐BAT) is a screening tool developed to identify individuals in need of work‐up for bleeding disorders. Nonetheless, large studies on self‐BAT scores on healthy individuals according to gender and age are lacking. Aim: Determine cut‐offs for abnormal total score of self‐BAT and investigate the prevalence of bleeding symptoms in blood donors and individuals representative of the general Danish population. Methods: Blood donors, 15,600 children (<18 years) and 18,200 adults from the general Danish population, were invited to complete a Danish version of the self‐BAT. To determine cut‐offs for abnormal total self‐BAT score, findings from healthy young children (0–11 years old), healthy adolescents (12–17 years old), healthy adult women and healthy adult men were used. Results: Among healthy young children (244 girls, 260 boys), healthy adolescents (58 girls, 83 boys), healthy women (n = 437) and healthy men (n = 278) from the general population, along with healthy blood donors (116 women, 176 men), the 95th percentile for total score was two for young girls, three for young boys, four for adolescent girls, three for adolescent boys, eight for women and four for men. Conclusion: Our findings indicate that the abnormal total self‐BAT score is ≥3 for girls aged 0–11 years old, ≥4 for boys aged 0–11 years old, ≥5 for girls aged 12—17 years old, ≥4 for boys aged 12–17 years old, ≥9 for women and ≥5 for men. To establish the accuracy of these cut‐offs for diagnosing bleeding disorders, further studies are needed. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 38-year-old female with abdominal bleeding during and after surgery of ovarian cyst and blood coagulation defect caused by the use of thrombomodulin. Topics discussed include use of red blood cell transfusions, desmopressin, laparotomy undertaken for surgical control of the bleeding and clot removal.

The article features the nonprofit James Lind Alliance (JLA) top 10 research priorities in bleeding disorders in Great Britain in 2019. Topics discussed include the role and effectiveness of blood clotting tests, the risk and benefit balancing of antithrombotic treatment for cardiovascular disease, and the best management of severe haemorrhage after delivery. Also noted is the participation of patients and carers in the development of the list.

Aims: This study aimed to develop and validate a new bleeding risk score to predict warfarin‐associated major bleeding for patients with mitral valve stenosis with atrial fibrillation (MSAF) or mechanical heart valves (MHV). Methods: A multicentre, retrospective cohort study was conducted at 3 hospitals in Thailand. Adult patients with MSAF or MHV receiving warfarin for ≥3 months during 2011–2015 were identified. Data collection and case validation were performed electronically and manually. Potential variables were screened using the least absolute shrinkage and selection operator. Multivariate logistic regression analysis using stepwise backward selection was used to construct a risk score. Predictive discrimination of the score was evaluated using the C‐statistic. Calibration was assessed using the Hosmer–Lemeshow goodness‐of‐fit test. Results: There were 1287 patients (3903.41 patient‐year of follow‐up), with 192 experiencing bleeding (4.92 event/100 patient‐year) in the derivation cohort. A new bleeding risk score termed, the HEARTS‐60 + 3 score (hypertension/history of bleeding; external factors, e.g., alcohol/drugs [aspirin or nonsteroidal anti‐inflammatory drugs]; anaemia/hypoalbuminaemia; renal/hepatic insufficiency; time in therapeutic range of <60%; stroke; age ≥60 y; target international normalized ratio of 3.0 [2.5–3.5]), was developed and showed good predictive performance (C‐statistic [95% confidence interval] of 0.88 [0.85–0.91]). In the external validation cohort of 832 patients (2018.45 patient‐year with a bleeding rate of 4.31 event/100 patient‐year), the HEARTS‐60 + 3 score showed a good predictive performance with a C‐statistic (95% confidence interval) of 0.84 (0.81–0.89). Conclusion: The HEARTS‐60 + 3 score shows a potential as a bleeding risk prediction score in MSAF or MHV patients. [ABSTRACT FROM AUTHOR]

