acenocoumarol and Thrombophlebitis

Lemierre's syndrome is a potentially fatal disease that usually presents with oropharyngeal infection, followed by sepsis, thrombosis of the internal jugular vein and septic emboli. Most cases are caused by the Gram-negative, anaerobic Fusobacterium necrophorum. We present two patients with an atypical presentation of Lemierre's syndrome and a review. These cases illustrate that a positive blood culture for F. necrophorum, even without the presence of clinical symptoms pointing towards thrombosis of the internal jugular vein, justifies further radiological testing for thrombophlebitis of the internal jugular vein.

Topics: Acenocoumarol; Anti-Bacterial Agents; Anticoagulants; Bacteremia; Deglutition Disorders; Diarrhea; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Jugular Veins; Male; Middle Aged; Nadroparin; Penicillins; Pharyngitis; Pneumonia, Bacterial; Syndrome; Thrombophlebitis; Ultrasonography; Young Adult

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; Adult; Aspirin; Clinical Trials as Topic; Dextrans; Dipyridamole; Heparin; Hip; Humans; Injections, Subcutaneous; Middle Aged; Postoperative Complications; Thrombophlebitis; United Kingdom

Topics: Acenocoumarol; Angina Pectoris; Anticoagulants; Cerebrovascular Disorders; Dicumarol; Heparin; Humans; Myocardial Infarction; Phlebitis; Rheumatic Heart Disease; Thromboembolism; Thrombophlebitis; Warfarin

The purpose of this study was to evaluate whether low molecular weight heparin (LMWH) could be equal or more effective than conventional oral anticoagulants (OAs) in the long-term treatment of deep venous thrombosis (DVT).. One hundred fifty-eight patients with symptomatic DVT of the lower limbs confirmed by means of duplex ultrasound scan were randomized to receive 3 to 6 months' treatment with nadroparine calcium or acenocoumarol. Quantitative and qualitative duplex scan scoring systems were used to study the evolution of thrombosis in both groups at 1, 3, 6, and 12 months.. During the 12-month surveillance period, two (2.5%) of the 81 patients who received LMWH and seven (9%) of the 77 patients who received OAs had recurrence of venous thrombosis (not significant). In the LMWH group no cases of major bleeding were found, and four cases (5.2%) occurred in the OA group (not significant). The mortality rate was nine (11.1%) in the LMWH group and 7.8% in the OA group (not significant). The quantitative mean duplex scan score decreased in both groups during the follow-up and had statistical significance after long-term LMWH treatment on iliofemoral DVT (1, 3, 6, and 12 months), femoropopliteal DVT (1-3 months), and infrapopliteal DVT (first month). Duplex scan evaluation showed that the rate of venous recanalization significantly increased in the common femoral vein at 6 and at 12 months and during each point of follow-up in the superficial and popliteal veins in the LMWH group. Reflux was significantly less frequent in communicating veins after LMWH treatment (17.9% vs 32.2% in the OA group). The reflux rates in the superficial (22.4% in the LMWH group, 30.6% in OA group) and deep (13.4% vs 17.7%) venous system showed no significant differences between groups.. The unmonitored subcutaneous administration of nadroparine in fixed daily doses was more effective than oral acenocoumarol with laboratory control adjustment in achieving recanalization of leg thrombi. With nadroparine, there was less late valvular communicating vein insufficiency, and it was at least as efficacious and safe as oral anticoagulants after long-term administration. These results suggest that LMWHs may therefore represent a real therapeutic advance in the long-term management of DVT.

Topics: Acenocoumarol; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anticoagulants; Blood Coagulation Tests; Female; Hemorrhage; Humans; Injections, Subcutaneous; Long-Term Care; Male; Middle Aged; Nadroparin; Survival Rate; Thrombophlebitis; Treatment Outcome; Ultrasonography, Doppler, Duplex

This study aims to establish the relative effectiveness and safety of low molecular weight heparin in elderly patients with venous thrombosis in order to find an alternative to oral anticoagulant therapy with less bleeding complications in the long-term treatment of deep venous thrombosis (DVT). One hundred consecutive elderly patients (>75 years old) with venographically demonstrated proximal DVT were included in a randomized trial. All patients were treated for ten days with adjusted doses of intravenous heparin. Informed consent was obtained and on the eight day, patients were randomly allocated to receive acenocoumarol (INR 2.0-3.0) or subcutaneous enoxaparin (4000 anti-Xa units once a day) for three months. All patients were followed-up clinically and venographically for a one year period. The results were analyzed with Fisher's exact test or chi-square test as appropriate. During the treatment and surveillance period, 6 of the 50 patients (12%) who received acenocoumarol and 8 of the 50 patients (16%) who received enoxaparin had new episodes of venous thromboembolism confirmed by objective testing (p = 0.6; 95% CI for the difference: -19.5 to 11.5). Hemorrhagic complications occurred in six of the 50 patients (12%) who received acenocoumarol and in one (2%) of those on enoxaparin (p = 0.1; 95% CI for the difference: -1.8 to 21.8). Vertebral fractures developed in 2 patients (4%) in the enoxaparin group (p = 0.5; 95% CI for the difference: -11.4 to 3.4). These results show that fixed dose enoxaparin seems to be effective and safe in the long-term treatment of proximal DVT in the elderly. In comparison with oral anticoagulants, the findings are inconclusive due to the wide confidence intervals for differences between outcomes, however they suggest that the former may have less bleeding complications with similar efficacy.

