acenocoumarol and Dyspnea

Deep vein thrombosis (DVT) has an incidence of 1 case per 1000 inhabitants in the general population and it is very rare after arthroscopy of the shoulder. Therefore, the current guidelines do not advise the administration of DVT prophylaxis in shoulder arthroscopy procedures.. We describe two cases of thrombosis of the arm after shoulder arthroscopy on a total of 10.452 shoulder arthroscopies performed during a period of ten years. One of two patients was further complicated by a bilateral pulmonary microembolism. In these two clinical cases the complication developed despite the absence of risk factors such as a concomitant neoplasm, thrombophilia, smoking habit, or a long duration of the procedure.. The DVT after shoulder arthroscopy procedure remain a very rare complication. However, in view of the growing number of patients undergoing this procedure, this figure is expected to rise. The clinician surgeon should take in mind this possible complication that normally appears in the first 3 weeks after surgery, so to perform anti-coagulant treatment. Further clinical studies are therefore warranted to assess the true risk of VTE. In fact, the presence of "minor" predisposing factors that are not routinely studied, as well as the postoperative immobilization period, are potential risk factors that, associated with the invasiveness of the arthroscopy procedure, could trigger a thromboembolism.

Topics: Acenocoumarol; Anticoagulants; Arm; Arthroscopy; Axillary Vein; Dyspnea; Edema; Heparin, Low-Molecular-Weight; Humans; Hyperbaric Oxygenation; Male; Middle Aged; Perfusion Imaging; Postoperative Care; Postoperative Complications; Pulmonary Embolism; Risk Factors; Shoulder Joint; Thrombophilia; Ultrasonography, Doppler, Color; Venous Thrombosis; Young Adult

Intra-alveolar bleeding is a rare and severe medical emergency due to numerous causes. We report the clinical case of a patient who could contribute to extend the literature on this subject. The study included a 62-year old man, with a history of a trial fibrillation, under anti-vitamins K antagonist admitted with dyspnoea of sudden onset associated with haemoptysis and practising self-medication using non-steroidal anti-inflammatory drugs. X-rays and chest scan showed diffuse bilateral alveolar opacities. Haemostatic screening tests on admission showed non-coagulable INR. The diagnosis of intra-alveolar bleeding was clinically and radiologically suspected and then confirmed by bronchial endoscopy with broncho-alveolar lavage (BAL) which detected uniformly hemorrhagic liquid. Previous studies of similar complications occurring after anti-vitamins K antagonists assumption are rare. In conclusion, it seems very important to emphasize the interest of strict and optimal clinico-biological monitoring of patients treated in anti-vitamins K antagonists to avoid an overdose which could contribute to a life-threatening severe haemorrhagic event.

Topics: Acenocoumarol; Anticoagulants; Dyspnea; Hemoptysis; Hemorrhage; Humans; Male; Middle Aged; Pulmonary Alveoli; Vitamin K

A 13-year-old girl presented with progressive dyspnoea and palpitation, diagnosed on echocardiography as primary right ventricular cardiomyopathy with atrial fibrillation. Her thyroid profile was positive for antithyroid microsomal antibody, and antithyroid peroxidase antibodies were suggestive of autoimmune hypothyroidism. She was managed with furosemide, digoxin, acenocoumarol and thyroxine following which she showed significant improvement. This is a rare case of isolated right ventricular cardiomyopathy and its association with autoimmune hypothyroidism presenting at the age of 13.

Topics: Acenocoumarol; Adolescent; Anti-Arrhythmia Agents; Anticoagulants; Cardiomyopathies; Digoxin; Diuretics; Dyspnea; Echocardiography; Female; Furosemide; Hashimoto Disease; Humans; Thyroiditis, Autoimmune; Thyroxine; Treatment Outcome

Behçet's disease is a vasculitis affecting both arteries and veins. Cardiac involvement is less well known. The association of an aneurysm of the pulmonary artery and intracardiac thrombosis is rare, and a therapeutic challenge. We report the case of a 26-year-old patient hospitalized for moderately abundant hemoptysis and New York Heart Association (NYHA) class III dyspnea, which illustrates the difficulty encountered when using anticoagulants in this complex situation.