Background: In older patients with atrial fibrillation (AF), cognitive impairment and frailty are prevalent. It is unknown whether the risk and benefit of anticoagulation differ by cognitive function and frailty. Methods: A total of 1244 individuals with AF with age ≥65 years and a CHADSVASC score ≥2 were recruited from clinics in Massachusetts and Georgia between 2016 and 18 and followed until 2020. At baseline, frailty status and cognitive function were assessed. Hazard ratios of anticoagulation on physician adjudicated outcomes were adjusted by the propensity for receiving anticoagulation and stratified by cognitive function and frailty status. Results: The average age was 75.5 (± 7.1) years, 49% were women, and 86% were prescribed oral anticoagulants. At baseline, 528 (42.4%) participants were cognitively impaired and 172 (13.8%) were frail. The adjusted hazard ratios of anticoagulation for the composite of major bleeding or death were 2.23 (95% confidence interval: 1.08–4.61) among cognitively impaired individuals and 0.94 (95% confidence interval: 0.49–1.79) among cognitively intact individuals (P for interaction = 0.08). Adjusted hazard ratios for anticoagulation were 1.84 (95% confidence interval: 0.66–5.13) among frail individuals and 1.39 (95% confidence interval: 0.84–2.40) among not frail individuals (P for interaction = 0.67). Conclusion: Compared with no anticoagulation, anticoagulation is associated with more major bleeding episodes and death in older patients with AF who are cognitively impaired. See related Editorial by Michael W. Rich in this issue. [ABSTRACT FROM AUTHOR]

Endometriosis can be associated with adverse pregnancy outcomes. We report six cases of endometriosis‐related spontaneous hemoperitoneum diagnosed in pregnant and postpartum women over 13 years. Spontaneous hemoperitoneum in pregnancy mainly occurred in the second half of gestation. All women presented with acute abdominal pain; four of them needed an emergent surgery, two were managed expectantly. The median estimated blood loss was 4250 ml, four women required massive transfusion. Three out of six women had a known history of endometriosis, all of them had histologically confirmed endometriosis after surgery. No maternal or perinatal deaths occurred. In one case, reticence to perform a computed tomography scan led to delayed diagnosis. Since delay can lead to lethal consequences, high levels of suspicion for spontaneous hemoperitoneum should be maintained in cases of severe abdominal pain, even with a woman's negative history of endometriosis. Improved knowledge and regular interdisciplinary meetings are pivotal to ameliorate outcomes. [ABSTRACT FROM AUTHOR]

Introduction: People with non‐severe haemophilia appear to be under‐treated in many countries, and this may lead to joint damage and worsen quality of life. Aim: To review literature for clotting factor replacement prophylaxis in people with non‐severe haemophilia A and B (HA/HB) in relation to long‐term outcomes to support clinical decision‐making. Methods: A targeted literature search was performed to identify studies published between 2000 and 2021 that included prophylaxis in people with non‐severe HA/HB and long‐term outcomes, including annualized bleeding rates, joint health and quality of life. Results: Although eligible articles included 2737 and 2272 people with mild or moderate HA, respectively, only 22% (n = 609) and 29% (n = 668) reported treatment regimens. A total of 549 people with moderate HA were treated with factor replacement prophylaxis and were from high‐income countries. On the contrary, nearly all people with mild HA received desmopressin (n = 599). Details of treatment regimens for women with haemophilia and people with HB were sparse. Three studies provided long‐term outcomes for people with moderate haemophilia who received prophylaxis with factor concentrate, supporting early prophylaxis in people with a frequent bleeding phenotype regardless of their endogenous clotting factor level to preserve joint health. Conclusion: There remain large knowledge gaps when considering how to provide optimal treatment for people with non‐severe haemophilia. Nonetheless, there is a strong rationale that prophylaxis should be considered early in life according to similar strategies as for severe haemophilia for those with a frequent severe bleeding phenotype. [ABSTRACT FROM AUTHOR]

We report an analytical approach to study dye desorption and transfer processes in aqueous environment. The study was conducted simulating standard laundry washes using two different donor textiles, a polyester textile dyed with Disperse Blue 79 and a cotton textile dyed with Reactive Red 239, and two acceptor textiles, undyed cotton and polyester, respectively. Dye bleeding/solubilization from a donor textile to the solution was investigated through UV–visible absorbance analysis, while the dye absorption onto acceptor textile was quantified by UV–visible reflectance analysis. Dye desorption and transfer processes were investigated in water and surfactant solutions at different concentrations. A desorption and transfer model for the two classes of dyes was hypothesized by performing kinetic experiments. The results show that both processes depend on the presence of surfactants for the disperse dye. Conversely, the presence of surfactants has little effect on the reactive dye. Finally, the presence of an acceptor polyester significantly increases the bleeding of the disperse dye, while the presence of an acceptor textiles less influences the total release of the reactive dye. [ABSTRACT FROM AUTHOR]

