acenocoumarol and Hematoma

Hemorrhagic rupture is a very rare complication of a simple hepatic cyst. We report the first case of a totally extraperitoneal rupture of a recurrent cyst, occurred in a 73-year-old man who presented with acute right hypochondralgia. Computed tomography revealed the rupture of a large hemorrhagic cyst in the right liver lobe and the formation of a voluminous hematoma in the retroperitoneal space. Despite the absence of hemoperitoneum, the entity of the bleeding led us to perform an urgent and successful surgical intervention. A review of the literature was conducted. To date, 9 cases of hemorrhagic rupture of simple hepatic cyst have been described and our case is the first one characterized by extraperitoneal bleeding. Our clinical management was in accordance with the majority of the other Authors. Different surgical procedures have been proposed and the best approach has not been established yet. However, the laparotomic approach should be preferred for a better control of the bleeding. In conclusion, the hemorrhagic rupture of a liver cyst is a life-threatening complication and a prompt surgery is necessary to prevent the hypovolemic shock.. Extraperitoneal rupture, Hemorrhagic rupture, Simple hepatic cyst.. Le cisti epatiche semplici sono patologie benigne di frequente riscontro nella popolazione generale, la cui incidenza è in progressivo aumento a seguito della larga diffusione di tecniche di imaging quali ecografia e TC addome. Tra le complicanze cui può andare incontro una cisti epatica, la rottura emorragica è sicuramente la più rara e temibile. Nel nostro lavoro riportiamo il caso di un paziente di 73 anni, giunto alla nostra osservazione per dolore ingravescente in ipocondrio destro. La TC dell’addome ha evidenziato la rottura emorragica di una voluminosa cisti del lobo epatico di destra, con formazione di un grossolano ematoma in sede retroperitoneale. L’instaurarsi di un iniziale quadro di instabilità emodinamica ha reso necessario l’esecuzione di un intervento chirurgico urgente, consistito nella resezione delle pareti cistiche e di parte del quinto segmento epatico da cui la cisti originava. Il decorso postoperatorio si è svolto in modo regolare ed il paziente è stato dimesso in sesta giornata postoperatoria. A dimostrazione della rarità dell’evento, abbiamo condotto una revisione della letteratura inglese. Ad oggi sono stati riportati 9 casi, incluso il nostro, di rottura emorragica di cisti epatica semplice. La peculiarità del caso da noi descritto, che lo rende unico in letteratura, è la rottura in sede extraperitoneale. Analizzando i pochi dati a disposizione, abbiamo cercato di individuare alcuni fattori di rischio per la rottura emorragica di una cisti epatica, riscontrando nell’età avanzata e nella terapia anticoagulante orale un ruolo predisponente. Riguardo al management clinico, la revisione della letteratura conferma il ruolo primario della chirurgia, riservando la gestione conservativa ai soli pazienti compromessi e non suscettibili di intervento. La rottura emorragica di una cisti epatica è infatti un evento “life-threatening”, che può indurre rapidamente uno scompenso emodinamico nel paziente. Secondo le nostre osservazioni, e in accordo con i dati estratti dalla letteratura, l’intervento chirurgico urgente si rende necessario al fine di prevenire lo shock ipovolemico.

Topics: Acenocoumarol; Aged; Anticoagulants; Cysts; Drainage; Emergencies; Erythrocyte Transfusion; Hematoma; Hemostasis, Surgical; Humans; Liver Diseases; Male; Recurrence; Retroperitoneal Space; Rupture, Spontaneous; Thrombophilia; Tomography, X-Ray Computed; Ultrasonography

Topics: Acenocoumarol; Amino Acid Substitution; Anticoagulants; Factor IX; Hematoma; Hemothorax; Humans; International Normalized Ratio; Laryngeal Diseases; Male; Middle Aged; Mutation, Missense; Pedigree; Radiography; Vitamin K

We describe the urological manifestations arising from hematoma of the left iliac psoas that developed in the course of anticoagulant therapy in a 54-year-old patient with a mitral prosthesis. The onset of the clinical picture was acute and mimicked left reno-ureteral colic. Ultrasound and CT were decisive in making the diagnosis, revealing a left retroperitoneal mass in the anterolateral aspect of the left psoas muscle. Intravenous urography evidenced the urological repercussions of the disease process consisting of medialization of the left ureter, ureterohydronephrosis, and anterior and lateral displacement of the kidney. Although this condition is considered by most to be a surgical emergency, we opted for conservative treatment because the patient had no hemodynamic instability, severe obstructive uropathy or signs or crural paralysis. The literature on the urological repercussions of psoas hematomas due to anticoagulant therapy is briefly reviewed.

