phenprocoumon and Gastrointestinal-Hemorrhage

Oral anticoagulation and antiplatelet therapy are risk factors for gastrointestinal (GI) bleeding. GI bleeding-especially lower GI bleeding-seems to be associated with a poorer outcome. With the introduction of dabigatrane and rivaroxaban, difficulties in the management of bleeding complications arose. Thus, the goal of the authors was to establish a standard operating procedure (SOP) for the treatment of severe GI bleeding associated with rivaroxaban, dabigatrane, and antiplatelet therapy. Bleeding complications during phenprocoumon treatment should be treated with prothrombin complex concentrates and vitamin K1. Dabigatrane elimination is highly dependent to the renal function. The measurement of drug concentrations of dabigatrane and rivaroxaban is useful to indicate an increased risk of bleeding complications. Severe bleeding associated with dabigatrane or rivaroxaban therapy should trigger prothrombin complex therapy, whereby in cases with severe bleeding associated with antiplatelet therapy platelet transfusion should be initiated. Low-dose aspirin should be continued after 24 h.

Topics: Algorithms; Anticoagulants; Benzimidazoles; beta-Alanine; Blood Coagulation Factors; Dabigatran; Drug Monitoring; Gastrointestinal Hemorrhage; Heart Diseases; Humans; Metabolic Clearance Rate; Morpholines; Phenprocoumon; Platelet Aggregation Inhibitors; Platelet Transfusion; Rivaroxaban; Thiophenes; Vitamin K

To evaluate medical versus interventional treatment (transjugular thrombus fragmentation, local thrombolysis with or without stent implantation) in patients with acute non-cirrhotic, non-malignant portal vein thrombosis (PVT).. This prospective, observational study enrolled 65 patients with acute (<28 days since begin of symptoms, no cavernoma) PVT in nine centres. Thirty patients received medical treatment and 35 patients received interventional treatment. PVT was graded into grade 1: short thrombosis and incomplete occlusion of the vessel lumen and grade 2: extended thrombosis or complete occlusion. Treatment response was classified as partial or complete, if thrombosis was reduced by one grade or to <25% of the vessel diameter respectively.. Partial and complete response rates were 7% and 30% in the medical compared to 17% and 54% (P < 0.001) in the interventional treatment group. In the multivariate analysis, interventional treatment showed a strong positive (OR 4.32, P < 0.016) and a myeloproliferative aetiology a negative (OR 0.09, P = 0.006) prediction of complete response. Complications were rare in the medical group and consisted of septicaemia and upper gastrointestinal bleeding of unknown origin in one patient each. Interventional treatment was accompanied by mild and self-limiting bleeding complications in nine patients, moderate intra-abdominal bleeding requiring transfusions (2 units) in one patient and peritoneal bleeding requiring surgical rescue in one patient. Four patients in each group developed intestinal gangrene requiring surgery. One patient died 52 days after unsuccessful interventional treatment.. Compared to medical treatment alone, interventional treatment doubled response rates at the cost of increased bleeding complications.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Anticoagulants; Female; Gastrointestinal Hemorrhage; Humans; Liver Diseases; Male; Middle Aged; Phenprocoumon; Portal Vein; Portasystemic Shunt, Transjugular Intrahepatic; Prospective Studies; Thrombolytic Therapy; Venous Thrombosis; Young Adult

Topics: Accidental Falls; Aged, 80 and over; Angioplasty, Balloon, Coronary; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Aspirin; Atrial Fibrillation; Combined Modality Therapy; Diagnosis, Differential; Diverticulum; Female; Gastrointestinal Hemorrhage; Humans; Intestine, Small; Myocardial Infarction; Phenprocoumon; Stents

Topics: Aged, 80 and over; Atrial Fibrillation; Checklist; Diagnosis, Differential; Emergencies; Female; Gastritis; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Kidney Failure, Chronic; Phenprocoumon

Spontaneous small-bowel hematomas most commonly involve the jejunum, followed by the ileum and duodenum, and occur in patients who receive excessive anticoagulation with phenprocoumon/warfarin or who have additional risk factors for bleeding. We report three cases of intramural small-bowel hematoma, all complications of treatment with phenprocoumon, which nowadays is used extensively for therapeutic and prophylactic purposes. Diagnosis can be readily attained by sonography and confirmed using computed tomography. Early diagnosis is crucial because most patients can be treated successfully without surgery. Based on this experience and data from the literature, conservative treatment is recommended for intramural intestinal hematomas, when other complications needing laparotomy have been excluded.

