acenocoumarol and Hypertension

Diffuse superficial siderosis of the central nervous system (CNS) is a rare condition due to hemosiderin deposits in the subpial layers of the brain and spinal cord. The source of chronic or recurrent bleeding into the subarachnoid space is detected in only 50 % of cases. The most characteristic symptoms are cerebellar ataxia and sensorineural hearing impairment. T2-weighted gradient echo magnetic resonance imaging constitutes the diagnostic method of choice.. We report four patients of diffuse superficial siderosis of the CNS associated to cerebral amyloid angiopathy, oral anticoagulation, schwannoma VIII, and without known source of bleeding in one case. Two patients developed cerebellar ataxia, three of them present transient focal neurological episodes, one dementia and, the last one, the diffuse superficial siderosis of the CNS is a radiological finding. No clinical progression was observed during follow-up (2-11 years) in three of them. The patient with cerebral amyloid angiopathy progresses to dementia.. Transient focal neurological episodes were the most common symptom in our cases of diffuse superficial siderosis of the CNS. The natural history of this condition is not very known and may be regarded as a radiological finding.. Siderosis superficial difusa del sistema nervioso central: descripcion de cuatro casos y revision de la bibliografia.. Introduccion. La siderosis superficial difusa del sistema nervioso central (SNC) es una rara condicion debida a depositos de hemosiderina en las capas subpiales del cerebro y la medula espinal. La fuente de sangrado cronico o recurrente en el espacio subaracnoideo se detecta solo en un 50% de los casos. Los sintomas mas caracteristicos son ataxia cerebelosa e hipoacusia neurosensorial. Las secuencias eco de gradiente potenciadas en T2 de resonancia magnetica constituyen el metodo diagnostico de eleccion. Casos clinicos. Presentamos cuatro pacientes con siderosis superficial difusa del SNC relacionada con angiopatia amiloide, anticoagulacion oral, schwannoma del VIII par craneal y sin fuente de sangrado conocida en un caso. Dos pacientes desarrollaron ataxia cerebelosa; tres de ellos, episodios recurrentes de alteracion focal neurologica; uno, demencia; y el cuarto es un hallazgo radiologico. No se objetivo progresion clinica durante el seguimiento (2-11 años) en tres de ellos. El paciente con angiopatia amiloide evoluciono a demencia. Conclusiones. Los episodios recurrentes de alteracion focal neurologica son los sintomas mas frecuentes en nuestros casos de siderosis superficial difusa del SNC. La evolucion natural de esta condicion no se conoce bien y puede constituir un hallazgo radiologico.

Topics: Acenocoumarol; Aged; Anticoagulants; Brain Chemistry; Cerebellar Ataxia; Cerebral Amyloid Angiopathy; Comorbidity; Dementia; Female; Hemosiderin; Hemosiderosis; Humans; Hypertension; Ischemic Attack, Transient; Magnetic Resonance Imaging; Male; Middle Aged; Neuroma, Acoustic; Radiography; Smoking; Subarachnoid Hemorrhage

Hypertension is the most frequent condition associated with atrial fibrillation (AF) and stroke, the most terrible complication of AF. Achieving blood pressure (BP) goals as well as an adequate antithrombotic treatment are critical to reduce the incidence of stroke. But are interactions between anticoagulants and antihypertensive agents relevant for achieving BP targets? We present the case of a patient with hypertension and AF in which the interaction between losartan and acenocoumarol was associated with an irregular systolic BP control, but after switching to dabigatran, BP control improved. In this report, the possible mechanisms that may explain this change are discussed.

Topics: Acenocoumarol; Aged, 80 and over; Anticoagulants; Antihypertensive Agents; Antithrombins; Atrial Fibrillation; Benzimidazoles; beta-Alanine; Dabigatran; Drug Interactions; Humans; Hypertension; Losartan; Male

The aim of this study was to test the hypothesis that a specific bleeding risk score, HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly), was better at predicting major bleeding compared with CHADS2 (congestive heart failure, hypertension, 75 years of age or older, diabetes mellitus, and previous stroke or transient ischemic attack) and CHA2DS2-VASc (congestive heart failure, hypertension, 75 years of age and older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, 65 to 74 years of age, female) in anticoagulated atrial fibrillation (AF) patients.. The CHADS2 and CHA2DS2-VASc scores are well-validated stroke risk prediction scores for AF, but are also associated with increased bleeding and mortality.. We recruited 1,370 consecutive AF patients (49% male; median age, 76 years) receiving oral anticoagulation therapy from our outpatient anticoagulation clinic, all of whom were receiving acenocoumarol and had an international normalized ratio between 2.0 and 3.0 during the preceding 6 months. During follow-up, major bleeding events were identified by the 2005 International Society on Thrombosis and Haemostasis criteria. Model performance was evaluated by calculating the C-statistic, and the improvement in predictive accuracy was evaluated by calculating the net reclassification improvement and integrated discrimination improvement.. After a median follow-up of 996 (range, 802 to 1,254) days, 114 patients (3.0%/year) presented with a major bleeding event; 31 of these events were intracranial hemorrhages (0.8%/year). Based on the C-statistic, HAS-BLED had a model performance superior to that of both CHADS2 and CHA2DS2-VASc (both p < 0.001). Both net reclassification improvement and integrated discrimination improvement analyses also show that HAS-BLED was more accurately associated with major bleeding compared with CHADS2 and CHA2DS2-VASc scores.. In anticoagulated AF patients, a validated specific bleeding risk score, HAS-BLED, should be used for assessing major bleeding. The practice of using CHADS2 and CHA2DS2-VASc as a measure of high bleeding risk should be discouraged, given its inferior predictive performance compared with the HAS-BLED score.