Topics: Acenocoumarol; Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Enoxaparin; Female; Hemorrhage; Humans; Injections, Intravenous; Male; Thrombophlebitis; Treatment Outcome

A broad spectrum of indications for low molecular weight heparin (LMWH) requires an assessment of side effects especially during prolonged administration. There are common risk factors for venous thromboembolism (VTE) and osteoporosis; heparin is "the drug of choice" for VTE treatment. The aim of our study was to assess the effect of treatment and prophylaxis with LMWH (enoxaparine sodium) and oral anticoagulant (acenocoumarol) for bone structure. Material consists of in- and outpatients. 49 densitometries were performed in 31 patients (in 15 cases double examination). We observed a decrease of bone mineral density in comparison to the initial examination in most cases: mean change of bone mass for examined areas was 3.05%.

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Bone Density; Female; Heparin, Low-Molecular-Weight; Humans; Male; Middle Aged; Osteoporosis; Risk Factors; Thrombophlebitis

The aim of this study was to determine the efficacy and safety of subcutaneous weight-adjusted dose low molecular weight heparin (LMWH) compared with oral anticoagulant (OA) in the prevention of recurrent venous thromboembolism. In a prospective multicenter trial, 202 patients with symptomatic proximal deep vein thrombosis (DVT) were included. As soon as the diagnosis of DVT was confirmed by phlebography, 101 were randomly assigned to receive LMWH (nadroparin) for secondary prophylaxis and 101 to receive OA (acenocoumarol). Patients in both groups were initially treated with nadroparin in a dose of 85 anti-Xa IU/kg s.c. every 12 h. Secondary prophylaxis with either nadroparin, 85 anti-Xa IU/kg s. c. once daily, or acenocoumarol was continued for at least 3 months. Three patients in the LMWH group and 6 in the OA group were excluded from analysis for various reasons. During the one-year combined secondary prophylaxis and surveillance period, 7 of of the 98 evaluable patients (7.1%) in the LMWH group and 9 of the 95 evaluable patients (9.5%) in the OA group had a documented recurrence of venous thromboembolism (Fisher's exact test, p = 0.61). Of these, 2 patients who received LMWH and 7 patients on acenocoumarol had recurrences in the 3-month period of secondary prophylaxis. Four patients (4.1%) in the LMWH group developed bleeding complications during this study period, as compared with 7 (7.4%) in the OA group (Fisher's exact test, p = 0.37). There were two major bleedings, one in the LMWH group and one in the OA group. Eleven patients died, 5 (5.1%) in the LMWH group and 6 (6.3%) in the OA group. It is concluded that nadroparin in a dose of 85 anti-Xa IU/kg s.c. once daily provides an effective and safe alternative to oral anticoagulants in the secondary prophylaxis of DVT.

Topics: Acenocoumarol; Administration, Oral; Anticoagulants; Heparin, Low-Molecular-Weight; Humans; Injections, Subcutaneous; Nadroparin; Secondary Prevention; Thrombophlebitis

Gynecologic malignancies are often associated with deep vein thrombosis and pulmonary embolism, even before treatment is begun. But such complications also happen during treatment, also if thromboembolism prophylaxis is performed. The incidence of pulmonary embolism before treatment was investigated using scintigraphy. In a retrospective and in a prospective randomized trial, various methods of thromboembolism prophylaxis were evaluated during primary or postoperative radiation therapy. Pulmonary embolism was present in 11.9% of the patients admitted with uterine malignancy. Retrospectively, there were deep vein thromboses in 6.8%, pulmonary embolisms in 3.8% and bleeding complications in 5.3% of the patients receiving thromboembolism prophylaxis with acenocoumarol during radiation therapy of cervical and endometrial cancer. In the prospective study, deep vein thromboses occurred in 1.5%, pulmonary embolisms in 5.9% and bleedings in 2.2%, with both the LMW heparin and the acenocoumarol groups presenting similar results. Thromboembolism is a frequent paraneoplasia of uterine malignancies. The prevention of thromboembolic complications during radiation therapy of uterine malignancies is efficacious and safe using either LMW heparin or acenocoumarol.

