acenocoumarol and Blood-Coagulation-Disorders

We describe a 57-year-old woman with homozygous protein C deficiency and mild thrombotic manifestations consisting of three spontaneous distal deep vein thromboses occurring after the age of 45. Previous surgery and pregnancies had been uneventful. Low but detectable protein C antigen and activity levels (both 20%) were discovered on the occasion of skin necrosis induced by oral anticoagulation. This therapy was interrupted because of skin necrosis and several episodes of disseminated intravascular coagulation (DIC) at the initiation of treatment despite a cautious protocol. No recurrent thromboembolic event has occurred in our patient using prophylactic doses of low molecular weight heparin for 24 months. New therapeutic approaches might be the administration of low molecular weight heparin or oral anticoagulation associated with protein C replacement in the induction period. This case reflects the variability of expression of protein C deficiency as well as the potential hazards of antivitamin K anticoagulation in this disorder.

Topics: Acenocoumarol; Administration, Oral; Age Factors; Blood Coagulation Disorders; Contraindications; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Female; Genetic Predisposition to Disease; Heparin; Homozygote; Humans; Middle Aged; Necrosis; Protein C Deficiency; Skin; Skin Diseases; Thrombophlebitis; Warfarin

The plasma concentration of heparin cofactor II was measured by "rocket" immunoelectrophoresis in healthy volunteers, patients taking Syncumar and thrombophiliacs. The values in healthy volunteers averaged 99% (+/- 16.5). In the group of Syncumar treated patients 100% (+/- 10.5) was measured. This did not differ from the control group. The average of heparin cofactor II level in thrombophiliacs was 92.5% (+/- 23). In this group three patients had low heparin cofactor II levels. In one case this was due to intestinal protein loss. In the two other cases the role of heparin cofactor II is uncertain in the pathogenesis of thrombophilia.

Topics: Acenocoumarol; Adult; Antithrombin III; Blood Coagulation Disorders; Evaluation Studies as Topic; Female; Humans; Immunoelectrophoresis; Male; Thrombophlebitis; Thrombosis

Topics: Acenocoumarol; Blood Coagulation Disorders; Blood Coagulation Tests; Humans; Methods; Prothrombin Time

The objective of this study was to investigate the impact of CYP2C9 polymorphisms and drug-drug interactions on the risk of overanticoagulation in patients treated with acenocoumarol, a vitamin K antagonist.. A prospective observational study was performed on patients starting acenocoumarol (n = 115). CYP2C9 genotypes were assessed. Data on International Normalized Ratio, comedications and doses of acenocoumarol were collected during the first 35 days of therapy. Overanticoagulation was defined as the occurrence of at least one International Normalized Ratio ≥4.. The presence of a CYP2C9 inhibitor or a CYP2C9 polymorphisms statistically increased the risk of overanticoagulation (hazard ratio [HR]: 2.8, p < 0.001 and HR: 1.7, p = 0.04, respectively). The presence of CYP2C9 polymorphisms almost tripled the risk of overanticoagulation (HR: 2.91, p = 0.01) in the presence of a clinically significant drug-drug interaction.. These findings support the fact that CYP2C9 genotyping could be useful to identify patients requiring closer monitoring, especially when a drug-drug interaction is expected.

Topics: Acenocoumarol; Anticoagulants; Aryl Hydrocarbon Hydroxylases; Blood Coagulation; Blood Coagulation Disorders; Cytochrome P-450 CYP2C9; Drug Interactions; Female; Genotype; Humans; International Normalized Ratio; Male; Middle Aged; Polymorphism, Genetic; Prospective Studies

