• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.3
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• pp.221-227
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• 2010

The most common local cause of active gingival bleeding is the vessel engorgement and erosion by severe inflammation. Abnormal gingival bleeding is also associated with the systemic disturbances. Hemorrhagic disorders in which abnormal gingival bleeding is encountered include the following: vascular abnormalities (vitamin C deficiency or allergy), platelet disorders, hypoprothrombinemia (vitamin K deficiency resulting from liver disease), and other coagulation defects (hemophilia, leukemia). There are many conventional methods for gingival bleeding control, such as, direct pressure, electrocoagulation, direct suture, drainage, application of hemostatic agents and crushing and packing. If the active continuous gingival bleeding is not stopped in spite of the application of all conventional bleeding control methods, the life of patient is threatened owing to upper airway obstruction, syncope, vomiting and hypovolemic shock. Therefore, the rapid and correct hemostatic method is very important in the emergency dental care. This is a case report of active gingival bleeding care via dental crown removal and emergency primary endodontic drainage as a last method in liver cirrhosis patient with advanced periodontitis.

• Gut and Liver
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• v.12 no.6
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• pp.704-713
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• 2018

Background/Aims: Gastric varices (GVs) are a major cause of upper gastrointestinal bleeding in patients with liver cirrhosis. The current treatments of choice are balloon-occluded retrograde transvenous obliteration (BRTO) and the placement of a transjugular intrahepatic portosystemic shunt (TIPS). We aimed to compare the efficacy and outcomes of these two methods for the management of GV bleeding. Methods: This retrospective study included consecutive patients who received BRTO (n=157) or TIPS (n=19) to control GV bleeding from January 2005 to December 2014 at a single tertiary hospital in Korea. The overall survival (OS), immediate bleeding control rate, rebleeding rate and complication rate were compared between patients in the BRTO and TIPS groups. Results: Patients in the BRTO group showed higher immediate bleeding control rates (p=0.059, odds ratio [OR]=4.72) and lower cumulative rebleeding rates (logrank p=0.060) than those in the TIPS group, although the difference failed to reach statistical significance. There were no significant differences in the rates of complications, including pleural effusion, aggravation of esophageal varices, portal hypertensive gastropathy, and portosystemic encephalopathy, although the rate of the progression of ascites was significantly higher in the BRTO group (p=0.02, OR=7.93). After adjusting for several confounding factors using a multivariate Cox analysis, the BRTO group had a significantly longer OS (adjusted hazard ratio [aHR]=0.44, p=0.01) and a longer rebleeding-free survival (aHR=0.34, p=0.001) than the TIPS group. Conclusions: BRTO provides better bleeding control, rebleeding-free survival, and OS than TIPS for patients with GV bleeding.

• The Journal of the Korean dental association
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• v.57 no.10
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• pp.613-622
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• 2019

The vitamin K antagonist (VKA), cumadin, or warfarin, is the only antithrombotic drug that can be orally administered and has excellent effective for decades. However, it is cumbersome to periodically inspect the prothrombin time (PT) order to maintain adequate concentrations that do not cause bleeding, takes a few days to indicate therapeutic effects, gets affected by several factors such as food and drugs etc, and narrow in the therapeutic range. Although recently in development, the non-vitamin K antagonist anticoagulants(NOACs) exhibit a rapid onset of action and have relatively short half- lives compared to Coumadin. Because of these pharmacokinetic properties, it is possible to modify an individual's anticoagulation status quite rapidly, minimizing the period where the anticoagulation activity is therapeutically suboptimal. And the short half -lives of these drug allow for the relatively rapid reduction of their anticoagulation effects. There are currently no published clinical trials specifically assessing the bleeding risks associated with dental procedures for patients taking the NOACs. It is not necessary to interrupt NOAC medication for dental procedures that are likely to cause bleeding, but which have a low risk of bleeding complications. Because the bleeding risk for these procedures is considered to be low, the balance of effects is in favour of continuing the NOAC treatment without modification, to avoid increasing the risk of a thromboembolic event. The patients should be advised to miss(apixaban or dabigatran) or delay(rivaroxaban) a dose of their NOAC prior to dental procedures that are likely to cause bleeding and which have a higher risk of bleeding complications. Because the risk of bleeding complications for these procedures is considered to be higher, the balance effects is in favour of missing or delaying the pretreatment NOAC dose. The interruption is only for a short time to minimize the effect on thromboembolic risk.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.3
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• pp.190-196
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• 2021

Objectives: The risk of bleeding after tooth extraction in thrombocytopenia patients remains unclear. Therefore, the present study aimed to assess the risk of bleeding after tooth extraction in patients with thrombocytopenia. Materials and Methods: The study included 220 patients who had a medical history of thrombocytopenia and underwent tooth extraction (330 teeth). The patients were divided into those who had thrombocytopenia (platelet count <150k) immediately before the tooth extraction, and those who had platelet counts that were between 150k and 250k before the extraction. Bleeding complications were recorded and compared between the patient groups. Results: Of the 220 patients, 130 underwent tooth extractions while having thrombocytopenia (platelet count <150k), and 90 had platelet counts that were between 150k and 250k before tooth extractions. Bleeding complications occurred in 11 patients (5.0%) of the 220 patients. Among those 11 patients with bleeding complications, 10 patients (7.7%) had thrombocytopenia (platelet count <150k) of the 130 patients, and 1 patient (1.1%) had a normal platelet count of the 90 patients. There was a significant difference between the patient groups regarding bleeding after extractions (P<0.001). No significant difference in the incidence of post-extraction bleeding was found between the subgroups by platelet count within the thrombocytopenia group. Conclusion: Thrombocytopenia (platelet count <150k) increases the risk of post-tooth extraction bleeding. Therefore, bleeding control under the proper evaluation of hemostasis and performing delicate tooth extraction procedures using hemostatic plugs is necessary during the tooth extraction of patients with thrombocytopenia.

