acenocoumarol and Antiphospholipid-Syndrome

The antiphospholipid syndrome is an antibody mediated hypercoagulable state characterized by recurrent venous and arterial thromboembolic events. Several studies have determined that the frequency of antiphospholipid syndrome in patients presenting with a venous thromboembolic event is between 4% and 14%. Classical criteria include the presence of anticardiolipin antibody or lupus anticoagulant with typical complications of thrombosis or pregnancy loss. Other common associated manifestations include livedo reticularis, thrombocytopenia, valvular heart disease, and nephropathy with renal insufficiency, hypertension and proteinuria. Because of the high risk for recurrent thromboembolism in these patients, current recommendations suggest a longer, potentially lifelong, course of antithrombotic therapy following an initial event. For an initial venous thromboembolic event, a target INR of 2.0 to 3.0 is supported by two prospective, randomized clinical trials. In contrast, relatively limited data exist for an initial arterial thromboembolic event in patients who have the antiphospholipid syndrome, and therapeutic recommendations range from aspirin to warfarin with a high target INR. Recurrent thromboembolic events can be extremely difficult to treat, and some patients may benefit from the addition of immunosuppressive therapies. It is very important to evaluate in this setting additional, coincident prothrombotic risk factors.

Topics: Abortion, Spontaneous; Acenocoumarol; Adult; Antibodies, Anticardiolipin; Anticoagulants; Antiphospholipid Syndrome; Aspirin; Enzyme-Linked Immunosorbent Assay; Female; Fibrinolytic Agents; Heparin; Humans; Lupus Coagulation Inhibitor; Male; Platelet Aggregation Inhibitors; Pregnancy; Prospective Studies; Randomized Controlled Trials as Topic; Recurrence; Risk Factors; Thrombophilia; Thrombosis; Warfarin

The optimal duration of oral anticoagulation in patients with idiopathic venous thromboembolism is uncertain. Testing of D-dimer levels may play a role in the assessment of the need for prolonged anticoagulation.. We performed D-dimer testing 1 month after the discontinuation of anticoagulation in patients with a first unprovoked proximal deep-vein thrombosis or pulmonary embolism who had received a vitamin K antagonist for at least 3 months. Patients with a normal D-dimer level did not resume anticoagulation, whereas those with an abnormal D-dimer level were randomly assigned either to resume or to discontinue treatment. The study outcome was the composite of recurrent venous thromboembolism and major bleeding during an average follow-up of 1.4 years.. The D-dimer assay was abnormal in 223 of 608 patients (36.7%). A total of 18 events occurred among the 120 patients who stopped anticoagulation (15.0%), as compared with 3 events among the 103 patients who resumed anticoagulation (2.9%), for an adjusted hazard ratio of 4.26 (95% confidence interval [CI], 1.23 to 14.6; P=0.02). Thromboembolism recurred in 24 of 385 patients with a normal D-dimer level (6.2%). Among patients who stopped anticoagulation, the adjusted hazard ratio for recurrent thromboembolism among those with an abnormal D-dimer level, as compared with those with a normal D-dimer level, was 2.27 (95% CI, 1.15 to 4.46; P=0.02).. Patients with an abnormal D-dimer level 1 month after the discontinuation of anticoagulation have a significant incidence of recurrent venous thromboembolism, which is reduced by the resumption of anticoagulation. The optimal course of anticoagulation in patients with a normal D-dimer level has not been clearly established. (ClinicalTrials.gov number, NCT00264277 [ClinicalTrials.gov].).

Topics: Acenocoumarol; Adult; Aged; Aged, 80 and over; Anticoagulants; Antiphospholipid Syndrome; Antithrombins; Drug Administration Schedule; Fibrin Fibrinogen Degradation Products; Follow-Up Studies; Hemorrhage; Humans; Middle Aged; Proportional Hazards Models; Prospective Studies; Pulmonary Embolism; Recurrence; Survival Analysis; Ultrasonography; Venous Thrombosis; Vitamin K; Warfarin

Ischemic stroke is a complex multifactorial disorder. Anticoagulation is a growing research area, with the main goal of preventing systemic embolization and stroke. We report the case of a 41-year-old woman with antiphospholipid syndrome who was unsuccessfully treated with Dabigatran, a new oral anticoagulant, as she developed a major stroke involving the right carotid artery, due to deep venous thrombosis with pulmonary embolism. We therefore suggest a closer monitoring of the safety and efficacy of dabigatran. Moreover, in the presence of multifactorial causes of pro-coagulation, we believe that warfarin should remain the mainstay of oral anticoagulation.

