Intra-alveolar epsilon-aminocaproic acid for the control of post-extraction bleeding in anticoagulated patients: randomized clinical trial.

The aim of this study was to compare the effectiveness of the intra-alveolar administration of epsilon-aminocaproic acid (EACA) and daily gentle rinsing with EACA mouthwash with that of routine postoperative procedures for the control of bleeding after tooth extraction in anticoagulated patients. A randomized clinical trial was conducted involving 52 patients submitted to 140 tooth extractions, assigned randomly to two groups. The intervention group was treated with intra-alveolar administration of EACA immediately after surgery and gentle rinsing with EACA mouthwash during the postoperative period. The control group received routine postoperative recommendations. A single episode of immediate bleeding occurred in the intervention group. Late bleeding episodes occurred in 23 procedures (16.4%): 11 (15.7%) in the intervention group and 12 (17.1%) in the control group. Among the patients with late bleeding, 18 (78.3%) events were classified as moderate and were controlled by the patient applying pressure to a gauze pack placed over the extraction socket. The remaining five cases (21.7%) required re-intervention. No statistically significant difference in the frequency of postoperative bleeding was observed between the groups. Thus, routine measures were as effective for the control of bleeding after simple tooth extractions in anticoagulated patients as the topical administration of EACA.

[Periventricular and intraventricular hemorrhage in the premature infants]. / Hemorragia periventricular e intraventricular de recién nacidos prematuros.

OBJECTIVE: To review intracranial hemorrhage originated in the subependymal germinal matrix region. DEVELOPMENT: Incidence rates of germinal matrix-intraventricular hemorrhage (GMH) range from 20 to 40% of infants born before 32 weeks gestational age or with birth weight less than 1,500 g. Because the GMH is usually diagnosed during the first 72 postnatal hours, that is the optimal time to perform ultrasound scans. The pathogenesis of GMH is multifactorial and related to vascular, intravascular and extravascular factors. The grading system relies on the detection of blood in the germinal matrix region and into the ventricular system. Ultrasound scans are the diagnostic method of choice, once it is easy to perform and has low costs. In a prospective study of 146 preterm infants (< 2,200 g), the incidence of GMH in those weighing less than 1,501 g, was 36%. GMH occurred mainly in the first week of life (65%) and in 70% of cases was classified as grade I. Risk factors found to be related to the GMH were: general anesthesia for cesarean section, Apgar score below 4 in the first minute or below 8 in the fifth minute, low birth weight, the presence of respiratory distress, patent ductus arteriosus, anemia, repeated arterial functions and umbilical arterial catheterization. Mean gestational age, systolic and diastolic pressure in the first 24 hours of life and hematocrit were lower in patients with GMH. CONCLUSIONS: GMH is frequent in the preterm infant, and occurs mainly in the first week of life. Ultrasound scans are the method of choice for the diagnosis and follow-up. Risk factors associated were hypoxia and excessive handling.