Low dose oral vitamin K rapidly reverses warfarin-associated coagulopathy. Its effect in patients receiving acenocoumarol is uncertain. We compared the effect of withholding acenocoumarol and administering 1 mg oral vitamin K with simply withholding acenocoumarol in asymptomatic patients presenting with INR values between 4.5 and 10.0. The primary end-point of the study was the INR value on the day following randomisation. We found that patients receiving oral vitamin K had more sub-therapeutic INR levels than controls (36.6% and 13.3%, respectively; RR 1.83, 95% confidence interval 1.16, 2.89) and a lower, but non-significant, proportion of INR values in range (50% and 66.6%, respectively) on the day following randomisation. After 5 +/- 1 days, there were more patients with an INR value in range in the vitamin K group than in controls (74.1% and 44.8%, respectively). There were no clinical events during 1 month follow-up. We conclude that the omission of a single dose of acenocoumarol is associated with an effective reduction of the INR in asymptomatic patients presenting with an INR value of 4.5 to 10.0. Furthermore, the use of a 1 mg dose of oral vitamin K results in an excessive risk of over-reversal of the INR.

Topics: Acenocoumarol; Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Antifibrinolytic Agents; Blood Coagulation Disorders; Chi-Square Distribution; Drug Antagonism; Female; Humans; International Normalized Ratio; Male; Middle Aged; Vitamin K

The risk of hemorrhage when coumarin anticoagulants are used sharply increases when the international normalized ratio (INR) is > or = 6.0. Such overanticoagulation may be caused by drug interactions. We performed a case-control study among previously stable outpatients of an anticoagulation clinic using phenprocoumon or acenocoumarol to identify changes in the use of potentially interacting drugs related to overanticoagulation.. Three hundred case patients with INR values > or = 6.0 were compared with 302 randomly selected matched control subjects with INR values within the target zone. Information on changes in the use of 87 potentially interacting drugs in the 4 weeks before the index day was collected by interviewing patients and by reviewing the anticoagulant medical record.. Forty-five potentially interacting drugs were not used in the 4-week study period, and only 15 drugs were used by at least 10 patients. For a number of drugs, too few patients had a relevant change in use to judge their association with overanticoagulation. A course of a combination product of sulfamethoxazole and trimethoprim strongly increased the risk of overanticoagulation (adjusted odds ratio, 24.2; 95% confidence interval [CI], 2.8 to 209.1; population attributable risk percentage [PAR%], 5.7%), especially in patients receiving acenocoumarol. Penicillins were associated with a risk of overanticoagulation of 2.4 (95% CI, 1.00 to 5.5); the corresponding PAR% was 3.4%. The effect was confined to amoxicillin (INN, amoxicilline) plus clavulanic acid.. Drug interactions as a cause of overanticoagulation predominantly concerned antibacterial drugs. If possible, the use of sulfamethoxazole-trimethoprim and amoxicillin plus clavulanic acid should be avoided in patients receiving coumarins. If there is no therapeutic alternative available, increased monitoring of INR values is warranted to prevent overanticoagulation and potential bleeding complications.

Topics: Acenocoumarol; Aged; Anti-Infective Agents; Anticoagulants; Blood Coagulation Disorders; Case-Control Studies; Cohort Studies; Drug Interactions; Female; Hemorrhage; Humans; Male; Middle Aged; Phenprocoumon; Risk Factors

Acute intoxication with a vitamin K antagonist may cause serious coagulopathy. We report the accidental ingestion of a high dose of acenocoumarol in a young child. Two intravenous administrations of 5 mg of vitamin K, in combination with fast and repeated administration of activated charcoal and sodium sulfate, were sufficient to prevent coagulopathy and related symptoms, despite a confirmed elevated blood acenocoumarol concentration (260 µg/L).

Topics: Acenocoumarol; Anticoagulants; Blood Coagulation Disorders; Child; Eating; Humans; Vitamin K

To analyze VKORC1, CYP2C9 and CYP4F2 polymorphisms in relation to the main outcomes in the first stages of acenocoumarol therapy.. Nine hundred and forty one patients who had started therapy and in whom time to stable dosage, time to over-anticoagulation and adverse events occurred during 3 first months were retrospectively analyzed.. VKORC1 AA patients needed fewer days to reach stable dosage (p = 0.017). International normalized ratio [INR] at 72 h, and VKORC1 and CYP2C9 genotypes conditioned INR values >2.5 (p < 0.001, p = 0.002 and p < 0.001, respectively), whereas CYP4F2 T carriers had a low risk of the same outcome (p = 0.009). In regards to combined genotypes, CYP4F2 had a significant effect on over-anticoagulation at the beginning of therapy except for the VKORC1 AA and CYP2C9*3 combination.. In addition to VKORC1 and CYP2C9, CYP4F2 gene has a slight but significant role in reaching INR >2.5 during the first weeks of acenocoumarol therapy.