Topics: Acenocoumarol; Anticoagulants; Combined Modality Therapy; Female; Genital Neoplasms, Female; Heparin, Low-Molecular-Weight; Humans; Postoperative Complications; Prospective Studies; Pulmonary Embolism; Radiotherapy, Adjuvant; Retrospective Studies; Thrombophlebitis; Treatment Outcome; Uterine Neoplasms

In most countries, heparin is used in the initial treatment of patients with deep-vein thrombosis. Well-designed studies establishing the efficacy of heparin therapy are lacking, however. Treatment with acenocoumarol alone, according to the hypothesis that high dosages of oral anticoagulants obviate the need for heparin, is considered an effective alternative in some countries.. In a randomized, double-blind study we compared the efficacy and safety of continuous intravenous heparin plus acenocoumarol with the efficacy and safety of acenocoumarol alone in the initial treatment of outpatients with proximal-vein thrombosis. The principal study end point was a confirmed symptomatic extension or recurrence of venous thromboembolism during six months of follow-up. In addition, we assessed asymptomatic extension or pulmonary embolism by repeating venography and lung scanning after the first week of treatment. The incidence of major bleeding was determined during three months of follow-up.. The study was terminated early by the Data Safety and Monitoring Committee because of an excess of symptomatic events in the group that received acenocoumarol alone (in 12 of 60 patients [20 percent], as compared with 4 of 60 patients [6.7 percent] in the combined-therapy group by intention-to-treat analysis; P = 0.058). Asymptomatic extension of venous thrombosis was observed in 39.6 percent of the patients in the acenocoumarol group and in 8.2 percent of patients treated with heparin plus acenocoumarol (P < 0.001). Major bleeding complications were infrequent and comparable in the two groups.. Patients with proximal-vein thrombosis require initial treatment with full-dose heparin, which can safely be combined with acenocoumarol therapy.

Topics: Acenocoumarol; Double-Blind Method; Drug Therapy, Combination; Female; Follow-Up Studies; Hemorrhage; Heparin; Humans; Male; Middle Aged; Pulmonary Embolism; Recurrence; Thrombophlebitis

The antithromboembolic efficacy of once a day low molecular weight heparin in fixed combination with dihydroergotamine (LMWH-DHE) was compared with conventional heparin-DHE in combination with Acenocoumarol (heparin-DHE/A) in 191 patients undergoing gynaecological surgery. LMWH-DHE proved equally effective in preventing thromboembolic complications, with a similar incidence of postoperative bleeding and side effects. Deep vein thrombosis occurred once in each group and one non-fatal pulmonary embolism occurred in the LMWH-DHE group. The main advantage of LMWH-DHE was significantly better patient acceptance of the single daily subcutaneous injection as compared with the two injections of conventional heparin-DHE (P = 0.02). On the other hand, LMWH-DHE was associated with significantly increased incidence of intraoperative bleeding (P less than 0.02). The bleeding did not, however, cause any clinical problems. Discontinuation of therapy due to bleeding or pain at the site of injection occurred three times in each group. We consider the use of LMWH-DHE to be an attractive, economic and safe method of thromboembolic prophylaxis.

Topics: Acenocoumarol; Clinical Trials as Topic; Dihydroergotamine; Drug Combinations; Female; Genital Diseases, Female; Hemorrhage; Heparin; Heparin, Low-Molecular-Weight; Humans; Hysterectomy; Postoperative Complications; Premedication; Prospective Studies; Pulmonary Embolism; Random Allocation; Thrombophlebitis

Topics: Acenocoumarol; Administration, Oral; Adult; Anticoagulants; Clinical Trials as Topic; Disseminated Intravascular Coagulation; Drug Evaluation; Glycoproteins; Humans; Male; Protein C; Protein S; Pulmonary Embolism; Thrombophlebitis

In a randomized double blind clinical trial, we compared indobufen, an antiplatelet drug, with acenocoumarol for the prevention of deep venous thrombosis (D.V.T.) in patients with acute myocardial infarction. Therapy was started on admission and continued for 10 days. All patients were screened daily with impedance plethysmography (I.P.G.) and 125I-fibrinogen leg scanning. Diagnosis of D.V.T. was made when either one or both tests became positive. 74 patients were randomized to treatment with indobufen (200 mg b.i.d.) and 76 patients to acenocoumarol (controlled by thrombotest). The incidence of venous thrombosis in patients with indobufen was 11% and in those treated with acenocoumarol 9%. Major bleeding was observed in 2 patients treated with acenocoumarol. In the indobufen group, no bleeding complications or other serious side-effects were observed. The majority of patients developed thrombosis after the first week of admission. For patients with and without thrombosis, there was no significant difference between the two treatment groups concerning the age, the coronary prognostic index, the maximum C.P.K. value, mobility, incidence of congestive heart failure and the site or extent of the infarct. In this study no clinical or laboratory (fibrinogen, platelet count and anti-thrombin III) parameter, either alone or in combination, was of predictive value for the development of D.V.T. It can be concluded that indobufen appears to be as good as acenocoumarol for the prevention of D.V.T. in patients with acute myocardial infarction. Because it is safe and easy to administer, indobufen seems to be preferable. Prophylaxis is required for at least 10 days.