Topics: Abortion, Spontaneous; Acenocoumarol; Adult; Antiphospholipid Syndrome; Antithrombins; Carotid Arteries; Computed Tomography Angiography; Dabigatran; Female; Follow-Up Studies; Humans; Product Surveillance, Postmarketing; Pulmonary Embolism; Stroke; Treatment Outcome; Venous Thrombosis; Warfarin

Anti-phospholipid syndrome (APLS) is a condition characterized by the presence of raised plasma levels of anti-phospholipid antibodies associated with thrombo-embolic disease and/or poor obstetrical outcomes in women. The epidemiology of APLS is unknown in most sub-Saharan African countries due to limited access to diagnosis tools. We report the case of APLS in a 29-year-old obese woman that was preceded by pre-eclampsia and fetal death. The diagnosis of APLS was made during a thrombo-embolic episode 4 years after the poor obstetrical outcome. Her management was challenging, as she had three thrombo-embolic events within 18-months despite treatment with anti-coagulant (acenocoumarol).. This case highlights the need for screening for APLS after an episode of hypertensive disease in pregnancy or fetal death, and the challenges faced with the treatment, such as resistance to antivitamin K anti-coagulants and the desire for maternity.

Topics: Acenocoumarol; Adult; Antibodies, Antiphospholipid; Anticoagulants; Antiphospholipid Syndrome; Cameroon; Disease Management; Female; Fetal Death; Fetus; Humans; Obesity; Pre-Eclampsia; Pregnancy; Thromboembolism

Topics: Acenocoumarol; Aged; Antiphospholipid Syndrome; Humans; Lupus Coagulation Inhibitor; Male; Prothrombin Time; Vitamin K

Two patients with systemic lupus erythematosus presented with vision loss, and were diagnosed with retinal vasculopathy. Patient 1 had occlusive vasculitis with macular oedema and retinal ischaemia in the right eye. Corticosteroid therapy was increased and intravenous rituximab added. Intravitreal therapy and panretinal photocoagulation were performed. Patient 2 presented with a left central retinal vein occlusion without vasculitis but was on anticoagulation therapy due to having an antiphospholipid syndrome. Both patients maintained a stable visual acuity.. Occlusive lupus retinal vasculitis has severe visual and systemic consequences (central nervous system vasculitis). It is crucial to differentiate it from standard vascular occlusion syndromes.

Topics: Acenocoumarol; Antibodies, Monoclonal, Murine-Derived; Anticoagulants; Antiphospholipid Syndrome; Cataract; Diagnosis, Differential; Female; Fluorescein Angiography; Humans; Immunosuppressive Agents; Ischemia; Lupus Erythematosus, Systemic; Macular Edema; Middle Aged; Mycophenolic Acid; Prednisone; Retinal Vasculitis; Retinal Vein Occlusion; Rituximab; Tomography, Optical Coherence

Topics: Acenocoumarol; Adrenal Cortex Function Tests; Adrenal Gland Diseases; Adrenal Glands; Adrenal Insufficiency; Adrenocorticotropic Hormone; Anticoagulants; Antiphospholipid Syndrome; Female; Fluorodeoxyglucose F18; Hemorrhage; Hemothorax; Hormone Replacement Therapy; Humans; Middle Aged; Positron-Emission Tomography; Radiopharmaceuticals; Thromboembolism

The aim of the study is to present our own perioperative bridging therapy with low molecular weight heparin (LMWH) for surgical patients with thrombophilia on long-term acenokumarol therapy [oral anticoagulant (OAC)]. In some European countries, the drug used in secondary antithrombotic prophylaxis is acenokumarol. Forty-two patients with inherited thrombophilia and 21 with antiphospholipid syndrome underwent surgery. All patients were on long-term OAC. This OAC was interrupted 2 days before elective surgery and since that day half of the individual therapeutic dose of LMWH was administered. On day of surgery, the LMWH therapeutic dose was divided into two parts. Starting with day 2 after surgery, the patient was again given half of the individual dose of LMWH every 24 h. On day 4, OAC was additionally included. Both drugs were administered until stabilization of international normalized ratio (INR) values within the therapeutic target for 2 consecutive days. LMWH was then interrupted, whereas OAC continued. No symptoms or episodes of venous thromboembolism were observed. No intraoperative or postoperative hemorrhagic complications were reported. The results suggest that our perioperative bridging therapy is safe and effective for prevention of thromboembolic and hemorrhagic complications.