Topics: Acenocoumarol; Adult; Aged; Biomarkers, Pharmacological; Blood Coagulation Disorders; Cytochrome P-450 CYP2C9; Cytochrome P-450 Enzyme System; Cytochrome P450 Family 4; Female; Genotype; Humans; International Normalized Ratio; Male; Middle Aged; Polymorphism, Single Nucleotide; Treatment Outcome; Vitamin K Epoxide Reductases

Topics: Acenocoumarol; Algorithms; Anticoagulants; Blood Coagulation Disorders; Cross-Sectional Studies; Cytochrome P-450 CYP3A; Cytochrome P-450 Enzyme System; Cytochrome P450 Family 4; Drug Administration Schedule; Genotype; Humans; Pharmacogenetics; Phenprocoumon; Polymorphism, Single Nucleotide; Vascular Diseases

To develop a population specific pharmacogenetic acenocoumarol dosing algorithm for north Indian patients and show its efficiency in dosage prediction.. Multiple and linear stepwise regression analyses were used to include age, sex, height, weight, body surface area, smoking status, VKORC1 -1639 G>A, CYP4F2 1347 G>A, CYP2C9*2,*3 and GGCX 12970 C>G polymorphisms as variables to generate dosing algorithms. The new dosing models were compared with already reported algorithms and also with the clinical data for various performance measures. Odds ratios for association of genotypes with drug sensitive and resistant groups were calculated.. The pharmacogenetic dosing algorithm generated by multiple regression analysis explains 41.4% (p-value <0.001) of dosage variation. Validation of the new algorithm showed its predictive ability to be better than the already established algorithms based on similar variables. Its validity in our population is reflected by increased sensitivity, specificity, accuracy and decreased rates of over- and under-estimation in comparison to clinical data. The VKORC1-1639 G>A polymorphism was found to be strongly associated with acenocoumarol sensitivity according to recessive model.. We have proposed an efficient north India specific pharmacogenetic acenocoumarol dosing algorithm which might become a baseline for personalised medicine approach for treatment of patients in future.

Topics: Acenocoumarol; Adult; Algorithms; Anticoagulants; Asian People; Blood Coagulation Disorders; Dose-Response Relationship, Drug; Female; Genotype; Humans; India; Male; Middle Aged; Pharmacogenetics; Polymorphism, Single Nucleotide; Reproducibility of Results

In the Netherlands, several reports have described a potentiation of acenocoumarol-induced anticoagulation by co-medication of omeprazole or esomeprazole and competitive inhibition of CYP2C19 has been suggested as a possible mechanism for this interaction. We conducted an observational cohort study to investigate the effects of various proton pump inhibitors (PPIs) on acenocoumarol effectiveness. All 2755 subjects from the Rotterdam Study who received acenocoumarol maintenance treatment between April 1st, 1991 and September 9th, 2009 were followed for events of an international normalized ratio (INR)≥6, until death, end of treatment, or end of the study period. The Andersen-Gill extension of the Cox proportional hazards model was used to calculate risks for repeated events of overanticoagulation in relation to concomitant PPI use. The risk for overanticoagulation was most pronounced for esomeprazole (HR 1·99, 95% CI 1·55-2·55) and lansoprazole (HR 1·49, 95% CI 1·05-2·10). There was also a lower and non-significant risk increase for the other PPIs. We did not detect a modification of these results by CYP2C19*2 genotype. Caution should be paid to co-medication with esomeprazole and lansoprazole during acenocoumarol treatment and possibly also with other PPIs.