Topics: Acenocoumarol; Aged; Antithrombin III; Female; Fibrinogen; Humans; Isoindoles; Leg; Male; Middle Aged; Myocardial Infarction; Phenylbutyrates; Platelet Count; Plethysmography, Impedance; Radionuclide Imaging; Thrombophlebitis

To investigate the possible clinical interaction between the platelet function regulator sulphinpyrazone (SP) and the oral anticoagulant acenocoumarol (AC), 22 in-patients of either sex were included in a single blind within-patient trial vs. placebo. After one week of stabilizing treatment with AC alone the patients were randomly allocated to two sequences (11 patients each), either SP + AC for weeks 2--3 followed by placebo + AC for weeks 4--5, or the reverse sequence, i.e. placebo + AC followed by SP + AC for the same periods. 17 patients completed the full five weeks. Four dropped out during SP treatment, all but one following some form of bleeding episode. One patient dropped out for the same reason during placebo. Apart from the bleeding episodes, no other undesirable effects were recorded. The daily dose of SP was always 800 mg. A statistically highly significant interaction (p less than 0.01) between SP and AC was found. The addition of SP to AC led to a drop in mean prothrombin time and rendered necessary a consequent reduction (of about 20%) in mean AC dosage. It is concluded that when initiating and withdrawing treatment with SP in a patient receiving AC, the prothrombin time should be checked daily for a few days to adapt (reduce) the dosage of AC to the change in prothrombin time induced by SP.

Topics: Acenocoumarol; Adult; Aged; Arterial Occlusive Diseases; Blood Coagulation; Clinical Trials as Topic; Drug Interactions; Female; Humans; Male; Middle Aged; Myocardial Infarction; Placebos; Pulmonary Embolism; Sulfinpyrazone; Thrombophlebitis

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

The British comparative thromboplastin (BCT) was used to monitor the effectiveness of oral anticoagulants in preventing deep vein thrombosis (DVT) in patients undergoing major gynaecological surgery. All patients were screened for DVT with the use of the (125)I-fibrinogen scan.One hundred and forty-five patients aged 40 years or more were randomised into three groups. Group 1 received oral anticoagulant (nicoumalone) treatment, stabilised over five days before surgery and continuing into the second postoperative week. The other patients served as two contrast groups and were managed on a double-blind basis. Group 2 received a subcutaneous low-dose regimen of heparin calcium. Group 3 received subcutaneous saline. Eleven of 48 patients in the saline group, three of 49 patients in the heparin group, and three of 48 patients in the oral anticoagulant group developed DVT as judged by (125)I-fibrinogen scanning. The incidences in groups 1 and 2 were significantly lower than in the saline group. The falls in haemoglobin concentration and incidence of haemorrhage were similar in all three groups.The study showed that oral anticoagulant prophylaxis stabilised preoperatively and low-dose heparin were equally effective in preventing deep vein thrombosis in a moderate-risk group. Immediate preoperative prothrombin ratios of 2.0-2.5 and postoperative ratios of 2.0-4.0 with the BCT gave adequate protection without increased haemorrhagic risk.

Topics: Acenocoumarol; Administration, Oral; Adult; Clinical Trials as Topic; Double-Blind Method; Female; Genitalia, Female; Hemoglobins; Hemorrhage; Heparin; Humans; Middle Aged; Thrombophlebitis; Thromboplastin

A double-blind crossover trial between diclofenac sodium and placebo was carried out in 32 hospitalized patients who were thought to be stabilized on concurrent anticoagulant therapy with acenocoumarol. The object of the trial was to investigate any possible interaction between diclofenac and anticoagulant by monitoring prothrombin times daily through the four week period. No statistically significant difference between placebo and diclofenac could be shown and some problems of accurately monitoring prothrombin times are discussed.

Topics: Acenocoumarol; Angina Pectoris; Arthritis, Rheumatoid; Diclofenac; Double-Blind Method; Drug Interactions; Electric Countershock; Female; Humans; Male; Middle Aged; Myocardial Infarction; Prothrombin Time; Pulmonary Embolism; Thrombophlebitis

Topics: Acenocoumarol; Adult; Aspirin; Clinical Trials as Topic; Dextrans; Dipyridamole; Heparin; Hip; Humans; Injections, Subcutaneous; Middle Aged; Postoperative Complications; Thrombophlebitis; United Kingdom

Topics: Acenocoumarol; Administration, Oral; Adult; Aged; Blood Coagulation Tests; Clinical Trials as Topic; Drug Evaluation; Fibrinogen; Heparin; Humans; Injections, Subcutaneous; Iodine Radioisotopes; Middle Aged; Postoperative Complications; Pulmonary Embolism; Surgical Procedures, Operative; Thrombophlebitis

Topics: Acenocoumarol; Adult; Aged; Catheterization; Dextrans; Drug Combinations; Female; Fibrinolytic Agents; Humans; Male; Middle Aged; Phlebography; Thrombophlebitis; Vena Cava, Superior

Topics: Acenocoumarol; Cesarean Section; Clinical Trials as Topic; Dextrans; Female; Genital Diseases, Female; Humans; Leg; Obstetric Labor Complications; Oxyphenbutazone; Phlebitis; Postoperative Complications; Pregnancy; Pulmonary Embolism; Thromboembolism; Thrombophlebitis

Topics: Acenocoumarol; Aged, 80 and over; Anticoagulants; Fluid Therapy; Furosemide; Heparin; Homozygote; Humans; Male; Mutation; Polypharmacy; Promoter Regions, Genetic; Prothrombin; Pulmonary Embolism; Thrombophilia; Thrombophlebitis

Topics: Acenocoumarol; Edema; Heparin; Heparin, Low-Molecular-Weight; Humans; Immunosuppression Therapy; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Polycystic Kidney, Autosomal Dominant; Polycythemia; Postoperative Complications; Recurrence; Renal Dialysis; Renal Veins; Thrombectomy; Thrombolytic Therapy; Thrombophilia; Thrombophlebitis; Time Factors; Treatment Outcome; Venous Thrombosis