Topics: Acenocoumarol; Female; Hematoma; Humans; Middle Aged; Muscular Diseases; Retroperitoneal Space; Urologic Diseases

Low-dose heparin (L.D.H.) prophylaxis gives good protection against deep venous thrombosis (D.V.T.). In the case of subjects presenting for herniorrhaphy the literature is less unanimous regarding the chance of wound hematoma. In this prospective randomised, matched trial in 86 patients, a wound hematoma incidence of 36 percent was noted in the treatment group as against 7% in the control group. This is statistically significant at the P less than 0.001 level.

Topics: Acenocoumarol; Clinical Trials as Topic; Hematoma; Heparin; Hernia, Inguinal; Humans; Male; Postoperative Complications; Thrombophlebitis

Topics: Acenocoumarol; Administration, Oral; Aged; Anticoagulants; Duodenal Diseases; Gastric Outlet Obstruction; Hematoma; Humans; Male; Tomography, X-Ray Computed

Vitamin K antagonists (VKA) based oral anticoagulation, is widely used for the prevention and treatment of thromboembolic disease. The major complication of this therapy is bleeding, and sometimes it can occur in unsuspected areas. Spontaneous pectoral hematoma is one of the rare complications due to over anticoagulation by VKA therapy, with only a few cases reported in the literature. Concomitant use of this therapy with commonly used antibiotic, especially in the elderly with multiple comorbidities, can increase the risk of bleeding. Herein, we report a case of a 72-year-old woman under VKA for the treatment of atrial fibrillation, who presented with a spontaneous massive pectoral hematoma, while using antibiotic to treat a respiratory tract infection, who was successfully managed.

Topics: Acenocoumarol; Aged; Anticoagulants; Atrial Fibrillation; Female; Hematoma; Hemorrhage; Humans; Thromboembolism; Vitamin K

Infection caused by SARS-CoV-2 (COVID-19) is associated with an increased risk of thromboembolic disease. So-me authors recommend anticoagulation at therapeutic doses for, at least, the most severely ill patients; this practice is not free of risks, which is why only thromboembolic prophylaxis is recommended by other consensuses. In the case of previously anticoagulated patients, changing the oral anticoagulant for a low molecular weight heparin (LMWH) is generally recommended. We present the cases of two patients admitted due to COVID-19, without serious clinical data, in whom anticoagulation (acenocoumarol and rivaroxaban, respectively) was replaced by LMWH at therapeutic doses, both presenting abdominal bleeding. This type of bleeding is an infrequent complication in anticoagulated patients, but the concurrence of two cases in a short period of time in the context of the COVID-19 pandemic leads us to consider that there is not yet any clear evidence on therapeutic anticoagulation in SARS-CoV-2 infection.

Topics: Abdomen; Acenocoumarol; Aged, 80 and over; Anticoagulants; Betacoronavirus; Coronavirus Infections; COVID-19; Female; Hematoma; Heparin, Low-Molecular-Weight; Humans; Pandemics; Pneumonia, Viral; Rivaroxaban; SARS-CoV-2; Venous Thromboembolism

Vitamin K antagonists (VKA) are widely used for the prevention and curative treatment of thromboembolic events. This study aims to describe the epidemiological, clinical and evolutionary aspects of overdose in Vitamin K antagonists administration and determine its hemorrhagic factors. We conducted a monocentric cross-sectional descriptive study at the Principal Hospital in Dakar. All patients with an INR greater than 5 were included. We studied patients' gender and age, VKA used, drug use period, indications, INR value, associated drugs, presence of hemorrhage, immediate management and evolution. We enrolled 154 patients. Acenocoumarol was the most prescribed VKA. Sex ratio favoured women. The average age was 63 years. Overdose was asymptomatic in 43% of patients. Hemorrhagic symptoms were mainly represented by gingival bleeding, epistaxis. Major bleeding episodes were found in 8.6% of patients and they were represented by melena in 6 patients (3.9%), deep muscle hematoma in 2 patients (1.3%) and intracerebral parenchymal hematoma in 2 patients. Two patients had cardiovascular collapse associated with deglobulisation. Nonsteroidal anti-inflammatory drugs (NSAIDs) assumption was noted in 21% of patients. VKA assumption was suspended transiently in all patients. Mortality was 2%, due to intracranial hemorrhage. The reduction in VKA overdose requires caregivers to manage overdose factors and provide proper patient education.