Topics: Acenocoumarol; Age Distribution; Aged; Aged, 80 and over; Anticoagulants; Aryl Hydrocarbon Hydroxylases; Blood Coagulation; Blood Coagulation Disorders; Cytochrome P-450 CYP2C19; Drug Synergism; Female; Genotype; Humans; International Normalized Ratio; Male; Middle Aged; Prospective Studies; Proton Pump Inhibitors; Risk Assessment

Bleeding is the most serious complication of oral anticoagulant therapy used for the prevention of thromboembolic complications. Drug-drug interactions are an important concern, as they may increase drug toxicity and, in the case of anticoagulant therapies, increase the risk of hemorrhage.. An 84-year-old woman presented to the emergency department with a bilateral cervical hematoma and symptoms of upper-airway obstruction that had been increasing for 72 hours, with dyspnea and difficulty speaking developing in the previous 24 hours. Transnasal fiberoptic laryngoscopy revealed a significant laryngeal hematoma, as well as a hematoma on the floor of the mouth and in the tonsil area. Laboratory abnormalities included a prothrombin time < 10%, an international normalized ratio exceeding the laboratory limits, and an activated partial thromboplastin time >120 seconds. The patient had been receiving acenocoumarol 4 mg/d for 10 years for episodes of atrial fibrillation and recurrent deep venous thrombosis. Seventeen days earlier, she had received a prescription for topical econazole lotion 1% to be applied 3 times daily for 1 month to treat a dermatitis affecting 12% of the body surface. The patient was admitted to the intensive care unit for treatment of respiratory failure, where oxygen was delivered by face mask. The coagulation disorders were treated with prothrombin complex concentrate 30 IU/kg IV and vitamin K1 10 mg IV, and values normalized within 36 hours. Surgical evacuation of the laryngeal hematoma was not necessary. After 48 hours, improvement in the patient's respiratory symptoms allowed transfer to the ear, nose, and throat unit, where daily endoscopic examination was performed. Aspirin was substituted for acenocoumarol, and the patient returned home after 10 days without sequelae. Based on a Naranjo score of 7, this episode was probably related to an interaction between acenocoumarol and econazole.. This report describes a case of a probable interaction between topical econazole lotion 1% and acenocoumarol that resulted in overanticoagulation and a life-threatening laryngeal hematoma in this elderly patient.

Topics: Acenocoumarol; Administration, Topical; Aged, 80 and over; Anticoagulants; Antifungal Agents; Aspirin; Blood Coagulation Disorders; Drug Interactions; Dyspnea; Econazole; Female; Hematoma; Humans; Laryngeal Diseases; Laryngoscopy; Platelet Aggregation Inhibitors; Prothrombin

Topics: Acenocoumarol; Anticoagulants; Aryl Hydrocarbon Hydroxylases; Blood Coagulation Disorders; Cost-Benefit Analysis; Cytochrome P-450 CYP2C9; Genotype; Humans; International Normalized Ratio; Models, Statistical; Netherlands

Our objective was to assess whether there is an association between the presence of allelic variants of the gene for cytochrome P450 (CYP) 2C9 and anticoagulation problems during the initial 3 to 6 months of acenocoumarol treatment.. A prospective follow-up study was performed at 2 anticoagulation clinics in the Netherlands. Included subjects started with a standard dose regimen as follows: 6 mg on the first day, 4 mg on the second day, and 2 mg on the third day. CYP2C9 genotypes were assessed, and data on international normalized ratio (INR), comedication, and comorbidity were collected.. The CYP2C9 genotype of 231 subjects was assessed. Of these, 147 (63.6%) were wild-type subjects (CYP2C9*1/*1), 38 (16.5%) were carriers of CYP2C9*2, and 46 (19.9%) were carriers of CYP2C9*3. Compared with wild-type subjects, carriers of the CYP2C9*3 allele had (1) a lower chance to achieve stability in the first 6 months of therapy (hazard ratio, 0.62; 95% confidence interval, 0.42-0.91; P <.05) and (2) an increased risk of severe overanticoagulation (INR >6.0) (hazard ratio, 3.80; 95% confidence interval, 1.54-9.39; P <.01). For both outcomes, there was no significant difference between carriers of the CYP2C9*2 allele and wild-type subjects.. In carriers of the CYP2C9*3 allele more difficulties in terms of stabilization and overanticoagulation were found as compared with wild-type subjects or CYP2C9*2 carriers. CYP2C9 genotyping could be useful to identify potential candidates for more frequent INR controls to minimize problems with acenocoumarol anticoagulation status.