The available data on the utility of low-molecular-weight heparins (LMWH) in the secondary prophylaxis of deep vein thrombosis (DVT) are limited. We compared two cohorts of patients diagnosed of DVT. One group followed treatment with LMWH and the other group did with oral anticoagulants (acenocoumarol). Safety was evaluated by the rate of major hemorrhage and 2.5-years period fracture rate, and efficacy was evaluated as the rate of early recurrence and one-year recurrence rate.. Of 65 patients treated with LMWH, the hemorrhagic rate was 1.5% (95% CI 0.08-9.40), fracture rate was 7.7% (95% CI 2.87-17.75), early recurrence was 1.5% (95% CI 0.08-9.40) and one-year recurrence was 3% (95% CI 53-11.64). In 118 patients treated with oral anticoagulants the hemorrhagic rate was 3.4% (95% CI 1.09-8.97), odds ratio 0.33, the fracture rate was 11% (95% CI 16.23-18.44), odds ratio 0.66, the early recurrence rate was 5% (95% CI 2.08-11.20), odds ratio 0.60 and one-year recurrence was 3.4% (95%CI 1.09-8.97), odds ratio 0.33.. Secondary prophylaxis of DVT with LMWH is as safe and effective as classical treatment with oral anticoagulants. In this study the 2.5-year period fracture rate was similar in both groups of treatment.

Topics: Acenocoumarol; Administration, Oral; Adult; Aged; Anticoagulants; Cohort Studies; Female; Fractures, Bone; Hemorrhage; Heparin, Low-Molecular-Weight; Humans; Incidence; Male; Middle Aged; Recurrence; Registries; Thrombophlebitis

Two patients with developing venous gangrene of the lower extremity and contraindications to systemic thrombolytic therapy are presented. Low-dose intraarterial burst therapy with urokinase provided rapid amelioration of symptoms and avoided amputation without any serious bleeding complications in both patients.

Topics: Acenocoumarol; Adult; Anticoagulants; Contraindications; Female; Gangrene; Heparin; Humans; Infusions, Intra-Arterial; International Normalized Ratio; Leg; Leg Ulcer; Plasminogen Activators; Shock, Septic; Thrombolytic Therapy; Thrombophlebitis; Ultrasonography; Urokinase-Type Plasminogen Activator; Venous Thrombosis

A 69-year-old man developed cholestatic liver enzyme disturbances three and a half weeks after starting treatment with acenocoumarol because of a deep venous thrombosis in his leg. Serological testing showed no signs of recent viral infections. A presumptive diagnosis of hepatotoxicity caused by the use of acenocoumarol was made and the anticoagulant was replaced by low molecular weight heparin. Three weeks after withdrawal of the acenocoumarol, the enzymes had improved. The patient made a full recovery within two months. This case suggests a causal relationship between acenocoumarol exposure and liver damage.

Topics: Acenocoumarol; Aged; Anticoagulants; Diagnosis, Differential; Follow-Up Studies; Humans; Jaundice; Liver; Liver Function Tests; Male; Thrombophlebitis

Deep vein thrombosis (DVT) seems to be related to a hypercoagulation and definite hemorheological alterations, but the importance of these alterations in the development of thrombotic events in the deep vein system has not been established. The present study examines both aspects in a group of 55 patients with DVT; the presence of a hypercoagulable state was assessed by quantifying the prothrombin fragment 1+2 (F1+2) and the thrombin-antithrombin III complex (T-AT), and the main hemorheological parameters were evaluated in the acute state and 6 and 12 months later. The results show marked hemorheological, F1+2, and TAT alterations in the acute phase. After 12 months the pattern shows a modest improvement, but erythrocyte aggregation, fibrinogen, F1+2 and T-AT remain increased with respect to the control group (8.51 +/- 1.43; 331 +/- 81 mg/dl; 1.33 +/- 0.60 nmol/l; 3.54 +/- 1.71 ng/ml vs. 8.10 +/- 1.40; 230 +/- 38; 0.94 +/- 0.40; 1.56 +/- 0.59, respectively). These data suggest that the thrombotic event could be influenced by the previous rheological situation and hypercoagulable state.

Topics: Acenocoumarol; Acute Disease; Adult; Aged; Anticoagulants; Antithrombin III; Blood Coagulation; Blood Viscosity; Convalescence; Erythrocyte Aggregation; Female; Fibrinogen; Follow-Up Studies; Hemorheology; Heparin; Humans; Male; Middle Aged; Peptide Fragments; Peptide Hydrolases; Postoperative Complications; Prothrombin; Thrombophilia; Thrombophlebitis; Wounds and Injuries

The authors describe the combined occurrence of heparin-induced thrombocytopenia and cumarin-induced skin necrosis, a rare condition that has not yet been reported in Hungary. The 69-year-old woman had received prophylactic heparin treatment prior to total hip arthroplasty. The first complication that the anticoagulant therapy brought about was serious thrombocytopenia paradoxically associated not with bleeding but with deep vein thrombosis. The latter necessitated coumarin therapy which resulted in severe skin necrosis.

