Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis
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Blood Coagul. Fibrinolysis · Mar 2014
Case ReportsManagement of severe bleeding in a ruptured extrauterine pregnancy: a theragnostic approach.
Haemoperitoneum due to ruptured extrauterine pregnancy is a complication that may occur in the first trimester of pregnancy, but massive haemorrhage with severe shock is rare. When severe bleeding does occur, timely diagnosis and rapid haemostatic treatment are vital. We present the case of a 37-year-old woman with severe bleeding and shock due to ruptured extrauterine pregnancy. ⋯ Surgery was successfully completed, and the patient was subsequently discharged 5 days after admission with no further complications. Haemorrhage in extrauterine pregnancy is commonly managed using autologous blood transfusion (via cell salvage) and homologous plasma transfusion. In this case of severe bleeding and shock due to ruptured extrauterine pregnancy, thromboelastometry-guided administration of fibrinogen concentrate enabled rapid restoration of haemostasis, complete avoidance of FFP transfusion and resulted in a successful outcome.
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Blood Coagul. Fibrinolysis · Mar 2014
Plasma D-dimer and in-hospital mortality in patients with Stanford type A acute aortic dissection.
Plasma D-dimer has been used as a complementary initial diagnostic marker for acute aortic dissection (AAD). However, its prognostic role in patients with Stanford type A AAD has not been clarified. We prospectively enrolled a consecutive series of patients with suspect AAD presented to our emergency department and measured the plasma D-dimer level (Stago-evolution, France) immediately following the admission. ⋯ After adjustment for age, systolic blood pressure, platelet counts, and intervals from symptom onset to hospital, a high admission D-dimer level (≥20 μg/ml) was still a powerful independent predictor of in-hospital mortality (hazard ratio 3.195, 95% confidence interval 1.110-9.196, P = 0.031). However, the predictive value of high admission D-dimer level disappeared when surgery was added to the Cox multivariate model. Our results suggest a high admission D-dimer level (≥20 μg/ml) might be a powerful predictor for increased in-hospital mortality in patients with Stanford type A AAD, and these patients may benefit more from surgical intervention.