Epistaxis (Nosebleed)

Researchers are comparing the effects of xylometazoline nasal drops and adrenaline nasal packing on nasal bleeding during nasotracheal intubation in participants undergoing elective oromaxillofacial surgeries. The trial aims to determine which of these two treatments better reduces nasal bleeding during the procedure. This study includes participants aged 18 to 60 years with specific health criteria to ensure safety and accuracy. Participants are randomly assigned to one of two groups. One group receives 0.1% xylometazoline nasal drops, administered as 3 to 5 drops in the selected nostril 15 minutes before surgery. The other group receives adrenaline nasal packing, where a gauze soaked in adrenaline is placed inside the nostril 15 minutes before surgery and removed after 7 to 10 minutes. Both groups undergo nasotracheal intubation under general anesthesia with careful monitoring. Throughout the study, participants will have vital signs monitored, including blood pressure, heart rate, ECG, and oxygen saturation. An experienced anesthesiologist will perform the procedures and record the incidence and severity of nasal bleeding during intubation and extubation. Data will be analyzed to compare bleeding outcomes between groups while considering factors like age, gender, and medical history. Participation lasts through the surgical procedure and immediate recovery monitoring.

This research evaluates the use of oral anticoagulation (OAC) combined with background antiplatelet therapy in patients who develop new-onset post-operative atrial fibrillation (POAF) after isolated coronary artery bypass graft (CABG) surgery. The study aims to assess how effectively this approach prevents thromboembolic events and its safety regarding major bleeding. Patients who decline randomization may join a parallel registry to capture their treatment choices and risk profiles. Participants will be randomly assigned to one of two treatment groups: an experimental arm receiving OAC (either a vitamin K antagonist or a direct oral anticoagulant) along with antiplatelet therapy, or a control arm receiving antiplatelet therapy alone. The anticoagulation treatment lasts 90 days, and patients in the control group who experience recurrent atrial fibrillation after 30 days may switch to OAC. Follow-up includes clinic visits at 90 days and phone calls at 30, 60, and 180 days. A digital health substudy involving a wearable heart monitor for 30 days post-discharge is also offered to some participants. During the study, researchers will monitor outcomes such as death, stroke, transient ischemic attack, myocardial infarction, and thromboembolism up to 180 days after randomization, along with bleeding events at 90 days. Data collection includes medical record reviews, risk profiling, and use of anticoagulants and antiplatelets. Safety and effectiveness will be analyzed by comparing the two treatment strategies. Participation may last up to six months, with assessments conducted in person and by phone.

Heart failure is a global health issue, and left ventricular assist devices (LVADs) like the HeartMate 3 are increasingly used to improve survival for patients with advanced heart failure. Despite advances, complications related to blood compatibility, such as clotting and bleeding, remain serious concerns. This trial investigates the safety and effectiveness of using an antithrombotic regimen without aspirin in patients supported by the HeartMate 3 LVAD, building on previous findings that avoiding aspirin may reduce bleeding without increasing clotting risks. The study is a prospective, randomized, controlled trial comparing two treatment groups of advanced heart failure patients who have been supported by the HeartMate 3 LVAD for more than three months. One group will receive warfarin alone, with doses adjusted to maintain a specific blood clotting goal, while the other group will receive warfarin combined with aspirin, which is the current standard of care. Participants will be randomly assigned to one of these two antithrombotic regimens and followed over time to assess outcomes. Participants will be monitored for one year after randomization, with researchers tracking survival free from major hemocompatibility-related events like stroke, pump thrombosis, and significant bleeding. Secondary outcomes such as rates of bleeding, clotting, stroke, rehospitalization, and economic impact will also be evaluated. The study aims to enroll up to 128 patients to ensure sufficient power and includes regular follow-ups to assess safety, treatment adherence, and clinical events.

Researchers are investigating how changes in atmospheric pressure may affect epistaxis, or nosebleeds, and whether these changes influence the causes of epistaxis. The study also aims to see if treatment adjustments based on weather forecasts can help prevent hypertensive emergencies and improve comfort for patients with high blood pressure. This observational study involves no risk to participants and is clinical in nature. The study will take place over six months at the Emergency Department of Ankara Etlik City Hospital. It focuses on patients who come to the emergency department with epistaxis, whether the bleeding is active or has resolved. After arriving, patients will receive routine emergency care including physical exams, vital sign checks, and blood tests such as coagulation and hemoglobin levels. No extra invasive or non-invasive procedures will be performed beyond standard care. Participants will provide data which will be combined with daily atmospheric pressure readings for analysis. The study team will monitor patients during their emergency visit and collect information on epistaxis occurrences within 24 hours. The research aims to better understand the link between weather changes and nosebleeds, potentially guiding future care for patients with related conditions.

Researchers are evaluating the use of a direct oral anticoagulant (DOAC) called apixaban compared to no anticoagulant in patients undergoing abdominal or pelvic surgery. This international, multicenter, randomized controlled trial focuses on patients with a moderate risk of venous thromboembolism (VTE) and bleeding where the benefits and harms of thromboprophylaxis are unclear. The study aims to clarify whether apixaban provides a net benefit or if avoiding anticoagulation is preferable in this population. The trial enrolls 5,436 patients who will be randomly assigned to receive either apixaban 2.5 mg orally twice daily for 28 days alongside standard mechanical prevention or no anticoagulant with standard mechanical prevention alone. Mechanical prophylaxis is provided as standard care in both groups. The study is open-label and compares the outcomes of using apixaban versus no anticoagulation after surgery. Participants will be monitored for 90 days to assess the incidence of VTE, including deep vein thrombosis and pulmonary embolism. Researchers will collect data on symptomatic events and major bleeding. Follow-up visits and assessments will track safety and effectiveness outcomes. The study’s results will help guide decisions about thromboprophylaxis after abdominal and pelvic surgeries in patients at moderate risk.