Topics: Acenocoumarol; Aged; Aged, 80 and over; Alleles; Anticoagulants; Aryl Hydrocarbon Hydroxylases; Blood Coagulation Disorders; Cytochrome P-450 CYP2C9; DNA Primers; Drug Administration Schedule; Female; Follow-Up Studies; Genotype; Humans; International Normalized Ratio; Male; Middle Aged; Netherlands; Polymerase Chain Reaction; Prospective Studies

We report the case of a young healthy woman who presented an early overanticoagulation when receiving acenocoumarol for a first thromboembolic episode. The patient had none of the risk factors known to influence the response to the coumarinic derivative except that she carried the rare *3 allelic variant of the cytochrome P450 CYP2C9 in a homozygous status. This case illustrates the role of the *3 polymorphism of the cytochrome P450 CYP2C9 as an independent risk factor modulating the sensitivity of patients to the anticoagulant effect of acenocoumarol. The usefulness of CYP2C9 genotyping before starting coumarinic treatments is discussed.

Topics: Acenocoumarol; Adult; Anticoagulants; Aryl Hydrocarbon Hydroxylases; Blood Coagulation Disorders; Cytochrome P-450 CYP2C9; Female; Genotype; Humans; Polymorphism, Genetic; Risk Factors; Thrombosis

Cytochrome P450 2C9 (CYP2C9) is the enzyme that terminates the anticoagulant effect of warfarin. The heterozygous carriers of the two allelic variants CYP2C9*2 and CYP2C9*3 have been associated with impaired warfarin metabolism and a higher risk of haemorrhage. Only three CYP2C9 poor metabolizers (CYP2C9*3/CYP2C9*3) initiating warfarin treatment have so far been identified, all of them with a dramatic overdose occurring a few days after treatment initiation. Acenocoumarol, another coumarinic anticoagulant, has recently been shown to be metabolized by CYP2C9. We report, for the first time, two cases of dramatic overanticoagulation occurring in patients starting acenocoumarol treatment while taking recommended doses (4 mg/day). In both cases, the overdose was discovered at the first INR control with values above 9. Genotyping revealed that the two patients were homozygous for the CYP2C9*3 allele. Our report highlights the need for CYP2C9 genotyping before starting oral anticoagulants in order to prevent early overanticoagulation episodes.

Topics: Acenocoumarol; Adolescent; Aged; Aged, 80 and over; Anticoagulants; Aryl Hydrocarbon Hydroxylases; Blood Coagulation Disorders; Cytochrome P-450 CYP2C9; Cytochrome P-450 Enzyme System; Female; Humans; International Normalized Ratio; Mutation; Steroid 16-alpha-Hydroxylase; Steroid Hydroxylases

Authors study the risk diseases in dental practice. They analyze the possible complications and the methods of their prevention in each risk group. They take deal with the importance of antibiotic prophylaxis, the problems of local anaesthesia and the management of patients who suffer from coagulation disturbances. They present the management of risk patients in two cases. They emphasize the importance of anamnestic history in every case before dental treatment.

Topics: Acenocoumarol; Adult; Anti-Bacterial Agents; Anticoagulants; Blood Coagulation Disorders; Blood Loss, Surgical; Dental Care; Female; Heparin, Low-Molecular-Weight; Humans; Male; Middle Aged; Nadroparin; Postoperative Complications; Risk Factors; Tooth Extraction; Venous Thrombosis; Vestibuloplasty

Topics: Acenocoumarol; Adult; Anticoagulants; Blood Coagulation Disorders; Cardiovascular System; Drug Overdose; Female; Headache; Humans; Male; Middle Aged; Urticaria; Vitamin E

