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  • Gruen, Russell L.  (11)
  • Hemorrhage
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  • 1
    Language: English
    In: The Lancet, 22 September 2012, Vol.380(9847), pp.1099-1108
    Description: Most surgeons have adopted damage control surgery for severely injured patients, in which the initial operation is abbreviated after control of bleeding and contamination to allow ongoing resuscitation in the intensive-care unit. Developments in early resuscitation that emphasise rapid control of bleeding, restrictive volume replacement, and prevention or early management of coagulopathy are making definitive surgery during the first operation possible for many patients. Improved topical haemostatic agents and interventional radiology are becoming increasingly useful adjuncts to surgical control of bleeding. Better understanding of trauma-induced coagulopathy is paving the way for the replacement of blind, unguided protocols for blood component therapy with systemic treatments targeting specific deficiencies in coagulation. Similarly, treatments targeting dysregulated inflammatory responses to severe injury are under investigation. As point-of-care diagnostics become more suited to emergency environments, timely targeted intervention for haemorrhage control will result in better patient outcomes and reduced demand for blood products. Our Series paper describes how our understanding of the roles of the microcirculation, inflammation, and coagulation has shaped new and emerging treatment strategies.
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
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  • 2
    In: Medical Journal of Australia, September 2013, Vol.199(5), pp.310-311
    Description: The dilemma that clinicians involved in the resuscitation of severely injured patients face with regards to the inclusion of tranexamic acid (TxA) in trauma management protocols is discussed. However, on the other hand, the need for more evidence to solve ongoing knowledge gaps has been emphasised, especially evidence of who benefits and whether anyone is harmed when TxA is administered to patients treated to modern civilian and military trauma standards.
    Keywords: Emergency Medicine
    ISSN: 0025-729X
    E-ISSN: 1326-5377
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  • 3
    Language: English
    In: The Lancet, 2011, Vol.377(9771), pp.1052-1054
    Description: Unlike coagulopathy that is secondary to haemodilution, hypothermia, or acidosis, acute traumatic coagulopathy is a hyperacute process in which systemic fibrinolysis releases D-dimers that are detectable within 30 min of injury.5 While the mechanisms are poorly understood, shock and tissue injury seem...
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
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  • 4
    Language: English
    In: The Lancet, 2010, Vol.376(9746), pp.1049-1049
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
    Source: ScienceDirect Journals (Elsevier)
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  • 5
    Language: English
    In: British Medical Journal, Nov 24, 2012, Vol.345(7884), p.46(2)
    Description: The article discusses the early administration of tranexamic acid to injured patients at risk of substantial bleeding. The advantages and disadvantages of this form of administration for patients are highlighted
    Keywords: Tranexamic Acid -- Dosage And Administration ; Hemorrhage -- Causes Of ; Hemorrhage -- Drug Therapy
    ISSN: 1759-2151
    ISSN: 09598146
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  • 6
    Language: English
    In: BMJ : British Medical Journal, 19 November 2012, Vol.345
    Description: Tranexamic acid was discovered in the 1950s and has been used during surgery to minimise blood loss. A systematic review evaluated 126 randomised controlled trials in elective surgery and three in emergency surgery (total of 10 488 patients) that had been conducted between 1972 and 2011. This showed that tranexamic acid reduced blood transfusions by a third (risk ratio 0.62, 95% confidence interval 0.58 to 0.65),4 an effect that persisted when only trials with adequate allocation concealment were considered (0.68, 0.62 to 0.74). In these higher quality trials the effect on mortality was uncertain (0.67, 0.33 to 1.34), as was the effect on myocardial infarction, stroke, and venous thromboembolism.