Topics: Acenocoumarol; Aged; Female; Heparin; Hip Prosthesis; Humans; Necrosis; Postoperative Complications; Preoperative Care; Skin; Thrombocytopenia; Thrombophlebitis

Topics: Acenocoumarol; Combined Modality Therapy; Female; Heparin; Humans; Middle Aged; Necrosis; Partial Thromboplastin Time; Plasma; Protein C; Protein C Deficiency; Skin; Thrombophlebitis; Warfarin

Fibrinolysis of 19 patients who developed CVI after deep vein thrombosis was examined. Mean age of patients at the first thrombosis was 31.8 years. For testing fibrinolysis fibrinogen, plasminogen, AP, ECLT, with venous occlusion were determined. In 10 patients t-PA and PAI-1 activities were also measured and plethysmography was carried out. For screening blood coagulation abnormalities of TCT count, PT, APTT, TT, AT III, protein C were tested. The common abnormality was the decreased fibrinolysis. Patients had been on coumarin for 6.14 years before entering the study. Under coumarin treatment 6 patients had relapsed DVT, 4 had crural ulcer and CVI deteriorated in 8 patients. Therefore we added fibrinolysis increasing PPS to coumarin. PPS dose was individually determined by PPS loading test (150-500 mg). Mean observation time with the combined treatment was 2.92 years. Clinical check up and fibrinolysis test were carried out every 6 months. Clinical improvement occurred in 13 patients, (decrease of swelling, pain etc). Two out of 4 patients with stasis ulcer experienced complete healing; in 1 the ulcer territory diminished in size. Maximum venous outflow improved in 7 patients, 3 patients were non-responders. We observed an increase of fibrinolysis in 10 patients. Venous occlusion enhanced the fibrinolysis increasing effect of PPS. The activity reached its maximum by the first control. The fibrinolysis increase and the clinical improvement do not always run parallel, therefore other effects of PPS as the reason for being beneficial in CVI must be considered (antiinflammatory, ect.). Combination of coumarin and PPS seems to be an effective therapy in CVI with decreased fibrinolysis.

Topics: Acenocoumarol; Administration, Oral; Adult; Chronic Disease; Drug Therapy, Combination; Female; Humans; Male; Pentosan Sulfuric Polyester; Thrombophlebitis; Venous Insufficiency

We present the case of a woman undergoing treatment with acenocoumarol for deep vein thrombosis, who maintained an international normalized ratio (INR) of between 2.5 and 4 for 2 months. Seven days after the introduction of amoxycillin (500 mg/8 h) for a probable respiratory infection, the patient developed spontaneous bruising, with an INR of 7.1. Treatment with amoxycillin was discontinued, and 3 weeks later the INR had returned to previous values. In this case, the increase in the INR value with associated bruising after the addition of amoxycillin suggests a drug interaction between acenocoumarol and amoxycillin, other possible causes having been eliminated.

Topics: Acenocoumarol; Aged; Aged, 80 and over; Amoxicillin; Drug Interactions; Drug Therapy, Combination; Female; Humans; Postoperative Complications; Respiratory Tract Infections; Thrombophlebitis; Time Factors

Topics: Acenocoumarol; Aged; Amiodarone; Drug Interactions; Drug Therapy, Combination; Female; Humans; Thrombophlebitis; Vasculitis, Leukocytoclastic, Cutaneous

Topics: Acenocoumarol; Administration, Oral; Asphyxia; Fatal Outcome; Female; Humans; Middle Aged; Thrombophlebitis

To report two cases of enhanced oral anticoagulant effect induced by doxycycline coadministration.. Case report.. University teaching hospital.. Two patients on chronic oral anticoagulation therapy who presented with severe bleeding and marked impairment in blood coagulation tests shortly after the initiation of doxycycline therapy.. The literature concerning the possible effects of tetracyclines on hemostasis with or without antecedent anticoagulation therapy is reviewed and the speculated mechanisms for such an interaction are discussed.. The administration of tetracyclines such as doxycycline to patients on chronic oral anticoagulation therapy may be associated with a marked enhancement in anticoagulant effect. In such patients the prothrombin ratio should be closely monitored and the anticoagulant dosage adjusted accordingly.

Topics: Acenocoumarol; Aged; Blood Coagulation; Doxycycline; Female; Hemorrhage; Hospitals, University; Humans; Male; Middle Aged; Thrombolytic Therapy; Thrombophlebitis

A case of a arachnoidal cyst with intracystic bleeding and subdural haematoma is reported. The association of an arachnoidal cyst in the middle cranial fossa with a subdural haematoma or intracystic bleeding is emphasised. The diagnosis of such lesions, the nature of the pathology and therapy are discussed.

Topics: Acenocoumarol; Adult; Arachnoid Cysts; Female; Hematoma, Subdural; Humans; Magnetic Resonance Imaging; Postoperative Complications; Recurrence; Thrombophlebitis; Tomography, X-Ray Computed

Topics: Acenocoumarol; Antithrombin III; Antithrombin III Deficiency; Drug Therapy, Combination; Female; Heparin; Humans; Pregnancy; Pregnancy Complications, Hematologic; Recurrence; Thrombophlebitis

A kindred with Type I protein S deficiency is described in which the index case developed skin necrosis during induction of oral anticoagulant therapy for deep venous thrombosis. Two other family members with protein S deficiency have been detected, and demonstrate the clinical variability of this condition.