Researchers are evaluating the use of prophylactic preoperative tranexamic acid (TXA) and desmopressin in patients with advanced kidney disease undergoing noncardiac surgery. This pilot study aims to assess the feasibility and design of a larger trial, provide preliminary safety and efficacy data, and gather pharmacokinetic information to help select appropriate dosages. The study addresses a gap since patients with severe kidney disease have been excluded from large trials despite bleeding risks during surgery. Participants will be randomly assigned to receive intravenous TXA, desmopressin, both, or placebos shortly before surgery. TXA dosing varies based on kidney function and dialysis status, with either 1000 mg or 500 mg infused over 10 minutes. Desmopressin is given as a 20 mcg infusion over 30 minutes. Placebo infusions use saline solutions matching the timing and volume of the active drugs. Treatment is administered within 20 minutes before the skin incision. During the study, researchers will monitor recruitment rates, drug administration timing, and conduct a 30-day follow-up after surgery. They will assess bleeding outcomes, blood transfusions, surgical complications, cardiovascular events, kidney function changes, and other safety measures. The total observation period includes the day of surgery and 30 days afterward, tracking hospital stay duration and postoperative recovery indicators to evaluate the interventions' impact comprehensively.

Endoscopic sinus surgery (ESS) is a common otolaryngologic procedure that aims to remove the partitions that separate the sinus cavities, remove inflamed tissue, and optimize the sinuses for topical medication use. In this procedure, the surgeon will inject a combination of drugs, local anesthetics, and vasoconstrictors, to reduce bleeding and improve visualization. However, previous studies have shown similar results when injected with only saline. In this study, investigators want to determine if the injection of local anesthesic+vasoconstrictor compared to no injection at all makes any difference in improving the surgeon's visualization during an ESS.

This research focuses on patients with acute cerebral arteriovenous malformation (AVM) bleeding, a leading cause of brain hemorrhage in young adults characterized by sudden onset and rapid progression. The study evaluates the use of a hybrid neurosurgical operating room that combines neurointervention and microneurosurgery to improve emergency treatment for cerebral AVM-related hemorrhage. Through a multicenter, prospective, registry-based approach, the study aims to establish standardized protocols and workflows for this emergency treatment. Participants admitted to the hybrid operating room first undergo emergency cerebral angiography to confirm diagnosis. If suitable for surgery, they receive one-stop composite surgery, which may include neurointerventional embolization, microsurgical removal of the vascular malformation, or minimally invasive hematoma evacuation. The treatment plan is tailored during surgery based on the characteristics of the malformation, and intraoperative ultrasound helps locate the lesion and assess removal completeness. Head digital subtraction angiography (DSA) is reviewed immediately after surgery to confirm treatment success or determine further intervention. Participants are monitored with neurological outcome assessments at 2 weeks, 3 months, and 6 months after surgery. Surgical information and any complications are collected before, during, and shortly after surgery, as well as during follow-up visits. The study aims to improve patient outcomes while reducing medical costs and societal burdens by continuously enhancing the quality of emergency AVM hemorrhage management using the hybrid neurosurgical platform. The total study duration includes these follow-up periods to comprehensively evaluate treatment impact.

Researchers are investigating the best approach to treat low-risk patients with isolated subsegmental pulmonary embolism (SSPE), a type of blood clot in small lung arteries. The study aims to determine whether monitoring patients without anticoagulation is as safe and effective as giving anticoagulant medication. This is important because many patients currently receive anticoagulants that carry a risk of bleeding, but it is unclear if all patients with isolated SSPE need this treatment. Patients in the trial are randomly assigned to one of two groups. One group receives the anticoagulant drug rivaroxaban, starting with 15 mg twice daily for 21 days, then 20 mg once daily for a total of 90 days. The other group receives a placebo matching the same schedule. The trial compares clinical surveillance without anticoagulation to anticoagulation treatment to assess safety and effectiveness. Participants will be followed for 90 days after randomization to monitor for recurrent venous thromboembolism, significant bleeding events, and overall survival. Researchers will track these outcomes through clinical assessments and safety monitoring. This study is designed to evaluate if careful monitoring alone is a safe alternative to anticoagulation in selected patients with isolated SSPE, potentially reducing bleeding risks from treatment.

Researchers are evaluating different anticoagulation methods for patients requiring extracorporeal membrane oxygenation (ECMO) support due to respiratory or circulatory failure. This phase IV, randomized controlled pilot study compares the standard treatment using unfractionated heparin with two alternatives: argatroban and enoxaparin. The goal is to determine if enoxaparin or argatroban are not worse than unfractionated heparin in preventing blood clots during ECMO therapy. Participants will be randomly assigned to one of three groups receiving anticoagulation during ECMO: subcutaneous enoxaparin given twice daily at 0.5 mg/kg, continuous intravenous argatroban infusion adjusted to target specific thrombin time levels, or continuous intravenous unfractionated heparin infusion adjusted to target anti-FXa levels. Anticoagulation treatment continues for the duration of ECMO support, which typically averages about 14 days. During the study, researchers will monitor participants for the occurrence of blood clots and bleeding events throughout their ECMO run. Assessments include regular measurements of clotting parameters to adjust medication doses appropriately. The primary outcome is the incidence of thromboembolic events during ECMO therapy. Participation involves close medical observation until ECMO support ends, with safety and treatment effectiveness closely tracked by the medical team.