acenocoumarol and Liver-Diseases

The purpose of this review article is to summarize the literature on diseases that are documented to have an effect on response to warfarin and other VKAs.. We searched the English literature from 1946 to September 2015 via PubMed, EMBASE, and Scopus for the effect of diseases on response vitamin K antagonists including warfarin, acenocoumarol, phenprocoumon, and fluindione.. Among many factors modifying response to VKAs, several disease states are clinically relevant. Liver disease, hyperthyroidism, and CKD are well documented to increase response to VKAs. Decompensated heart failure, fever, and diarrhea may also elevate response to VKAs, but more study is needed. Hypothyroidism is associated with decreased effect of VKAs, and obese patients will likely require higher initial doses of VKAs.. In order to minimize risks with VKAs while ensuring efficacy, clinicians must be aware of the effect of disease states when prescribing these oral anticoagulants.

Topics: Acenocoumarol; Administration, Oral; Anticoagulants; Cardiovascular Diseases; Diarrhea; Fibrinolytic Agents; Heart Failure; Humans; Hyperthyroidism; Kidney Failure, Chronic; Liver Diseases; Obesity; Phenindione; Phenprocoumon; Vitamin K; Warfarin

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; Adult; Cholestasis; Chromogenic Compounds; Cohort Studies; Desmin; Factor Xa; Humans; Liver Diseases; Middle Aged; Partial Thromboplastin Time; Peptic Ulcer; Prothrombin; Thrombin Time; Thrombosis

The prothrombin time, also called thromboplastin time ("Quick"), is usually measured by using citrated plasma from venous blood. Recently, portable coagulation monitors have been developed which measure prothrombin time using non-anticoagulated capillary whole blood from a finger-stick. In the present study we evaluated the CoaguChek Plus coagulation monitor in comparison with a standard laboratory method in various patient groups: patients on oral anticoagulation with or without heparinisation, patients receiving heparin without oral anticoagulation, patients with a deficiency of one of the coagulation factors of the extrinsic or common pathway, and patients with liver disease. Furthermore, we studied the influence of the haemoglobin concentration on the test results.. Capillary prothrombin time was measured by using the portable coagulation monitor CoaguChek Plus and venous prothrombin time was assessed by using Thromborel S.. We found a correlation coefficient of 0.94 between capillary and venous INR values in 216 determinations from 167 patients. The slope of the regression line was 1.03, and the y-intercept 0.05, 93.5% of the results were within 0.9, 90.7% within 0.7, and 83.8% within 0.5 INR units. Similar results were obtained in patients on oral anticoagulation, patients with a deficiency of a factor of the extrinsic system and in patients with liver disease. Correlation and agreement were somewhat lower among patients on oral anticoagulation and simultaneous heparinisation (40 patients): correlation coefficient was 0.83, slope of the regression line was 0.87 and y-intercept was 0.27 INR units. No influence of the haemoglobin concentration on INR results could be demonstrated.. Our results show the CoaguChek Plus coagulation monitor to be a valuable tool for measuring prothrombin time in patients on oral anticoagulation, in patients with liver disease to estimate the capacity of protein synthesis, and to screen for possible deficiencies of one of the coagulation factors of the extrinsic or common pathway. However, based on our preliminary data we cannot recommend the use of the CoaguChek Plus coagulation monitor in heparinised patients.

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Drug Monitoring; Drug Therapy, Combination; Female; Follow-Up Studies; Hemoglobinometry; Heparin; Humans; International Normalized Ratio; Liver Diseases; Male; Middle Aged; Phenprocoumon; Prothrombin Time; Sensitivity and Specificity

The aim of our study was to evaluate the possibility of using a chromogenic substrate for the prothrombin time determination. The reagent used by us (Chromoquick) is composed of a human placenta thromboplastin and chromogenic substrate (Tos-Gly-Pro-Arg-5-amino-2-nitrobenzoic acid-isopropylamide), calcium chloride and a buffer. Normal subjects, patients with liver disease, patients on oral anticoagulant therapy, patients on heparin therapy, heterozygous and homozygous patients for prothrombin complex defects and other miscellaneous conditions have been investigated. The results of chromoquick have been related with standard prothrombin time obtained using a human placenta thromboplastin (Thromborel) and rabbit brain and lung thromboplastin (Simplastin). The normal range was 18-23 s for chromoquick and 13.5-15.5 s for the standard prothrombin times using Thromborel and Simplastin. In all groups of patients examined we noticed a significant correlation between the chromogenic and the classic prothrombin times with r values varying between +0.505 and +0.947. The statistical significance resulted from p values varying between less than 0.05 and less than 0.001. Only in the case of some heterozygotes for prothrombin complex factor defects the values obtained have not been unequivocal in the sense that in a few instances the heterozygotes seemed to escape detection. Therefore, it seems that the introduction of chromogenic substrates in laboratory practice for the prothrombin time determination is possible and can offer considerable advantages like standardization and automation. The only disadvantage may be caused by costs involved.

Topics: Acenocoumarol; Administration, Oral; Adult; Chromogenic Compounds; Female; Hematologic Diseases; Humans; Liver Diseases; Male; Middle Aged; Oligopeptides; Prothrombin Time