Topics: Acenocoumarol; Adult; Female; Heparin; Humans; Male; Necrosis; Partial Thromboplastin Time; Pregnancy; Protein C; Skin; Thrombophlebitis; Transcription Factors; Transcription Factors, General; Transcriptional Elongation Factors

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; Anticoagulants; Fibrinolytic Agents; Heparin; Humans; Middle Aged; Thrombophlebitis

A hundred and fifty-two patients who were to undergo major orthopaedic surgery were divided into two groups in order to study the value of dextrans administered as adjuvants to oral anticoagulants in the prevention of deep venous thrombosis. The control group had oral anticoagulants only from the evening before the day of operation, aimed at the 15 per cent thrombotest level. The dextran group had peroperative and postoperative dextran infusions as well. Radionuclide venography was used for thrombosis detection. The dextran group had a lower incidence of thrombosis, but more haemorrhagic problems. The incidence of thrombosis was high in both groups.

Topics: Acenocoumarol; Anticoagulants; Dextrans; Female; Hemorrhage; Humans; Intraoperative Care; Male; Orthopedics; Postoperative Care; Postoperative Complications; Premedication; Thrombophlebitis

It is reported on the occurrence of haemorrhagic complications at old age in patients treated with coumarin. Altogether 352 patients were examined, 96 of them were older than 70 years. A small part of the patients, above all men with obliterating vascular occlusions of the lower extremity were additionally given also thrombocyte aggregation inhibitors. The effective prothrombin level was nearly the same in the two, groups, i.e. in the patients younger and older than 70 years. There was no difference in frequency and severity of the haemorrhages with the exception of macrohaematuria which, however, appeared above all in the younger age group and in women older than 70 years. Under observation of the indications and with a regular control a long-term treatment with coumarin preparations can performed without any particular risk also at old age.

Topics: Acenocoumarol; Aged; Arteriosclerosis Obliterans; Cerebral Hemorrhage; Female; Hemorrhage; Humans; Long-Term Care; Male; Prothrombin; Pulmonary Embolism; Thromboembolism; Thrombophlebitis

Topics: Acenocoumarol; Drug Interactions; Humans; Thrombophlebitis

Topics: Acenocoumarol; Adenocarcinoma; Adult; Anticoagulants; Bronchial Neoplasms; Female; Humans; Leg; Necrosis; Thrombophlebitis

A female patient is described who developed skin and subcutaneous fat necrosis on two occasions after intake of acenocoumarol. Several months later identical skin changes occurred during an episode of cholestasis associated with a prolongation of the prothrombin time to an extent comparable with therapeutic anticoagulation; intake of oral anticoagulants could be excluded. This association gives new insights in the pathogenetic mechanisms responsible for the so-called coumarin necrosis and indicates that it may be not due to drug toxicity or allergy.

Topics: Acenocoumarol; Adipose Tissue; Adult; Blood Coagulation Factors; Cholestasis; Drug Therapy, Combination; Female; Heparin; Humans; Necrosis; Recurrence; Skin Diseases; Thrombophlebitis; Vitamin K

Topics: Acenocoumarol; Anticoagulants; Antithrombin III; Humans; India; Male; Middle Aged; Thrombophlebitis

Topics: Abdomen; Acenocoumarol; Buttocks; Female; Humans; Leg; Male; Middle Aged; Necrosis; Thrombophlebitis

Topics: Acenocoumarol; Adolescent; Adult; Aged; Arm; Female; Fibrinolytic Agents; Heparin; Humans; Leg; Middle Aged; Streptokinase; Thrombophlebitis

Topics: Acenocoumarol; Administration, Oral; Adult; Ecchymosis; Female; Humans; Thrombophlebitis

Topics: Acenocoumarol; Drug Resistance; Female; Heparin; Humans; Middle Aged; Thrombophlebitis; Warfarin

Topics: Acenocoumarol; Adult; Female; Heart Septal Defects, Atrial; Heparin; Humans; Leg; Thrombophlebitis

Topics: Acenocoumarol; Aged; Fibrin; Fibrinogen; Half-Life; Heart Failure; Heparin; Humans; Injections, Intravenous; Iodine Radioisotopes; Leg; Middle Aged; Radionuclide Imaging; Thrombophlebitis

Topics: Acenocoumarol; Adult; Anticoagulants; Dose-Response Relationship, Drug; Drug Evaluation; Female; Heparin; Humans; Injections, Subcutaneous; Male; Middle Aged; Pulmonary Embolism; Spinal Cord Injuries; Thrombophlebitis

Topics: Acenocoumarol; Adult; Drug Therapy, Combination; Female; Heparin; Humans; Male; Methods; Streptokinase; Thrombophlebitis

Topics: Acenocoumarol; Blood Coagulation Tests; Fibrinogen; Half-Life; Humans; Iodine Radioisotopes; Thrombophlebitis