    Keywords: Change Page
    ISSN: BMJ
    E-ISSN: 1756-1833
    E-ISSN: 17561833
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  • 7
    In: Shock, 2013, Vol.40(2), pp.160-161
    Keywords: Antifibrinolytic Agents -- Therapeutic Use ; Hemorrhage -- Prevention & Control ; Tranexamic Acid -- Therapeutic Use ; Wounds and Injuries -- Drug Therapy;
    ISSN: 1073-2322
    E-ISSN: 15400514
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  • 8
    In: Medical Journal of Australia, March 2014, Vol.200(5), pp.255-255
    Keywords: Emergency Medicine
    ISSN: 0025-729X
    E-ISSN: 1326-5377
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  • 9
    In: ANZ Journal of Surgery, March 2016, Vol.86(3), pp.167-172
    Description: Byline: Daniel T. Breen, Nuttaya Chavalertsakul, Eldho Paul, Russell L. Gruen, Jonathan Serpell Keywords: blood loss; elective; heparin; low-molecular-weight; surgical procedure; surgical; thromboembolism; warfarin Abstract Background Patients taking warfarin are often given interim anticoagulation in the perioperative period. Institutional guidelines that use low-molecular-weight heparin (LMWH) 'bridging' while the international normalized ratio (INR) is sub-therapeutic are often based on the American College of Chest Physicians Anticoagulation Guidelines. Purpose This study aims to identify if patients at a tertiary referral hospital were anticoagulated in line with these guidelines, and the incidence and nature of bleeding and thromboembolic complications. Methods A retrospective review of the Alfred Hospital General Surgical and 'Hospital at Home' databases was conducted, identifying patients who underwent elective general surgical procedures and received bridging anticoagulation with enoxaparin. Demographics, indication for anticoagulation, bleeding and thromboembolism rates were recorded. Thromboembolic risk was estimated. Results The study identified 108 patients. Three-quarters of all patients were anticoagulated with LMWH doses in accordance with the guidelines. Thirty of the 108 patients suffered bleeding complications. This group was younger, weighed less, received higher doses of enoxaparin and were at higher predicted risk of thromboembolism than non-bleeding patients. Wound haematoma, rectal bleeding and intra-abdominal bleeding were the most frequent complications. The peak time of bleeding was 3.5 days after surgery. Twelve patients returned to theatre, 13 were readmitted and 3 received blood transfusion. One patient suffered pulmonary emboli on the first post-operative day. Conclusion LMWH bridging therapy when prescribed appropriately is associated with low rates of inpatient thromboembolism in elective general surgical patients within our institution, but an unexpectedly high rate of bleeding complications. Article Note: D. T. Breen MBBS; N. Chavalertsakul MBBS; E. Paul MSc; R. L. Gruen MBBS, PhD, FRACS; J. Serpell MB, BS, MD, MEd, FRACS, FACS. This study is based on research presented at the 2012 RACS ASM.
    Keywords: Blood Loss ; Elective ; Heparin ; Low‐Molecular‐Weight ; Surgical Procedure ; Surgical ; Thromboembolism ; Warfarin
    ISSN: 1445-1433
    E-ISSN: 1445-2197
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  • 10
    In: Emergency Medicine Australasia, April 2014, Vol.26(2), pp.194-197
    Description: Following findings of the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH‐2) trial, tranexamic acid () use post trauma is becoming widespread. However, issues of generalisability, applicability and predictability beyond the context of study sites remain unresolved. Internal and external validity of the ‐2 trial are currently lacking and therefore incorporation of into routine trauma resuscitation guidelines appears premature. The Pre‐hospital Antifibrinolytics for Traumatic Coagulopathy and Haemorrhage (PATCH)‐Trauma study is a National Health and Medical Research Council‐funded randomised controlled trial of early administration of in severely injured patients likely to have acute traumatic coagulopathy. The study population chosen has high mortality and morbidity and is potentially most likely to benefit from 's known mechanisms of action. This and further trials involving appropriate sample populations are required before evidence based guidelines on use during trauma resuscitation can be developed.
    Keywords: Evidence‐Based Practice ; Haemorrhage ; Resuscitation ; Tranexamic Acid ; Wounds And Injuries
    ISSN: 1742-6731
    E-ISSN: 1742-6723
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