Topics: Acenocoumarol; Adult; Aged; Aged, 80 and over; Anticoagulants; Cross-Sectional Studies; Drug Overdose; Female; Hematoma; Hemorrhage; Humans; International Normalized Ratio; Intracranial Hemorrhages; Male; Middle Aged; Senegal; Vitamin K; Young Adult

Topics: Acenocoumarol; Aged; Anticoagulants; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Radiography; Stomach Diseases

Acenocumarol is widely used in long-term anticoagulant treatment. Overdose of this drug may result in suffusions in various parts of the body. In three cases, we observed suffusion in the rectus sheath, which is an unusual site of hematomas. At early stage, the lack of discoloration of the abdominal wall may lead to problems in differential diagnosis. Chronic anticoagulant treatment in a patient's history in combination with a palpable abdominal mass facilitate the correct diagnosis. In addition, high INR also makes hemorrhagic complications more likely. In simple cases, suggestive past medical history, abdominal palpation, INR and ultrasound examination can be sufficient to make a diagnosis. However, in more complicated cases, further assessment by CT is required to set up the diagnosis; while, in a further case discussed in this article, we could only establish an accurate diagnosis with laparoscopy. Decreased plasma prothrombin levels were always normalized with vitamin K.

Topics: Acenocoumarol; Aged; Anticoagulants; Antifibrinolytic Agents; Diagnosis, Differential; Drug Overdose; Female; Hematoma; Humans; International Normalized Ratio; Laparoscopy; Male; Middle Aged; Palpation; Rectus Abdominis; Tomography, X-Ray Computed; Vitamin K

Topics: Abdomen, Acute; Acenocoumarol; Acute Disease; Aged; Anticoagulants; Enoxaparin; Female; Hematoma; Humans

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

The haemoperitoneum and bowel haematoma are complications of the oral anticoagulant treatment. The abdominal pain in patient under oral anticoagulant drugs represents a diagnostic problem; apart of the acute abdomen, we also have to consider unusual haemorrhagic lesion, rare in patients without coagulation problems. The early diagnosis of the complication in the patients permits a conservative treatment with excellent prognosis, instead of performing surgical operations in subjects with frequent comorbidities. We report a case of haemoperitoneum and intramural bowel haematoma in a patient with altered laboratory parameters and haemodynamic instability that required an urgent surgical procedure.

Topics: Acenocoumarol; Aged; Angina Pectoris; Anticoagulants; Hematoma; Hemoperitoneum; Humans; Jejunal Diseases; Male; Treatment Outcome

Bleeding complications of oral anticoagulant therapy are not rare. The locations for bleeding are most often gastrointestinal, genitourinary and intracranial. Upper airway obstruction remains one of the reported complications. It is produced in most cases by a retropharyngeal haematoma. On the other hand, sublingual haematoma is exceptional and constitutes a problem to secure patient's airway. We report the case of a 16-year-old patient, admitted tenhours after accidental ingestion of 40mg of Sintrom((R)) with major breathing difficulty, haemoptysis and epistaxis. The endotracheal intubation was performed blindly using an Eschmann candle. This rare complication should be prevented by an adapted clinical and biological monitoring.

Topics: Accidents, Home; Acenocoumarol; Administration, Oral; Adolescent; Airway Obstruction; Anticoagulants; Drug Overdose; Erythrocyte Transfusion; Heart Valve Prosthesis; Hematoma; Humans; Intubation, Intratracheal; Male; Mouth Floor; Plasma

Topics: Acenocoumarol; Aged; Anticoagulants; Hematoma; Humans; Ileal Diseases; Intestinal Obstruction; Male

Topics: Acenocoumarol; Aged, 80 and over; Anticoagulants; Duodenal Diseases; Female; Hematemesis; Hematoma; Humans; Vomiting

Topics: Abdominal Pain; Acenocoumarol; Aged; Anticoagulants; Hematoma; Humans; Intestine, Small; Male; Tomography, X-Ray Computed; Treatment Outcome