Topics: Acenocoumarol; Adult; Fracture Fixation, Intramedullary; Humans; Leg; Middle Aged; Phlebography; Thrombophlebitis; Tibial Fractures; Time Factors; Veins

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Female; Fibrinogen; Half-Life; Heart Failure; Humans; Iodine Isotopes; Male; Middle Aged; Prothrombin Time; Thrombophlebitis

Topics: Acenocoumarol; Aged; Agglutination Tests; Anti-Bacterial Agents; Antibodies; Female; Hemagglutination Tests; Humans; Sepsis; Serotyping; Thrombophlebitis; Vibrio; Vibrio Infections

Topics: Acenocoumarol; Adult; Aged; Alopecia; Anticoagulants; Blood Coagulation; Blood Coagulation Tests; Coumarins; Dosage Forms; Drug Synergism; Female; Hemorrhage; Heparin; Heparinoids; Humans; Liver; Male; Middle Aged; Myocardial Infarction; Protamines; Thrombophlebitis; Thrombosis; Time Factors

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Breast Diseases; Coumarins; Diabetes Complications; Female; Foot Diseases; Hemorrhage; Humans; Intracranial Embolism and Thrombosis; Middle Aged; Necrosis; Obesity; Pulmonary Embolism; Thromboembolism; Thrombophlebitis; Thrombosis

Topics: Acenocoumarol; Breast Diseases; Female; Humans; Middle Aged; Necrosis; Skin; Skin Diseases; Thrombophlebitis

Topics: Acenocoumarol; Adult; Aged; Blood Coagulation; Female; Humans; Indomethacin; Joint Diseases; Male; Middle Aged; Prothrombin; Thrombophlebitis

Topics: Acenocoumarol; Eye Diseases; Humans; Lipopolysaccharides; Retinal Vessels; Thrombophlebitis

Topics: Acenocoumarol; Anticoagulants; Dicumarol; Drug Therapy; Heparin; Phenindione; Postoperative Complications; Preventive Medicine; Pulmonary Embolism; Thrombophlebitis; Toxicology; Venous Thrombosis; Vitamin K 1; Warfarin

Topics: Acenocoumarol; Anticoagulants; Coumarins; Dicumarol; Drug Therapy; Ecchymosis; Ethyl Biscoumacetate; Gangrene; Necrosis; Phenindione; Pulmonary Embolism; Purpura; Skin Diseases; Thrombophlebitis; Toxicology; Warfarin

Topics: Acenocoumarol; Anticoagulants; Budd-Chiari Syndrome; Endotoxins; Escherichia coli Infections; Heparin; Hirudins; Hyperlipidemias; Pharmacology; Prothrombin Time; Rats; Research; Salmonella Infections; Salmonella Infections, Animal; Thrombophlebitis; Toxicology; Venous Thrombosis

Topics: Acenocoumarol; Adult; Blood Coagulation Tests; Ethyl Biscoumacetate; Female; Humans; Leg; Male; Middle Aged; Phenindione; Thrombophlebitis

Topics: Acenocoumarol; Aminopyrine; Anticoagulants; Blood Pressure Determination; Heparin; Intracranial Embolism; Intracranial Embolism and Thrombosis; Liver Function Tests; Myocardial Infarction; Phenylbutazone; Prothrombin Time; Pulmonary Embolism; Thrombophlebitis; Thrombosis; Toxicology

Topics: Acenocoumarol; Anticoagulants; Coronary Disease; Coumarins; Ethyl Biscoumacetate; Prothrombin Time; Pulmonary Embolism; Thrombophlebitis; Thrombosis

Topics: Acenocoumarol; Anticoagulants; Antithrombins; Blood; Blood Coagulation Tests; Coumarins; Drug Therapy; Factor V; Factor VII; Female; Fetus; Heparin; Humans; Maternal-Fetal Exchange; Pregnancy; Pregnancy Complications; Pregnancy Complications, Cardiovascular; Prothrombin Time; Thrombophlebitis; Umbilical Cord

Topics: Acenocoumarol; Anticoagulants; Blood Coagulation Tests; Capillary Resistance; Drug Therapy; Equipment and Supplies; Myocardial Infarction; Prothrombin; Thrombophlebitis; Toxicology

Topics: Acenocoumarol; Anticoagulants; Arrhythmias, Cardiac; Embolism; Humans; Myocardial Infarction; Pulmonary Embolism; Thrombophlebitis

Topics: Acenocoumarol; Anticoagulants; Blood Coagulation Tests; Coumarins; Drug Therapy; Embolism; Heparin; Humans; Hungary; Myocardial Infarction; Thrombophlebitis; Thrombosis

Topics: Acenocoumarol; Aphasia; Blood Coagulation Tests; Female; Heparin; Humans; Intracranial Embolism; Intracranial Embolism and Thrombosis; Leg; Leg Ulcer; Pregnancy; Pregnancy Complications; Pregnancy Complications, Cardiovascular; Thrombophlebitis; Thrombosis

Topics: Abdomen; Abdominal Cavity; Acenocoumarol; Anticoagulants; Humans; Postoperative Care; Thrombophlebitis; Venous Thrombosis