Topics: Acenocoumarol; Adult; Age Factors; Aged; Alcohol Drinking; Anticoagulants; Atrial Fibrillation; Diabetes Complications; Female; Follow-Up Studies; Heart Failure; Hemorrhage; Humans; Hypertension; International Normalized Ratio; Ischemic Attack, Transient; Kidney; Liver; Male; Middle Aged; Predictive Value of Tests; Risk Assessment; Risk Factors; Stroke; Substance-Related Disorders

Topics: Acenocoumarol; Aged, 80 and over; Anticoagulants; Asthma; Atrial Fibrillation; Calciphylaxis; Calcium; Diabetes Complications; Female; Humans; Hypertension; Leg Ulcer; Livedo Reticularis; Polypharmacy; Thrombophilia

A 42-year-old man presented with ptosis and miosis in his left eye and a history of headache over the last 20 days. An angioresonance showed dissection of internal carotid artery.. "Painful Horner's Syndrome" is considered to be a medical emergency due possible onset of an internal carotid artery dissection. We consider that awareness of neuro-ophthalmologic emergencies is very important in the clinical praxis of an ophthalmologist. Multidisciplinary treatment and follow-up of these patients is required.

Topics: Acenocoumarol; Adult; Analgesics; Anticoagulants; Antihypertensive Agents; Bed Rest; Blepharoptosis; Carotid Artery Thrombosis; Carotid Artery, Internal, Dissection; Combined Modality Therapy; Headache; Horner Syndrome; Humans; Hypertension; Magnetic Resonance Angiography; Male

Topics: Acenocoumarol; Administration, Oral; Anticoagulants; Aortic Aneurysm; Brain Ischemia; Cyanosis; Heparin; Humans; Hyperlipidemias; Hypertension; Male; Middle Aged; Myocardial Infarction; Risk Factors; Thromboembolism; Thrombosis; Toes; Urinary Bladder Neoplasms

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

Although the indications for oral anticoagulation (AO) in the treatment of cerebral vascular disease (CVD) are well established, their potential side effects continue to give cause for worry.. To describe the complications and ischemic relapses in patients treated with AO for secondary prevention of CVD of cardiac embolic origin.. We included 169 patients with embologenic cardiopathy who, following an CVD, were treated with AO and followed-up at our medical centre for at least three months. We recorded their past clinical history and risk factors, occurrence of vascular relapses (VR), complications involving hemorrhage (CH), and data regarding course and follow-up.. During an average follow-up of 50.3 months of a total of 707.9 patient/years, 20 VR (2.8% per year) were recorded; 15 of these were cerebro-vascular and mainly mild. We recorded 59 CH in 41 patients (8.3% per year) of which 6 were considered to be major. There was a 30% drop-out rate from follow-up at our centre, mainly due to death from other causes or to change of referral centre.. There is a low incidence of relapse and of complications (usually mild) following AO for the secondary prevention of CVD of cardio-embolic origin. Efficacy and security are maintained in the long term.

Topics: Acenocoumarol; Administration, Oral; Alcoholism; Anticoagulants; Arteriosclerosis; Atrial Fibrillation; Cardiomyopathy, Dilated; Cohort Studies; Comorbidity; Diabetes Mellitus; Disease-Free Survival; Follow-Up Studies; Heart Valve Diseases; Hemorrhage; Humans; Hyperlipidemias; Hypertension; Intracranial Embolism and Thrombosis; Life Tables; Myocardial Infarction; Recurrence; Risk Factors; Smoking; Spain; Treatment Outcome

Topics: Acenocoumarol; Blood Coagulation; Cerebrovascular Disorders; Electrocardiography; Fibrinogen; Heparin; Humans; Hypertension; Intracranial Arteriosclerosis; Thrombelastography

Topics: Acenocoumarol; Ambulatory Care; Arteriosclerosis; Heparin; Humans; Hypertension

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Blood Coagulation Tests; Cardiovascular Diseases; Dicumarol; Female; Hemorrhage; Heparin; Humans; Hypertension; Male; Middle Aged; Phenindione

Topics: Acenocoumarol; Dipyridamole; Electrocardiography; Geriatrics; Heart Defects, Congenital; Heart Diseases; Heart Failure; Humans; Hypertension; Myocardial Infarction; Niacin; Occupational Therapy; Papaverine; Psychology; Rehabilitation; Social Work; Thiamine