Previous evidence suggests that hydroxymethylglutaryl coenzyme A-reductase inhibitors (statins) might potentiate the effect of oral anticoagulants, but a MEDLINE search (key terms: stains, rosuvastatin, anticoagulants, acenocoumarol, and interaction; years: 1980-2005) revealed no reports of an interaction between rosuvastatin and acenocoumarol.. The aim of this article was to describe a case of possible interaction between rosuvastatin and acenocoumarol.. We report the case of a 36-year-old male patient receiving long-term oral treatment with acenocoumarol, a synthetic coumarin anticoagulant, who experienced an increase in international normalized ratio (INR) and a hematoma in the left leg approximately 45 days after the initiation of treatment with rosuvastatin.. After discontinuation of both drugs, an unexpectedly rapid decrease in INR was observed.. Based on the results of this case, a possible pharmacologic interaction between rosuvastatin and acenocoumarol should be considered. Rosuvastatin might enhance the anticoagulant effect of acenocoumarol, and a rebound effect in cases of simultaneous discontinuation of both drugs might occur. Rosuvastatin should be administered with extreme caution in patients receiving long-term acenocoumarol therapy.

Topics: Acenocoumarol; Administration, Oral; Adult; Anticoagulants; Drug Interactions; Drug Therapy, Combination; Fluorobenzenes; Hematoma; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; International Normalized Ratio; Leg; Male; Pyrimidines; Rosuvastatin Calcium; Sulfonamides; Time Factors; Treatment Outcome

Topics: Acenocoumarol; Aged; Aged, 80 and over; Anticoagulants; Female; Hematoma; Humans; Psoas Muscles; Tomography, X-Ray Computed

Topics: Acenocoumarol; Aged; Anticoagulants; Diagnosis, Differential; Female; Hematoma; Humans; Male; Middle Aged; Retroperitoneal Space

Topics: Acenocoumarol; Aged; Aged, 80 and over; Anticoagulants; Aortic Valve; Female; Fibrinolytic Agents; Heart Valve Prosthesis Implantation; Hematoma; Heparin; Humans; Psoas Muscles; Radiography; Venous Thrombosis

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

Topics: 4-Hydroxycoumarins; Abdomen; Acenocoumarol; Aged; Anti-Bacterial Agents; Anticoagulants; Coronary Disease; Cytochrome P-450 Enzyme System; Drug Interactions; Hematoma; Humans; Indenes; Liver; Male; Roxithromycin; Vitamin K

Coumarin anticoagulants must be strictly monitored because of their narrow therapeutic index and their potential interactions with other drugs. The high probability of interactions can be explained by two pharmacokinetic properties of coumarins: high binding to plasma albumin (99%), being displaced by other drugs with greater affinity to this protein, and metabolism by liver microsomal enzymes (cytochrome P450), which can be induced or inhibited by other compounds (Shinn & Shrewsbury 1985). A case is reported of a clinically relevant drug interaction of phenytoin and acenocoumarol, possibly potentiated by concomitant treatment with paroxetine, leading to a retroperitoneal haematoma.

Topics: Acenocoumarol; Aged; Anticoagulants; Anticonvulsants; Antidepressive Agents, Second-Generation; Drug Interactions; Drug Therapy, Combination; Female; Hematoma; Humans; Paroxetine; Phenytoin; Retroperitoneal Space

The development of abdominal pain in the patient receiving anticoagulant therapy is more likely to pose a diagnostic dilemma. A group of intra-abdominal bleeding syndromes, which are extremely rare in patients with normal haemostasis, have been described in patients on anticoagulant therapy. Theses syndromes are of particular interest to surgeons because they simulate acute surgical conditions of the abdomen. We herein report the preoperative diagnosis of a spontaneous intramural hematoma of the small bowel by computed tomography. The authors conclude that CT should be used early in the diagnostic evaluation of abdominal pain and of acute abdomen in patients receiving anticoagulant therapy. Indications for the operative management of these patients include active bleeding, pneumoperitoneum, failure to improve with conservative management within 72 hours, worsening of symptoms, and uncertain diagnosis.