To check out the reproducibility and costs of prothrombin time (PT) determination as a control of oral anticoagulant therapy (OAT) in plasma and capillary blood.. The study was carried out in two phases: along two years, 1,700 patients with OAT were controlled, 700 of them in the hospital outpatient clinic. In 149 patients INR was simultaneously determined in both capillary and venous blood. The 700 patients receiving acenocoumarin who had been controlled in 1991 according to the conventional plasma-sample fashion, were controlled in the second year (i.e., 1992) by means of capillary blood testing, a comparison of the costs of each method and the need for anticoagulant drugs being undertaken. Venous blood PT was assessed with reagent thromboplastin (Tromborel S) in an Electra-1000 (MLA) system. An automated Trombotrack system was used for the capillary blood tests using Thrombotest as current procedure. The results were expressed as INR in both methods. The statistical evaluation of the results was carried out by means of Student's t, variance analysis, and correlation study.. No significant differences were found in the anticoagulation intervals attained from venous or capillary blood samples. No significant differences were seen in 87 patients on whom the test was repeated in two samples drawn from a single capillary puncture. The weekly OAT doses of 30 patients along six months were analysed. The need for anticoagulant drugs was similar (17.4 vs 17.2 mg/patient/week). The mean INR in 1991 was 2.82 and the mean drug-need was 15.24 mg/week, whereas in 1992 the mean INR was 2.86 and the need for anticoagulant was 15.49 mg/week. The costs of the conventional method were 103.6 Pta, this being 70 Pta for capillary blood, which means a 32% savings.. OAT control by means of PT performed on capillary blood must be considered a substitutive method for the venous blood assay due to its efficacy, simplicity and lower costs.

Topics: Acenocoumarol; Administration, Oral; Blood Coagulation; Blood Coagulation Disorders; Blood Specimen Collection; Capillaries; Costs and Cost Analysis; Humans; Prothrombin Time; Reference Standards; Reproducibility of Results; Thromboplastin; Veins

A 62-year-old male patient, suffering from a hypertensive cardiopathy, an arteriopathy of the lower extremities and a type II insulin independent diabetes had a prothrombin time ratio R of 2.15 (therapeutic range: 2.1-1.45) during a daily treatment of 4-6 mg acenocoumarin. On admission to the psychiatric hospital for depression, a mianserin treatment was commenced, leading to a sharp modification in the PT ratio R, in effect that the acenocoumarin treatment had to be increased to keep R within the therapeutic range. The possible mechanism of this interaction between mianserin and acenocoumarin is discussed, taking into account the possible role of the comedicated amiodarone.

Topics: Acenocoumarol; Amiodarone; Blood Coagulation Disorders; Depressive Disorder; Drug Interactions; Humans; Male; Mianserin; Middle Aged; Prothrombin Time

Topics: Acenocoumarol; Blood Coagulation Disorders; Carnitine; Drug Synergism; Female; Humans; Middle Aged

Topics: Acenocoumarol; Blood Coagulation Disorders; Drug Interactions; Gastrointestinal Hemorrhage; Hernia, Hiatal; Humans; Male; Middle Aged; Piroxicam

This case report concerns a child admitted to the County Hospital of Zalaegerszeg with the symptoms of ataxia, focal convulsions and hemiparesis. Anticonvulsive therapy abolished the epileptic manifestations, but hemiparesis remained unchanged. At the age of six and half years progressive venous thrombosis developed first on the left and some days later on the right lower limb. Phlebography revealed on both sides thrombosis of the vena iliaca which led to stenosis of the right femoral vein and dilated venous collaterals on the abdomen and right thigh. Coeliacography showed an enlarged spleen and varicosity around the portal vein. Later thrombosis of the arteria dorsalis pedis developed indicated by the gangrene the fifth toe. At this stage the child was transfered to the Pediatric Department of the University of Pécs for further evaluation. Examination of the hemostasis showed hypercoagulability due to antithrombin III deficiency pointing towards a common cause, namely thromboembolism of the earlier and recent clinical manifestations. A reduced activity of the antithrombin III was also observed in the mother and two sisters of the child. The response to Syncumar therapy was beneficial, arterial thrombosis regressed and no further thromboembolic complications developed.