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Antiphospholipid Syndrome; Female; Heparin, Low-Molecular-Weight; Humans; Male; Middle Aged; Postoperative Complications; Thromboembolism

The recommended treatment in patients with primary antiphospholipid syndrome (APS) after a thrombotic event is long-term anticoagulation. However, it is still not exactly known how to manage patients who remain stable for years and whose antiphospholipid antibodies (APA) decrease until becoming negative. This study aims to assess the course of the primary APS in a group of patients after anticoagulation therapy is discontinued.. Ten patients with primary APS who had developed deep venous thrombosis in the limbs (9) or in the aorta (1) were included. After a minimum period of 12 months of anticoagulation therapy, this was discontinued if the patients were negative APA during the follow-up in two consecutive measurements.. Six patients (60%) developed persistent negative APA. Four had transient risk factors (2 pregnant, 1 immobilization, 2 oral contraceptives). No new thrombosis episode was observed after a follow-up period of 21 +/- 4.9 months.. Our data suggest that anticoagulation can be discontinued in those patients with primary APS and persistent negative APA, especially if the thrombotic event was venous and occurred in association with a transient risk factor, such as immobilization or pregnancy. Extensive studies are required to confirm these results.

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Antiphospholipid Syndrome; Female; Heparin, Low-Molecular-Weight; Humans; Male; Middle Aged; Retrospective Studies; Venous Thrombosis

Topics: Acenocoumarol; Adult; Antiphospholipid Syndrome; Calcium; Cardiovascular Diseases; Female; Growth Hormone; Humans; Hyperhomocysteinemia; Hyperparathyroidism; Ischemia; Magnetic Resonance Imaging

We describe the case of a 31-year-old man who presented with an antiphospholipid syndrome (APS), which manifested as multifocal avascular necrosis (AVN) one year after orthotopic liver transplantation. The patient developed multiple AVN affecting hips, left knee, humerus and tarsal bones just after withdrawal of corticosteroid therapy. Three years later when lupus anticoagulant was detected, he began anticoagulant treatment and no further AVN episodes were observed. It is important to be aware of this clinical manifestation of APS, especially in these cases where it can be easily overlooked because of corticosteroid therapy.

Topics: Acenocoumarol; Adrenal Cortex Hormones; Adult; Anticoagulants; Antiphospholipid Syndrome; Femur Head Necrosis; Follow-Up Studies; Hip; Humans; Humerus; Knee; Liver Transplantation; Magnetic Resonance Imaging; Male; Osteonecrosis; Periostitis; Radiography; Tarsal Bones; Tibia; Time Factors; Treatment Outcome

Topics: Acenocoumarol; Antibodies, Anticardiolipin; Anticoagulants; Antiphospholipid Syndrome; Choroid Diseases; Female; Humans; Middle Aged; Visual Acuity

Topics: Acenocoumarol; Acute Disease; Aged; Anticoagulants; Antiphospholipid Syndrome; Budd-Chiari Syndrome; Female; Humans

Topics: Acenocoumarol; Administration, Oral; Adult; Anticoagulants; Antiphospholipid Syndrome; Biological Availability; Cyclooxygenase Inhibitors; Drug Synergism; Female; Humans; International Normalized Ratio; Lactones; Sulfones; Thrombosis

We describe a 26-year-old white female with a history of Raynaud phenomenon, erythema nodosum, polyarthralgias, migraine, vertigo, seizures, transient ischemic attacks, one fetal loss, and false positive VDRL, who developed milk hypertension without overt lupus nephritis. She had positive antinuclear antibodies (ANA) and double-stranded deoxyribonucleic acid (dsDNA) antibodies. The lupus anticoagulant test (LAC) and cardiolipins antibodies (aCL) were positive. She was diagnosed as having a Systemic Lupus Erythematosus-like illness (SLE-like) with 'secondary' antiphospholipid syndrome (APS). Renal spiral computed tomography (CT) with intravenous (IV) contrast showed bilateral renal artery stenosis. Anticoagulation with acenocumarol was started. She became normotensive without antihypertensive drugs five months later. A follow-up renal spiral CT showed complete recanalization of both renal arteries, making thrombosis the more likely culprit pathology in the stenosis. After two years follow up the patient is normotensive. She remains on acenocumarol.

Topics: Acenocoumarol; Adult; Antibodies, Anticardiolipin; Antibodies, Antinuclear; Anticoagulants; Antiphospholipid Syndrome; DNA; Female; Humans; Hypertension; Lupus Coagulation Inhibitor; Raynaud Disease; Renal Artery; Renal Artery Obstruction; Tomography, X-Ray Computed