phenprocoumon and Embolism

For patients who suffered a TIA or a stroke the risk of a second event is high. The recurrence rate, however, can be significantly reduced by a number of prophylactic strategies. Methods for secondary stroke prevention include a healthy lifestyle, intensive body exercise, a low cholesterol diet, and the cessation of smoking. High levels of blood pressure, cholesterol and blood glucose should be rigorously controlled. In particular, blood pressure levels should remain below 135/85 mmHg including a physiological day/night profile. All patients at high risk for cardiac embolism should receive oral anticoagulants. As the risk for embolic events increases with age (especially in patients with atrial fibrillation), a rigid "age-cutoff" for anticoagulation is not justified.

Topics: Administration, Oral; Adult; Anticholesteremic Agents; Anticoagulants; Antihypertensive Agents; Blood Coagulation Disorders; Brain Ischemia; Carotid Artery, Internal; Carotid Stenosis; Cerebral Infarction; Clinical Trials as Topic; Contraceptives, Oral; Embolism; Endarterectomy, Carotid; Exercise; Female; Humans; Hypertension; Hypolipidemic Agents; Ischemic Attack, Transient; Life Style; Male; Phenprocoumon; Platelet Aggregation Inhibitors; Recurrence; Simvastatin; Smoking Cessation; Stroke

A male with atrial fibrillation for 30 years underwent embolectomy in his right leg at age 78 years. Postoperatively, he received enoxaparin 60 mg/twice a day (bid), and on day 5, phenprocoumon was started. The patient's son, a general practitioner, changed phenprocoumon to dabigatran 110 mg/bid on day 8. Pain in his left calf induced readmission after 5 days. International normalized ratio was 2.5 and D-dimer was 20 μg/mL. Dabigatran was stopped and dalteparin 5000 International Units/bid and 40 μg alprostadil infusions were started. After 8 hours, he became comatose due to basilar artery occlusion and eventually died. This tragic case raises the issue of postoperative use of dabigatran, a recently introduced thrombin inhibitor.

Topics: Aged; Anticoagulants; Antithrombins; Arterial Occlusive Diseases; Atrial Fibrillation; Benzimidazoles; beta-Alanine; Cerebral Angiography; Dabigatran; Drug Monitoring; Drug Therapy, Combination; Embolectomy; Embolism; Enoxaparin; Fatal Outcome; Femoral Artery; Humans; International Normalized Ratio; Male; Phenprocoumon; Vertebrobasilar Insufficiency

Topics: Aged; Anticoagulants; Atrial Fibrillation; Atrioventricular Block; Diagnosis, Differential; Electrocardiography; Embolism; Female; Humans; Phenprocoumon; Risk Factors

Topics: Aged; Anticoagulants; Atrial Fibrillation; Embolism; Emergencies; Heparin; Humans; Ischemia; Leg; Male; Patient Admission; Phenprocoumon; Treatment Refusal

Topics: Aged; Anticoagulants; Aspirin; Atrial Fibrillation; Embolism; Female; Humans; Hyperthyroidism; Male; Phenprocoumon; Risk Factors; Thyroid Gland; Thyrotropin

To investigate risk factors for embolization in patients with echocardiographically detected left atrial thrombi and to evaluate thrombus development, we examined 29 patients with transesophageal and transthoracic echocardiography at two points during a follow-up of 18 months. We compared patients with a history of possible arterial embolization (n = 13) with those without (n = 16) in regard to age, gender, left atrial dilatation, localization of the thrombus in the left atrial cavity, spontaneous echo contrast, and atrial fibrillation. Eight patients were treated with aspirin, 20 with phenprocoumon. Only left atrial spontaneous contrast was associated with thromboembolism (10/15 patients with spontaneous contrast experienced arterial embolism; p = 0.038). In six patients arterial embolism occurred after thrombus detection (14% per patient per year). Four of these patients were treated with phenprocoumon, two with aspirin. At reexamination, one thrombus was detected in the patient without anticoagulant treatment and one thrombus was detected in the 8 patients treated with aspirin (13%), compared with ten thrombi detected in the 20 patients (50%) treated with phenprocoumon (p = NS). In 17 patients no thrombus was seen at reexamination. Since only 2 patients had undergone thrombectomy and 3 experienced arterial embolism during follow-up, thrombi disappeared under medical therapy in 12 patients. Patients with left atrial thrombi have a high risk of arterial embolization despite proper anticoagulative or antiplatelet treatment. Embolization occurs significantly more often if spontaneous echo contrast can be visualized. Left atrial thrombi can be reduced in size by the administration of antiplatelet and anticoagulative agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Aspirin; Atrial Fibrillation; Dilatation, Pathologic; Echocardiography; Echocardiography, Transesophageal; Embolism; Female; Follow-Up Studies; Heart Atria; Heart Diseases; Heparin; Humans; Intracranial Embolism and Thrombosis; Male; Middle Aged; Mitral Valve Stenosis; Peripheral Vascular Diseases; Phenprocoumon; Risk Factors; Thrombosis

An 81 year old male patient treated by sulfonylurea and diet was known to have type II diabetes for three years. Because of pulmonary embolism phenprocoumon had been administered for four months. Painful livedo racemosa developed acutely on both lateral sides of the feet and the left knee. A necrosis of the skin over the base of the left small toe developed within a few days. On the basis of the clinical picture cholesterol-embolism was diagnosed. Since anticoagulation is known to promote cholesterol-embolism it was discontinued. Prostaglandin E1 infusions into both legs were administered. Within 3 months the cutaneous lesions healed completely.

Topics: Aged; Aged, 80 and over; Cholesterol; Diabetes Mellitus, Type 2; Embolism; Foot; Humans; Male; Necrosis; Phenprocoumon; Pulmonary Embolism

The incidence of arterial embolism (AE) and pulmonary embolism (PE) during treatment with oral anticoagulants (OA) or without OA therapy was studied in 38 patients with dilated cardiomyopathy (DCMP). AE/PE occurred in 17 patients (44.7%) before initiation of OA treatment. The severity of DCMP was a risk factor for AE/PE, but not the presence of atrial fibrillation or intracardial thrombi. No AE/PE episodes occurred during the period of OA therapy. No major bleeding complications were seen, probably due to the moderate intensity of OA therapy (therapeutic range 5-15% Thrombotest [TT], 2.1-4.8 International Normalized Ratio [INR], median TT value 11%, median INR 2.6). Recurrence of AE was observed in 4 of 5 patients in whom treatment with OA had been discontinued.

Topics: 4-Hydroxycoumarins; Administration, Oral; Adult; Aged; Arteries; Cardiomyopathy, Dilated; Embolism; Female; Hemorrhage; Humans; Male; Middle Aged; Phenprocoumon; Pulmonary Embolism; Retrospective Studies; Risk

Topics: 4-Hydroxycoumarins; Aged; Angiography; Cholesterol; Embolism; Humans; Male; Phenprocoumon

Topics: Anticoagulants; Blood Coagulation Disorders; Coumarins; Embolism; Phenprocoumon; Thrombosis

Topics: Anticoagulants; Coumarins; Dicumarol; Embolism; Humans; Phenprocoumon; Postoperative Complications; Surgical Procedures, Operative; Thromboembolism

Topics: Coumarins; Disease; Embolism; Humans; Phenprocoumon; Thigh