Topics: Acenocoumarol; Adult; Aneurysm; Anticoagulants; Behcet Syndrome; Cyclophosphamide; Dyspnea; Heart Atria; Heart Diseases; Hemoptysis; Heparin; Humans; Male; Pulmonary Artery; Pulmonary Embolism; Recurrence; Thrombosis; Ultrasonography; Weight Loss

Topics: Acenocoumarol; Aged; Amiodarone; Anemia; Anti-Arrhythmia Agents; Anticoagulants; Dyspnea; Hemoptysis; Hemorrhage; Humans; Lung Diseases; Male

A case report of young woman diagnosed as having microscopic polyangiitis (MPO) presenting with diffuse alveolar hemorrhage (DAH). DAH is a rare, but life-threatening disorder. The patients presented with dyspnea, cough, hemoptysis (not constant). The radiographic features are very characteristic and reveal the signs of diffuse, bilateral alveolar filling in chest HRCT especially in middle and lower zones. Anaemia with iron deficiency and hypoxic respiratory failure. Elevation of diffuse capacity (above 30% of predicted) is often recognized as a result of presence of blood in the alveoli. Broncho-alveolar lavage reveal haemosiderin laden macrophages. It may occurs most frequently as a secondary condition due to microscopic polyangiitis (MPA), Wegener's granulomatosis (WG), Goodpasture syndrome. Among the many conditions it can accompany connective tissue disorders, antiphospholipid antibody syndrome, some medicines or toxic exposures.

Topics: Acenocoumarol; Anticoagulants; Diagnosis, Differential; Dyspnea; Female; Hemoptysis; Hemorrhage; Humans; Lung Diseases, Interstitial; Microscopic Polyangiitis; Venous Thrombosis

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

In this study we presented the case of 55 years old man who was admitted to the Dept. of Lung Diseases and Tuberculosis in Zabrze with haemoptysis, dyspnoea, fever and lung infiltration. Initially the neoplastic disease was diagnosed. From the information gathered from the patient's family it was stated that the patient has been taking acenocoumarol for a considerably long time without any professional supervision. In this study we emphasize the importance of motivating and informing patients about the purposefulness of control examinations while using this kind of drugs.

Topics: Acenocoumarol; Anticoagulants; Autopsy; Dyspnea; Fatal Outcome; Fever; Hemoptysis; Humans; Lung Diseases; Lung Neoplasms; Male; Middle Aged

Percutaneous vertebroplasty is increasingly used for the treatment of vertebral compression fractures. Local leakage of polymethylmethacrylate cement into the perivertebral space is a common complication, but important systemic effects have rarely been reported. The authors describe the case of a 52-year-old patient with central pulmonary embolism after percutaneous vertebroplasty of the eleventh thoracic vertebral body. The large cement embolus was removed from the right pulmonary artery with a hybrid technique combining an interventional catheter procedure with an open heart operation. The patient made an uneventful recovery. The authors review how appropriate arthroplasty techniques might minimize the risk of this dreadful complication.

Topics: Acenocoumarol; Anticoagulants; Bone Cements; Dyspnea; Female; Humans; Middle Aged; Polymethyl Methacrylate; Postoperative Complications; Pulmonary Embolism; Spinal Fractures; Surgical Procedures, Operative; Thoracic Vertebrae; Treatment Outcome

Topics: Acenocoumarol; Acute Disease; Adult; Anticoagulants; Drug Eruptions; Dyspnea; Humans; Male

The case-histories of three patients treated with acenocumarol attended urgently because of sudden onset dyspnea and dysphonia an presented. Endoscopic and radiologic studies revealed in these patients a laryngeal obstruction by haematomas in a different grade, due to an excess in the effect of anticoagulant therapy, since prothrombine times measured as INR were too high. In one of the cases, the sudden and infrequent evolution associating initialy difficulty of breathing without any inspiratory or phonetic disorder, moved to a late diagnosis with a tragic ending, because it delayed an urgent tracheostomy, which bled profusely. It was a patient with a defective anticoagulant therapy control and numerous previous haemorrhagic incidents. The not so fulminant pattern in the other two cases allowed its early diagnostic and treatment planning, which included the admission to hospital and withdrawal of the anticoagulant drug and the vigilance of symptoms, up to confirm healing. Haemorrhagic laryngeal complications due to acenocoumarol, though unusual, imply an obvious vital trouble that moves to an urgent therapeutic attitude more or less aggressive. Its clinical suspicion obliges to its early discard.

Topics: Acenocoumarol; Airway Obstruction; Anticoagulants; Dyspnea; Fatal Outcome; Heart Arrest; Hematoma; Humans; International Normalized Ratio; Laryngeal Diseases; Male; Middle Aged; Voice Disorders