• The Journal of Korean Medicine
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• v.35 no.4
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• pp.116-122
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• 2014

Objectives: Rectal cancer bleeding occurs approximately 20% of overall rectal cancer patients. The current standard treatments cannot cover minor bleeding enough. Failures of the local or systemic approaches to stop bleeding are frequently reported. Methods: we reported a case of male rectal cancer patient who was treated with herbal decoction and significantly improved on symptoms, such as, loose stools and rectal bleeding. Previous to first visiting to our clinic, he was prescribed to use oral tranexamic acids, which failed to relieve his symptoms. He was administered with an herbal decoction, Inhyungtang, clinically known to have hemostastic effect in hematochezia. Results & Conclusion: The prescription showed significant improvement on his symptom, in particular, his bleeding. Thus, we report his case and we expect further experiences and experimental studies to support efficacy of Inhyungtang.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.2
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• pp.143-147
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• 2017

The use of novel oral anticoagulants (NOACs) has increased in recent times in an effort to overcome the shortcomings of warfarin. They are being used primarily for the prevention of thrombosis caused by atrial fibrillation and offer the advantages of having fewer drug interactions than warfarin, no dietary restrictions, and no requirement for regular blood tests. Although there is reportedly less postoperative bleeding even if the drug is not discontinued during procedures that can cause local bleeding, such as dental procedures, no well-designed clinical studies have assessed postoperative bleeding associated with the use of these drugs. This article reports a case of a 74-year-old male patient who was taking rivaroxaban. The patient underwent a dental implant procedure after discontinuing rivaroxaban for one day and subsequently suffered delayed bleeding on postoperative day 6. Accordingly, this article also reports that the use of NOACs may also lead to delayed bleeding.

• Journal of Trauma and Injury
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• v.24 no.2
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• pp.159-163
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• 2011

Massive bleeding due to traumatic pelvic bone fracture is a leading cause of death. Thus, several methods to control bleeding have been attempted, but none of these has yet been clearly established. After an automobile accident, a 34-year-old motorist was admitted to the Emergency Department for right hip,leg and abdominal pain. Because the patient's pressure remained consistently low and pelvic bone fracture and abdominal bleeding were found on radiologic examination, an explorative laparotomy was performed. After pelvic packing and bleeding control, bleeding still continued, so Angiography was performed, and arterial embolization for bleeding was performed.

• The Journal of Internal Korean Medicine
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• v.22 no.4
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• pp.621-625
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• 2001

Objectives: We examined if their hematological status could be changed by blood loss in patients treated with bleeding pressure therapy. Methods: The patients were divided into two groups as follows: The Subject group(B) were 42 cases treated with bleeding pressure therapy. The Control group(N) were 43 cases treated with negative bleeding pressure therapy, We checked CBC & differ cell count of two groups. Results: The means of RBC, Hb count and Hct were slightly decreased after 1 week. but they were recovered after 2 weeks. Conclusions: These results indicate that Bleeding Pressure Therapy don't reduced RBC, Hb count and Hct in Patients.

• Journal of The Korean Dental Society of Anesthesiology
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• v.9 no.2
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• pp.91-97
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• 2009

Background: Nasotracheal intubation for general anesthesia is preferred for oral and maxillofacial procedures because it provides improved access to the operative site. Fiberopic nasotracheal intubation is a useful technique when airway management seems difficult. But, intaoral bleeding is considered as the important factor that makes fiberopic nasotracheal intubation difficult. The purpose of our study was to elucidate the effect of laryngeal view and bleeding on intubation difficulty during fiberopic intubation. Methods: We studied 461 patients undergoing nasotracheal intubation with permission. Laryngeal view grades were examined with laryngoscope and were recorded. Then, intubation time and the amounts of bleeding were measured during fibroptic nasotracheal intubation under general anesthesia. Results: There was no significant difference between laryngeal view grade and intubation difficulty (P > 0.05). But severity of bleeding increased intubation difficulty (P < 0.05). Conclusions: In this study, the significant amounts of bleeding had an effect on intubation difficulty.

• The Korean journal of helicobacter and upper gastrointestinal research
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• v.18 no.4
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• pp.235-241
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• 2018

Peptic ulcer bleeding is a common complication of peptic ulcer disease and the most common cause of upper gastrointestinal bleeding. Despite advances in drug usage and endoscopic modalities, no significant improvement is observed in the mortality rate of bleeding ulcers. The purpose of this review is to discuss various endoscopic hemostatic methods to treat peptic ulcer bleeding. Endoscopic hemostatic techniques can be classified into injection, mechanical, electrocoagulation, hemostatic powder, and endoscopic Doppler-guided hemostatic therapies (the last mentioned being a newly developed technique). Endoscopic hemostasis can be performed as mono or combination therapy using the aforementioned methods. Endoscopic hemostasis is the most important treatment for patients with peptic ulcer bleeding. Endoscopists should consider the treatment approach for peptic ulcer bleeding based on patient characteristics, the size and shape of the lesion, the endoscopist's expertise, and the resources and circumstances at each hospital. Follow-up studies are needed to evaluate the efficacy of newly developed hemostatic powder therapy and endoscopic Doppler-guided hemostasis.