Spontaneous bleeds are a leading cause of death in the pediatric JAG1‐related liver disease Alagille syndrome (ALGS). We asked whether there are sex differences in bleeding events in patients, whether Jag1Ndr/Ndr mice display bleeds or vascular defects, and whether discovered vascular pathology can be confirmed in patients non‐invasively. We performed a systematic review of patients with ALGS and vascular events following PRISMA guidelines, in the context of patient sex, and found significantly more girls than boys reported with spontaneous intracranial hemorrhage. We investigated vascular development, homeostasis, and bleeding in Jag1Ndr/Ndr mice, using retina as a model. Jag1Ndr/Ndr mice displayed sporadic brain bleeds, a thin skull, tortuous blood vessels, sparse arterial smooth muscle cell coverage in multiple organs, which could be aggravated by hypertension, and sex‐specific venous defects. Importantly, we demonstrated that retinographs from patients display similar characteristics with significantly increased vascular tortuosity. In conclusion, there are clinically important sex differences in vascular disease in ALGS, and retinography allows non‐invasive vascular analysis in patients. Finally, Jag1Ndr/Ndr mice represent a new model for vascular compromise in ALGS. Synopsis: Spontaneous bleeds are a significant cause of death in the rare genetic disease Alagille syndrome, but little is known about the risk factors contributing to the bleeding events, or about vascular development and maintenance in the course of the disease. Alagille syndrome is modeled by Jag1Ndr/Ndr mice, including high mortality and sporadic bleeding.More female than male patients with Alagille syndrome are reported with intracranial bleeds, and certain vascular phenotypes are more severe in female Jag1Ndr/Ndr mice.Bleeding risk in Jag1Ndr/Ndr mice may be further modified by thin skull bones, fragile vascular smooth muscle cells, premature vascular aging, and increased venous tortuosity.Developmental and homeostatic vascular defects were detected in both endothelial cells and vascular smooth muscle cells in Jag1Ndr/Ndr mice.The vascular defects observed in Jag1Ndr/Ndr mice could be visualized, quantified, and validated in retinographs from patients, suggesting a non‐invasive method to assess vascular health. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal membrane oxygenation (ECMO) represents an advanced option for supporting refractory respiratory and/or cardiac failure. Systemic anticoagulation with unfractionated heparin (UFH) is routinely used. However, patients with bleeding risk and/or heparin‐related side effects may necessitate alternative strategies: among these, nafamostat mesilate (NM) has been reported. Methods: We conducted a systematic literature search (PubMed and EMBASE, updated 12/08/2021), including all studies reporting NM anticoagulation for ECMO. We focused on reasons for starting NM, its dose and the anticoagulation monitoring approach, the incidence of bleeding/thrombosis complications, the NM‐related side effects, ECMO weaning, and mortality. Results: The search revealed 11 relevant findings, all with retrospective design. Of these, three large studies reported a control group receiving UFH, the other were case series (n = 3) or case reports (n = 5). The main reason reported for NM use was an ongoing or high risk of bleeding. The NM dose varied largely as did the anticoagulation monitoring approach. The average NM dose ranged from 0.46 to 0.67 mg/kg/h, but two groups of authors reported larger doses when monitoring anticoagulation with ACT. Conflicting findings were found on bleeding and thrombosis. The only NM‐related side effect was hyperkalemia (n = 2 studies) with an incidence of 15%–18% in patients anticoagulated with NM. Weaning and survival varied across studies. Conclusion: Anticoagulation with NM in ECMO has not been prospectively studied. While several centers have experience with this approach in high‐risk patients, prospective studies are warranted to establish the optimal space of this approach in ECMO. [ABSTRACT FROM AUTHOR]

In this issue of Cancer, Nguyen and colleagues describe high risk of disseminated intravascular coagulation (DIC) in patients with KMT2Ar acute myeloid leukemia (AML) compared with matched controls in a retrospective single‐institution analysis. The authors of this editorial put this study into perspective of other AML subtypes at high risk of DIC and bleeding. [ABSTRACT FROM AUTHOR]