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Current recommendations for the prevention of deep venous thrombosis
Published in Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki, Handbook of Venous and Lymphatic Disorders, 2017
For patients in whom spinal hematoma is suspected, diagnostic imaging and definitive surgical therapy must be performed as rapidly as possible in order to avoid permanent paresis. In summary, all patients receiving neuraxial anesthesia and anticoagulant prophylaxis should be monitored carefully and frequently for early signs of cord compression.
Epidural and spinal analgesia
Published in Pamela E Macintyre, Suellen M Walker, David J Rowbotham, Clinical Pain Management, 2008
Among the most dreaded and devastating adverse events associated with neuraxial techniques are bleeding complications with resultant permanent damage of the spinal cord. Fortunately, despite a rising number of patients on chronic or perioperative anticoagulant drugs, spinal hematomas remain very rare, and estimations of its incidence are difficult. In a large Finnish study based on 23,500 patient insurance claims from 1987 to 1993, the overall incidence was 0.005 percent, with 0.003 percent of spinal hematomas occurring after epidural and 0.004 percent after spinal anesthesia.60 Another Swedish report summarizes severe neurological complications after central neuraxial blockades between 1990 and 1999.61 Among 1, 260, 000 spinal blocks and 450,000 epidurals, spinal hematoma occurred in only 33 cases, 11 of which were associated with anticoagulation. However, the consequences of spinal and epidural hematoma in this review were severe. Only six patients made a full recovery and 27 suffered permanent neurological damage, such as paraparesis, cauda equina syndrome, and sensory deficits. A more recent review of 8120 patients with epidural catheters under the care of an acute pain service identified two epidural hematomas (incidence < 0.05 percent) with no long-term neurological sequelae.62
Cost of hemophilia A in Turkey: an economic disease burden analysis
Published in Journal of Medical Economics, 2021
Simten Malhan, Ergün Öksüz, Bülent Antmen, Muhlis Cem Ar, Can Balkan, Kaan Kavaklı
Hemophilia A is an X chromosome-linked bleeding disorder characterized by the deficiency of clotting factor VIII (FVIII). Hemophilia A has a recessive genetic pattern and is almost always seen in males. The general incidence of hemophilia A is 17.1 (14.8–19.3) in 100,000 male births1. Bleeding episodes involving joints and surrounding soft tissue constitutes the hallmarks of the disease and might lead to arthropathy in the long-term if insufficiently treated2. Randomized clinical trials and real-world evidence have demonstrated that prevention prevents joint bleeding and deterioration of joint status, and primary prevention with FVIII has, therefore, been recognized as the standard of care for individuals with severe hemophilia A in countries with adequate resources. Prophylactic therapy also reduces the incidence of central nervous system bleeds (intracranial and spinal hematoma), which are less common than joint bleeding but much more life-threatening. Additional advantages of prophylaxis vs. on-demand treatment include reduced hospitalizations and absenteeism from school or work, greater participation in social activities and, overall, improved health-related quality-of-life3.
Risks and patient outcomes of surgical intervention for hemophilic arthropathy
Published in Expert Review of Hematology, 2019
The level of evidence on hemophilia in the literature is very low. In fact, to date no study on the adverse joint events in hemophilia has been included in the Cochrane Library. Appropriate treatment of hemarthrosis should include prompt diagnosis, adequate hematological management, evacuation of blood in the joint (arthrocentesis), physical medicine and rehabilitation, and prevention of recurrent bleeding. Clinical diagnosis should be confirmed by US. X-rays should also be carried out to discard (or confirm) radiological signs of articular disease. In cases of chronic synovitis, arthroscopic synovectomy should be performed after failure of RS to control the problem. Many people with hemophilia under the age of forty, and even as young as ten, already have severe articular degeneration (advanced joint disease). Currently, the plausible surgical treatments are radial head removal, TEA, THA, arthroscopic debridement of the knee and ankle, TKA, ankle fusion and TAA. In orthopedic surgery for people with hemophilia, general anesthesia is advised, because spinal anesthesia can result in dangerous complications (secondary to a spinal hematoma). The chief benefit of orthopedic surgery in hemophilia is that it notably improves the patient’s quality of life.
A simplified treatment algorithm for treating thoracic and lumbar spine trauma
Published in The Journal of Spinal Cord Medicine, 2019
Andrei F. Joaquim, Alpesh A. Patel, Gregory D. Schroeder, Alexander R. Vaccaro
This group includes most of the fractures not associated with any degree of vertebral dislocation, without any spine misalignment, without facet subluxation or luxation, without or with only minor canal compression and without any degree of increasing distance of the spinous process. The diagnosis can be made preferentially with CT scan but an MRI may be used to discharge a suspect ligamentous injury, spinal hematoma or disc herniation. Standing plain radiographs may also be performed to rule out occult ligamentous injury and to evaluate the effect of the body weight in the fracture site.