Secondary Open-Angle Glaucomas
Neil T. Choplin, Carlo E. Traverso in Atlas of Glaucoma, 2014
Patients with hyphema are generally kept on bed rest and treated with mydriatics and topical steroids. Aminocaproic acid, an antifibrinolytic agent, is also used in some centers to reduce the incidence of re-bleeds, which may be severe. Prolonged elevation of IOP may require surgical evacuation of the blood. Timing is dependent on the ability of the nerve to withstand elevated pressures; otherwise, healthy nerves may tolerate pressures of up to 50 mmHg for several days. Evacuation may also be necessary because of the development of blood staining of the cornea, especially in those at risk for amblyopia (Figure 10.20). Surgical evacuation is ideally performed near the fourth day post-trauma. This is past the peak incidence of re-bleed and allows time for the anterior-chamber blood to clot and retract somewhat from ocular structures, facilitating removal.
The HbS Containing Cell
Ronald L. Nagel in Genetically Abnormal Red Cells, 2019
Treatment of these patients involves transfusions and in some cases surgery. Epsilon aminocaproic acid in a dosage of 2 to 8 g/day is enthusiastically supported by some250 but a formal trial has not been done to asses its usefulness.
Bleeding
Mervyn Dean, Juan-Diego Harris, Claud Regnard, Jo Hockley in Symptom Relief in Palliative Care, 2018
Tranexamic/aminocaproic acid inhibits the breakdown of fibrin clots and is well absorbed orally,9 but in hematuria it can produce hard clots that are difficult to remove and can cause obstruction.10
Conserved anti-inflammatory effects and sensing of butyrate in zebrafish
Published in Gut Microbes, 2020
Pradeep Manuneedhi Cholan, Alvin Han, Brad R Woodie, Maxinne Watchon, Angela RM Kurz, Angela S Laird, Warwick J Britton, Lihua Ye, Zachary C Holmes, Jessica R McCann, Lawrence A David, John F Rawls, Stefan H Oehlers
We used Tg(fabp10a:fgb-EGFP)mi4001, where fibrin clots are visualized by GFP deposition, and Tg(−6.0itga2b:eGFP)la2, where thrombocytes are GFP-labeled, transgenic zebrafish lines to monitor hemostasis following transection of the dorsal aorta and posterior cardinal vein.33,34 We stabilized clots with aminocaproic acid as a positive control.35 Fibrinogen accumulation in Tg(fabp10a:fgb-EGFP)mi4001 embryos was unchanged at the wound site in response to butyrate treatment; however, we noted that propionate treatment caused increased fibrinogen accumulation (Supplementary Figure 1A). No changes were observed in thrombocytes accumulation in the Tg(−6.0itga2b:eGFP)la2 line following any of the SCFA treatments (Supplementary Figure 1B).
Acute intraoperative subgaleal hematoma associated with vitreoretinal surgery in a patient with Ehlers-Danlos Syndrome Type VI
Published in Ophthalmic Genetics, 2023
Marissa M. Patel, Thomas A. Lazzarini, Joshua H. Uhr, Catherin I. Negron, Audina M. Berrocal
The patient was admitted to the inpatient hospital where the hematology service was consulted. Computed tomography (CT) imaging of the head showed a 5 × 15 × 11 cm right subgaleal hematoma (Figure 2), suggestive of combined acute and hyperacute bleeding. The patient also exhibited a drop in hemoglobin from 14.1 to 8.6 g/dl within 24 hours. CT angiography (CTA) did not demonstrate active extravasation or a vascular malformation. The hematology team recommended treating the patient for von Willebrand Disease (VWD) Type 2 on the basis of the loss of HMWMs on preoperative von Willebrand factor analysis. The patient was treated with intravenous aminocaproic acid and human antihemophilic factor/von Willebrand factor complex (Humate-P). Over her five-day hospitalization, the patient’s hemoglobin stabilized at 11 g/dl without signs of additional bleeding or the need for blood transfusion. The patient was titrated off of aminocaproic acid and Humate-P and was discharged with outpatient hematology follow-up.
Hypoplastic thrombocytopenia and platelet transfusion: therapeutic goals
Published in Hospital Practice, 2019
Stamatis J. Karakatsanis, Stamatis S. Papadatos, Konstantinos N. Syrigos
In spite of the fact that prophylactic PLT transfusions decrease the incidence of bleeding among patients with thrombocytopenia a certain bleeding risk remains, while this approach necessitates frequent visits to the medical center, is hampered by PLT shortages, and ultimately leads often to alloimmunization and PLT refractoriness. In addition, this approach is ineffective in preventing significant bleeding episodes in 20% to 50% of patients [35]. Therefore, the American Association of Blood Banks recommends further prophylactic measures, for example, antifibrinolytic treatment [4]. It has been well-established that epsilon aminocaproic acid (EACA, a synthetic lysine analog that inhibits fibrinolysis, leads to thrombus stabilization and has antiplasmin activity [36]) may contribute to the prevention as well as the treatment of bleeding episodes in patients with thrombocytopenia [37,38]. EACA administration is well tolerated and results in fast and significant reduction in bleeding episodes as well as RBC transfusions in patients with thrombocytopenia [37,38]. Phase II PROBLEMΑ (PRevention Of BLeeding in hEmatological Malignancies With Antifibrinolytic, NCT02074436) study aims to compare the effectiveness of EACA administration to PLT transfusion in patients with thrombocytopenia and hematological malignancies, regarding the prevention of bleeding episodes [39]. The administration of tranexamic acid, another antifibrinolytic agent, is effective only in the prevention of thrombocytopenia-induced bleeding [40,41]. Nonetheless, it should be recognized that anti-fibrinolytics may increase the risk of DIC, of which patients with hematological malignancies are already at an increased risk.