Bleeding, drug treatment

Fremes SE, Wong BI, Lee E, Mai R, Christakis GT, McLean RF, Goldman BS, Naylor CD. Metaanalysis of prophylactic drug treatment in the prevention of postoperative bleeding. Ann Thorac Surg 1994 58(6) 1580-8. 

In addition, the template bleeding time is measured at various time intervals before and after drug treatment (depending on the route of administration) in the shaved inner ear using the Simplate device. Care is taken to select parts of the skin without larger vessels. 

Therapeutically t-PA and urokinase are the most important drugs for fibrinolytic therapy (myocardial infarction, stroke, massive pulmonary embolism). This treatment is associated with an enhanced risk of bleeding complications. 

Penicillamine. The primary healHi care provider will explain Hie treatment regimen and adverse reacHons before therapy is started. You must know which toxic reactions require contacting Hie primary healHi care provider immediately. Take penicillamine on an empty stomach, 1 hour before or 2 hours after a meal. If other drugp are prescribed, penicillamine is taken 1 hour apart from any other drug. Observe skin areas over Hie elbows, shoulders, and buttocks for evidence of bruising, bleeding, or break in the skin (delayed wound healing may occur). If Hiese occur, do not self-treat the... 

These drug are used for the medical treatment of agastric or duodenal ulcer, gastric hypersecretory (excessive gastric secretion of hydrochloric acid) conditions, and GERD. These drug may also be used as prophylaxis of stress-related ulcers and acute upper GI bleeding in critically ill patients. 

The progestins are used in the treatment of amenorrhea, endometriosis, and functional uterine bleeding. Progestins are also used as oral contraceptives, either alone or in combination with an estrogen (see the Summary Drug Table Female Hormones and Table 52-1). 

Given that VTE can be debilitating or fatal, it is important to treat it quickly and aggressively.8 On the other hand, because major bleeding induced by antithrombotic drugs can be equally harmful, it is important to avoid treatment when the diagnosis is not reasonably certain. Assessment of the patient s status should focus on the search for risk factors in the patient s medical history... 

Balloon tamponade involves the application of direct pressure to the area of bleeding with an inflatable balloon attached to a nasogastric tube. It is an option for patients in whom drug therapy and band ligation fail to stop variceal bleeding. Balloon tamponade is used only when other methods have failed. Once the direct pressure of the balloon is removed, rebleeding often occurs, so balloon tamponade is only a temporary measure prior to more definitive treatment such as shunting.11... 

Contraindications to heparin therapy include hypersensitivity to the drug, active bleeding, hemophilia, severe liver disease with elevated prothrombin time (PT), severe thrombocytopenia, malignant hypertension, and inability to meticulously supervise and monitor treatment. 

Although treatment is minimally effective if used for 7 days, 10-14 days of treatment is recommended. The antisecretory drug may be continued beyond antimicrobial treatment in patients with a history of complicated ulcer (e g., bleeding or in heavy smokers). In the setting of an active ulcer, acid suppression is added to hasten pain relief. 

Many chronic diseases can cause hypotension. Heart conditions (and drugs used for its treatment) can lead to bradycardia, thyroid dysfunction (either under- or over activity), diabetes mellitus, Parkinson s disease and neuropathies. Also, all acute conditions with the risk of dehydration, such as fever, vomiting, diarrhoea and bleeding, can cause hypotension. 

The FDA approved this selective cyclooxigenase (COX)-2 inhibitor (Vioxx) for the treatment of pain and inflammation in 1999. This NSAID demonstrated to have a lower risk of side effects such as gastrointestinal ulcers and bleeding than nonse-lective COX inhibitors, for example, ibuprofen. In 2004, a long-term study of Vioxx in patients at increased risk of colon polyps was halted because of an increased cardiovascular risk (heart attack, stroke) in the rofecoxib group. Subsequently, Merck withdrew the drug from the world market at the end of September 2004 [46]. 

All antiplatelet drugs increase the risk of bleeding. Even at the low ASA doses used to inhibit platelet function (100 mg/d), ulcerogenic and bronchocon-strictor (aspirin asthma) effects may occur. Ticlopidine frequently causes diarrhea and, more rarely, leukopenia, necessitating cessation of treatment Clopidogrel reportedly does not cause hematological problems. 

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