Topics: Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Cholangiopancreatography, Endoscopic Retrograde; Duodenal Diseases; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Image Enhancement; Intestine, Small; Jejunal Diseases; Magnetic Resonance Imaging; Male; Phenprocoumon; Tomography, X-Ray Computed; Ultrasonography

Treatment with vitamin K antagonists (coumarins) is associated with an increased risk of bleeding. In order to elucidate the bleeding risk of users of antiplatelet drugs among users of coumarins, we assessed the odds ratio of major bleeding associated with use of antiplatelet drugs in users of the coumarins acenocoumarol and phenprocoumon. We used data from a Dutch record linkage system, including pharmacy and linked hospitalization records for approximately two million subjects, to conduct a nested case control study in a cohort of new users of coumarins. Cases were patients who were hospitalized with a primary diagnosis of major bleeding while taking coumarin and were matched with up to four control subjects. Conditional logistic regression analysis was used to determine ORs and 95% confidence intervals (CI). We identified 1848 case patients who were matched to 5818 controls. Users of clopidogrel or aspirin showed a significantly increased risk of hospitalization because of major bleeding (OR 2.9, 95% CI 1.2-6.9 and OR 1.6, 95% CI 1.3-1.9, respectively), whereas users of dipyridamole and combinations of antiplatelet drugs showed a strong trend (OR 1.5, 95% CI 1.0-2.3 and OR 1.8, 95 % CI 1.0-3.3, respectively). In all cases, the risks were greater for upper gastrointestinal bleedings than for other bleedings. In conclusion, the use of any antiplatelet drug increases the risk of hospitalization for major bleeding among users of coumarins. Concurrent use of clopidogrel or dipyridamole and coumarins is probably not safer than concurrent use of aspirin and coumarins.

Topics: Acenocoumarol; Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Aspirin; Blood Coagulation; Case-Control Studies; Clopidogrel; Coumarins; Dipyridamole; Drug Therapy, Combination; Female; Gastrointestinal Hemorrhage; Hemorrhage; Hospitalization; Humans; Logistic Models; Male; Medical Records Systems, Computerized; Middle Aged; Netherlands; Odds Ratio; Phenprocoumon; Platelet Aggregation Inhibitors; Risk Assessment; Ticlopidine; Vitamin K

Topics: Aged; Anticoagulants; Female; Gastrointestinal Hemorrhage; Humans; Intestinal Diseases; Intestine, Small; Laparotomy; Phenprocoumon; Radiography, Abdominal; Tomography, X-Ray Computed

Topics: Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Aspirin; Colonic Polyps; Contraindications; Dose-Response Relationship, Drug; Gastrointestinal Hemorrhage; Heparin; Humans; Phenprocoumon; Risk Factors; Thromboembolism

Pneumatosis cystoides intestinalis is a rarely observed disorder on plain abdominal X-ray or colonoscopy examination. Although causing few complaints in adults, it can nevertheless lead to gastrointestinal bleeding. In the reported case, gastrointestinal bleeding was observed with coinciding pneumatosis and phenprocoumon therapy. After stopping anticoagulant therapy, pneumatosis vanished completely, thus suggesting that phenprocoumon is probably a further cause of the cystic disease. In the known list of drugs able to provoke pneumatosis, this case adds a new mechanism of affliction different to either immunosuppression or gas production.

Topics: Aged; Anticoagulants; Gastrointestinal Hemorrhage; Humans; Male; Phenprocoumon; Pneumatosis Cystoides Intestinalis; Radiography

Topics: Adult; Anticoagulants; Gastrointestinal Hemorrhage; Hematoma; Humans; Male; Phenprocoumon; Rectal Diseases; Tomography, X-Ray Computed; Vitamin K

Topics: Abdominal Pain; Aged; Drug Overdose; Female; Gastritis; Gastrointestinal Hemorrhage; Hematoma; Humans; Phenprocoumon; Self Medication; Skin Diseases; Vitamin K Deficiency

We report the history of a 68-year-old man who has been hospitalized for an aortic valve endocarditis. The patient was under full anticoagulation therapy because of an artificial aortic valve (Omnicarbon 23 mm). During hospitalization the patient developed a subacute abdomen accompanied by upper gastrointestinal tract hemorrhage. At endoscopy and radiology an intramural hematoma of the duodenum was found. The typical findings of intramural hematoma such as abdominal X-ray, ultrasound, CT scan, selective small bowel transit and endoscopy are presented and the history as well as therapeutic modalities discussed.

Topics: 4-Hydroxycoumarins; Aged; Aortic Valve; Duodenal Diseases; Gastrointestinal Hemorrhage; Heart Valve Prosthesis; Hematoma; Humans; Male; Phenprocoumon

We report a case of intramural haemorrhage in the duodenum, which was diagnosed by endoscopy and clinical findings. The typical endoscopic findings are described and illustrated. Different causes of intramural haemorrhage of the gut are discussed.

Topics: 4-Hydroxycoumarins; Duodenal Diseases; Endoscopy; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Phenprocoumon

Topics: 4-Hydroxycoumarins; Abdomen, Acute; Coronary Disease; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestine, Small; Laparotomy; Male; Middle Aged; Phenprocoumon

Topics: Aged; Anticoagulants; Duodenal Diseases; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Male; Middle Aged; Phenprocoumon

Topics: 4-Hydroxycoumarins; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Nephrotic Syndrome; Phenprocoumon; Protein Binding; Pulmonary Embolism; Serum Albumin

Topics: 4-Hydroxycoumarins; Enteritis; Gastrointestinal Hemorrhage; Humans; Intestine, Small; Ischemia; Male; Middle Aged; Phenprocoumon; Recurrence

Topics: 4-Hydroxycoumarins; Abdomen, Acute; Blood Coagulation Disorders; Diagnosis, Differential; Gastrointestinal Hemorrhage; Humans; Ileum; Intestinal Obstruction; Jejunum; Phenprocoumon