Topics: Acenocoumarol; Anticoagulants; Gastrointestinal Hemorrhage; Hematoma; Humans; Ileal Diseases; Male; Middle Aged

Topics: Acenocoumarol; Deglutition Disorders; Female; Hematoma; Humans; Middle Aged; Oral Hemorrhage; Pharyngeal Diseases; Tongue Diseases

Rats received a single subcutaneous dose of the inflammatory agent carrageenin on the top of the skull, followed by oral acenocoumarol for 3 days; in every case, an extensive haematoma was observed on the skull on day 4. The capillary resistance on the depilated dorsal skin was significantly reduced by this combined inflammatory + anticoagulant treatment. Haematoma development was not inhibited by cortisone, non-steroidal anti-phlogistics (piroxicam, proquazone) or benzopyrone derivatives (hesperidin methylchalcone, oligomeric procyanidin). On pretreatment with vitamin K1 for 1 day, followed by daily treatment for 3 days, no haematoma was observed.

Topics: Acenocoumarol; Animals; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Capillaries; Carrageenan; Chromones; Coumarins; Disease Models, Animal; Female; Hematoma; Hemorrhage; Male; Rats; Rats, Inbred Strains; Steroids; Vascular Resistance; Vitamin K 1

A patient developed an intramural hematoma of cecum as a result of indirect anticoagulant treatment. The case is remarkable with respect to the symptomatology and the very restricted extension of the lesion, these features probably resulting from a process of secondary infection.

Topics: Acenocoumarol; Bacterial Infections; Cecal Diseases; Gastrointestinal Hemorrhage; Hematoma; Humans; Inflammation; Intestinal Mucosa; Male; Middle Aged

Topics: Acenocoumarol; Aged; Cerebral Hemorrhage; Factor XII Deficiency; Hematoma; Humans; Male

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestine, Small; Male; Middle Aged; Prothrombin; Vitamin K

Topics: Abdominal Muscles; Acenocoumarol; Aged; Female; Giant Cell Arteritis; Hematoma; Humans

Topics: Acenocoumarol; Adult; Anticoagulants; Femoral Nerve; Hematoma; Humans; Ilium; Male; Middle Aged; Muscular Diseases; Nerve Compression Syndromes; Tomography, X-Ray Computed; Warfarin

A case is presented of spontaneous haemorrhage into the floor of the mouth occurring in a patient receiving anticoagulants. Spread of interstitial haematoma to the submucosal tissues of the pharynx and larynx caused respiratory embarrassment necessitating a tracheostomy. The genesis and management of such a problem are discussed, and it can be appreciated that close co-operation between the otolaryngologist, haematologist and anaesthetist is essential.

Topics: Acenocoumarol; Adult; Anticoagulants; Asphyxia; Female; Hematoma; Humans; Laryngeal Diseases; Oral Hemorrhage; Pharyngeal Diseases; Tracheotomy

The authors present a case of intramural hematoma of the small intestines during anticoagulant treatment. With reference to this case, they study the frequency, etiopathogenesis and anatomy of this hematoma and particularly look at the radiological manifestations. In this respect they distinguish three stages in the evolution. The first, when the straight X-ray of the abdomen and barium followthrough demonstrate an axial stenosis of the small intestines with dilation of the proximal loops; the second (between the 7th and 20th days) when the loop affected by the hematoma takes on a characteristic "palissade" or "spring" -like sausage appearance; finally the third (after the 3rd week), when only thickening of the haustrations persists with progressive return to normal. The radiological diagnosis is discussed, not only with intramural hematomas of the small intestines of other etiologies (traumatic, during pancreatitis, during disorders in hemostatis), but also with conditions giving rise to similar radiological pictures: malabsorption, inflammatory conditions, etc.

Topics: Acenocoumarol; Adult; Anticoagulants; Clofibrate; Gastrointestinal Hemorrhage; Hematoma; Humans; Jejunum; Male; Radiography

Topics: Acenocoumarol; Aged; Ethyl Biscoumacetate; Hematoma; Hemorrhage; Humans; Lung Diseases; Middle Aged; Neck

Topics: Acenocoumarol; Adrenal Gland Diseases; Hematoma; Heparin; Humans; Male; Middle Aged; Myocardial Infarction

Topics: Acenocoumarol; Anticoagulants; Hematoma; Hematoma, Subdural; Hemorrhage; Humans; Pathology; Rheumatic Heart Disease; Spinal Cord; Spinal Diseases; Subdural Space; Toxicology

Topics: Acenocoumarol; Hematoma; Humans; Necrosis; Thrombosis

Topics: Acenocoumarol; Anticoagulants; Cesarean Section; Coumarins; Diagnosis, Differential; Female; Hematoma; Humans; Pregnancy; Thrombosis