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 aims to assess the effectiveness and safety of adding oral anticoagulation OAC to background antiplatelet therapy in patients who develop new-onset post-operative atrial fibrillation POAF after isolated coronary artery bypass graft CABG surgery. The study is a prospective, multicenter, open-label, randomized trial comparing OAC with no OAC to evaluate the prevention of thromboembolic events and the risk of major bleeding. Participants are randomly assigned to either an OAC-based strategy using vitamin K antagonists or approved direct oral anticoagulants alongside antiplatelet therapy, or to an antiplatelet-only strategy. The anticoagulation treatment lasts for 90 days, with option for crossover to OAC if recurrent atrial fibrillation occurs after 30 days in the control group. Up to 500 patients may also participate in a digital health substudy using a wearable heart rhythm monitor for 30 days post-discharge. During the study, participants have follow-up visits at 30, 60, 90, and 180 days after randomization, including phone contacts and clinical assessments. Researchers will monitor outcomes such as death, stroke, transient ischemic attacks, myocardial infarction, thromboembolism, and bleeding events up to 180 days. Data from patients who decline randomization are collected in a parallel registry to compare baseline risk and treatment strategies.

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 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 studys 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 procedure to clear sinus cavities, remove inflamed tissue, and enhance sinus medication use. This trial evaluates whether injecting a combination of local anesthetic and vasoconstrictor during ESS improves the surgeons view compared to no injection. Previous studies indicated saline injections may have similar effects, so this study aims to clarify the benefit of the drug combination during surgery. Participants are randomly assigned to one of two groups one receives an injection of 0.25% bupivacaine with epinephrine, and the other undergoes a sham injection involving only a puncture without medication. The trial is double-blinded, so neither participants nor surgeons know which procedure is given. The study takes place during the one-day surgery visit. During the procedure, researchers assess bleeding using the Boezzart bleeding score along with total blood loss, surgical time, blood pressure, postoperative bleeding, and pain. These measures are recorded throughout the surgery day. The study aims to enroll adults aged 19 and older scheduled for primary ESS, with follow-up focused on surgical conditions and recovery outcomes.

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 mgkg, 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.

Researchers are conducting the Comprehensive HHT Outcomes Registry of the United States CHORUS, an observational study focusing on Hereditary Hemorrhagic Telangiectasia HHT, a rare genetic condition causing abnormal blood vessels in various organs. The study aims to better understand HHT, its symptoms, complications, and how it affects peoples lives. By collecting detailed information over time, the study hopes to improve knowledge of the disease and assist in developing new treatments. Participants diagnosed with HHT based on specific criteria or genetic testing will be included in the registry. The study will collect long-term data both retrospectively and prospectively from about 10,000 patients across multiple centers in the U.S. Over up to 10 years, participants will provide information through medical records and yearly questionnaires, helping researchers track changes in health, treatments, and symptoms. During participation, individuals will allow access to their medical records and answer study questions at enrollment and annually for up to 10 years or until the study ends. The data collected includes demographic details, diagnosis, family history, test results, symptoms, and treatments. The main outcomes measured over 10 years include baseline health status and clinical outcomes using specific assessment scales. The study also monitors severity of nosebleeds, development of vascular malformations, treatment results, and serious health events related to HHT.