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Managing care for life-threatening, uncontrolled bleeds

Introduction

Millions of people experience a life-threatening bleed each year due to an accident or injury, chronic disease, or as an uncommon but significant complication of medicines such as blood thinners.1-3 Management of these bleeds often requires a range of specialists including emergency care clinicians, haematologists, cardiologists, internists, surgeons and pharmacists to coordinate potentially lifesaving treatment in the emergency care setting.4

 

What is uncontrolled bleeding?

If not effectively managed in the emergency setting, major bleeds can cause serious complications and become life threatening.5 These types of uncontrolled bleeds have led to more than 450,000 deaths globally each year, making it a priority condition to quickly and efficiently manage.6

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References

1. American Heart Association [Internet]. 2021 Heart Disease & Stroke Statistical Update Fact Sheet Global Burden of Disease. 2021; [cited 2023 Apr 28]. Available from: https://professional.heart.org/-/media/PHD-Files-2/Science-News/2/2021-Heart-and-Stroke-Stat-Update/2021_Stat_Update_factsheet_Global_Burden_of_Disease.pdf.

2. Cleveland Clinic [Internet]. What are the most common causes of hemorrhage? 2023; [cited 2023 Apr 28]. Available from: https://my.clevelandclinic.org/health/symptoms/21654-hemorrhage#possible-causes.

3. Dhakal P, et al. Reversal of anticoagulation and management of bleeding in patients on anticoagulants. Clin Appl Thromb Hemost. 2017;23:410-415.

4. Baugh CW, Levine M, Cornutt D, et al. Anticoagulant reversal strategies in the emergency department setting: recommendation of a multidisciplinary expert panel. Ann Emerg Med. 2020;76:470-485.

5. Donley ER, et al. [Internet]. Hemorrhage control; [cited 2023 Apr 28]. Available from:  https://www.ncbi.nlm.nih.gov/books/NBK535393/. February 12, 2023.

6. World Health Organization [Internet]. Uncontrolled Bleeds. 2020; [cited 2023 Apr 28]. Available from: https://www.who.int/home/search?indexCatalogue=genericsearchindex1&searchQuery=uncontrolled%20bleeding&wordsMode=AnyWord.

7. Johnson AB and Burns B [Internet]. Hemorrhage; [cited 2023 Apr 28]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542273/. February 15, 2023.

8. Kaikita K, et al; on behalf of the AFIRE Investigators. Bleeding and subsequent cardiovascular events and death in atrial fibrillation with stable coronary artery disease. Circ Cardiovasc Interv. 2021;14:e010476.

9. Hasegawa S, et al. Association between diabetes and major bleeding complications of renal biopsy. Kidney Int Rep.  2022;7:232-240.

10. Mayo Clinic [Internet]. High blood pressure dangers: hypertension’s effects on your body. 2022; [cited 2023 Apr 28]. Available from: https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20045868.

11. Kim E, et al. Life-threatening lower gastrointestinal hemorrhage in pediatric Crohn’s disease. Pediatr Gastroenterol Hepatol Nutr. 2013;16:53-60.

12. Fashner J and Gitu AC. Common gastrointestinal symptoms: irritable bowel syndrome. FP Essent.  2013;413:16-23.

13. National Institutes of Health [Internet]. Bleeding disorders: causes and risk factors; [cited 2023 Apr 28]. Available from: https://www.nhlbi.nih.gov/health/bleeding-disorders/causes.

14. Compton K [Internet]. Blood thinners. 2022; [cited 2023 Apr 28]. Available from: https://www.drugwatch.com/health/cardiovascular-health/blood-thinners/.

15. Cleveland Clinic [Internet]. Blood clots; [cited 2023 Apr 28]. Available from: https://my.clevelandclinic.org/health/diseases/17675-blood-clots.

16. Chen A, et al. Direct oral anticoagulant use: a practical guide to common clinical challenges. J Am Heart Assoc. 2020;9:e017559.

17. Milling TJ, Frontera J. Exploring indications for the use of direct oral anticoagulants and the associated risks of major bleeding [Internet]. The American journal of managed care. U.S. National Library of Medicine; 2017 [cited 2023Mar16]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568002/

18. Kauvar DS, Wade CE. The epidemiology and modern management of traumatic hemorrhage: US and International Perspectives [Internet]. Critical Care . BioMed Central; 2005 [cited 2023Mar24]. Available from: https://ccforum.biomedcentral.com/articles/10.1186/cc3779

19. Tomaselli GF, et al. 2020 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2020;76:594-622.

20. Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, et al. The European guideline on management of major bleeding and coagulopathy following trauma: Fifth edition - critical care [Internet]. BioMed Central; 2019 [cited 2023 May 15]. Available from: https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2347-3

21. Zhu W, He W, Guo L, et al. The HAS‐BLED score for predicting major bleeding risk in anticoagulated patients with atrial fibrillation: a systematic review and meta‐analysis. Clin Cardiol. 2015;38:555-561