Topics: Acenocoumarol; Antithrombin III Deficiency; Ataxia; Blood Coagulation Disorders; Child; Epilepsies, Partial; Female; Hemiplegia; Humans; Radiography; Roma; Thrombophlebitis; Thrombosis

Topics: Acenocoumarol; Blood Coagulation Disorders; Diet, Reducing; Female; Humans; Middle Aged; Vitamin K

Topics: Acenocoumarol; Aged; Amiodarone; Blood Coagulation Disorders; Drug Combinations; Drug Synergism; Female; Hemorrhage; Humans; Male; Middle Aged

Topics: Acenocoumarol; Adult; Aged; Blood Coagulation Disorders; Drug Evaluation; Female; Humans; Middle Aged

Thrombotest clotting times of mixtures of coumarin plasmas and normal plasma yielded a patterm similar to that observed in mixtures of plasma with congenital coagulation disorders and normal plasma. The presence of 10 or 20% of test plasma in the mixture failed to affect the clotting times which resulted in normal limits. The only exception to this rule was the hemophilia BM plasma. In this case even the presence of 10-20% of patient plasma in the mixture caused a prolongation of the clotting time. This indicates that no inhibitor is present in coumarin plasmas and in the plasma of congenital coagulation disorders of the prothrombin complex save for hemophilia BM plasma which does contain an inhibitor.

Topics: Acenocoumarol; Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Tests; Female; Hemophilia B; Humans; Male; Prothrombin; Thromboplastin; Warfarin

A Normotest (NT)-Thrombotest (TT) discrepancy is claimed to reflect the presence of coumarin-induced inhibitors or intravascular coagulation, or both. The results of this study indicate, however, that a significant NT-TT discrepancy is also present in all plasmas from patients who have congenital coagulation disorders of the prothrombin complex. None of these patients had received an anticoagulant or showed any sign of intravascular clotting; nevertheless the discrepancy observed was similar to that found in plasmas of coumarin-treated patients: average values were 0.437 and 0.450, respectively. As no inhibitor was present in the congenital coagulation disorders, except in hemophilia BM, the phenomenon does not appear to be specific for coumarin plasma. This indicates that the NT/TT discrepancy is a non-specific phenomenon that does not seem to provide any additional information about coumarin-treated patients compared with that obtainable by means of a simple prothrombin time test.

Topics: Acenocoumarol; Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Tests; Factor X Deficiency; Hemophilia A; Humans; Hypoprothrombinemias; Prothrombin Time

Topics: Acenocoumarol; Aged; Anticoagulants; Aspirin; Blood Coagulation Disorders; Dextrans; Drug Therapy, Combination; Female; Germany, West; Hemorrhage; Heparin; Humans; Middle Aged; Postoperative Care; Postoperative Complications; Preoperative Care; Pulmonary Embolism; Thromboembolism; Time Factors

Topics: Acenocoumarol; Adult; Aged; Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Tests; Drug Evaluation; Heart Diseases; Humans; Middle Aged; Time Factors

Topics: Acenocoumarol; Animals; Blood Coagulation Disorders; Blood Coagulation Tests; Evaluation Studies as Topic; Humans; Prothrombin Time; Rabbits; Thromboplastin

Topics: Acenocoumarol; Adolescent; Adult; Aged; Amides; Arginine; Blood Coagulation; Blood Coagulation Disorders; Humans

Topics: Acenocoumarol; Acute Disease; Blood Coagulation Disorders; Chemical and Drug Induced Liver Injury; Child, Preschool; Factor VII; Factor VIII; Factor X; Hemorrhage; Humans; Kidney Diseases; Kidney Function Tests; Liver Function Tests; Male; Medication Errors; Prothrombin; Prothrombin Time; Vitamin K

Topics: Acenocoumarol; Blood Coagulation Disorders; Humans; Vascular Surgical Procedures

Topics: Acenocoumarol; Anticoagulants; Blood Coagulation Disorders; Coumarins; Embolism; Femoral Neck Fractures; Humans; Postoperative Complications; Thromboembolism; Veins

Topics: Acenocoumarol; Anticoagulants; Blood Coagulation; Blood Coagulation Disorders; Coumarins; Humans; Prothrombin