phenprocoumon and Hematoma

The characteristics and natural history of acute non-vitamin K antagonists oral anticoagulants (NOAC)-associated intracerebral haemorrhage (ICH) are largely unknown. We performed a comprehensive systematic review and meta-analysis to compare baseline ICH volume, haematoma expansion and clinical outcomes between NOAC-ICH versus vitamin K antagonists-ICH (VKA-ICH).. We searched PubMed and conference abstracts for observational studies comparing baseline characteristics and outcomes in patients with NOAC-ICH versus VKA-ICH using an appropriate keyword/MeSH term search strategy. Data were extracted following PRISMA and MOOSE guidelines. The main outcome measures were mortality and unfavourable functional outcome (modified Rankin Score: 4-6) at discharge and at 3 months, as well as ICH volumes and haematoma expansion rates in the two groups. Random-effects models with DerSimonian-Laird weights were used for pooled estimates calculation.. Twelve studies including 393 NOAC-ICH and 3482 VKA-ICH were pooled in meta-analysis. There was no difference in mean ICH-volume between the two groups (standard mean difference: -0.24; 95% CI -0.52 to 0.04, p=0.093). The rates of haematoma expansion were comparable in NOAC-ICH versus VKA-ICH (OR: 0.76; 95% CI 0.49 to 1.19, p=0.236). We did not find any difference between patients with NOAC-ICH versus VKA-ICH in all-cause mortality at discharge (OR: 0.66; 95% CI 0.42 to 1.05, p=0.077) and unfavourable functional outcome at discharge (OR: 0.77; 95% CI 0.41 to 1.44, p=0.413). The 3-month outcome was also comparable between the two ICH groups. Moderate-to-substantial statistical heterogeneity was noted.. Our results confirm that ICH volume, haematoma expansion, mortality and functional outcome appear to be similar for NOAC-ICH versus VKA-ICH. Large prospective cohorts and updated meta-analyses are needed to provide more precise estimates.

Topics: Anticoagulants; Antithrombins; Cerebral Hemorrhage; Dabigatran; Factor Xa Inhibitors; Hematoma; Humans; Mortality; Odds Ratio; Phenprocoumon; Pyrazoles; Pyridines; Pyridones; Rivaroxaban; Severity of Illness Index; Thiazoles; Vitamin K; Warfarin

Rapid reversal of the anticoagulatory effect of vitamin K antagonists represents the primary emergency treatment for oral anticoagulant-related intracerebral hemorrhage (OAC-ICH). Predicting the amount of prothrombin complex concentrate (PCC) needed to reverse OAC in individual patients is difficult, and repeated international normalized ratio (INR) measurements in central laboratories (CLs) are time-consuming. Accuracy and effectiveness of point-of-care INR coagulometers (POCs) for INR reversal in OAC-ICH have not been evaluated.. In phase 1, the agreement of emergency POC and CL INR measurements was determined. In phase 2, stepwise OAC reversal was performed with PCC using a predetermined dosing schedule. Concordance of POC and CL INR measurements during reversal and time gain due to POC were determined.. In phase 1 (n = 165), Bland-Altman analysis showed close agreement between POCs and CLs (mean INR deviation 0.04). In phase 2 (n = 26), POCs caused a median initial net time gain of 24 minutes for the start of treatment with PCC. Median time for POC-documented complete OAC reversal was 28 minutes, compared with 120 minutes for CLs. Bland-Altman analysis between POCs and CLs revealed a mean INR deviation of 0.13 during stepwise PCC administration. POCs tended to slightly overestimate the INR, especially at higher INR levels. Remarkably, POC-guided reversal led to a median reduction of 30.5% of PCC dose compared with the a priori dose calculation. Hematomas enlarged in 20% of patients.. POC INR monitoring is a fast, effective, and economic means of PCC dose-titration in OAC-ICH. Larger studies examining the clinical efficacy of this procedure are warranted.

Topics: Aged; Aged, 80 and over; Anticoagulants; Blood Coagulation Factors; Cerebral Hemorrhage; Female; Follow-Up Studies; Hematoma; Humans; International Normalized Ratio; Male; Phenprocoumon; Prospective Studies; Time Factors; Treatment Outcome

The aim of this observational study was to compare the postprocedural incidence of bleeding and thromboembolic complications associated with novel oral anticoagulants (NOACs) with that of interrupted and continuous phenprocoumon after pulmonary vein isolation (PVI) using a purse-string suture (PSS) closure of the puncture site.. Consecutive patients who had undergone PVI via cryoballoon ablation were divided into the following groups: (1) interrupted phenprocoumon with heparin bridging (n=101), (2) continuous phenprocoumon targeting an internationally normalized ratio>2 (n=70), and (3) NOACs without bridging that were restarted 2-4h after the procedure (n=185). Protamine was not administered after venous closure with PSS at the end of the procedure. The total complication rate was significantly lower in group 3 than in groups 1 and 2 (1.62% vs. 6.93% vs. 7.14%, p=0.04). The hospital costs were lower and the hospital stay length was significantly shorter (4484±3742 vs. 6082±4044 Euro vs. 4908±2925, p=0.03; 1.94±1.67 vs. 2.70±1.80 vs. 2.19±1.30days, p<0.01). No thromboembolic event occurred. Vascular complications were the most common complications noted (80%). The occurrence of any complication led to a significantly longer hospital stay (5 vs. 2days, p<0.01) and higher costs (10,052±6241 Euro vs. 4747±3447, p<0.01). The vascular complication rate after PSS was independent of intraprocedural heparin dosage and activated clotting time.. NOACs have a lower complication rate and appear to be safer in this setting than phenprocoumon. The hospital costs and hospital stay length after PVI was significantly reduced in patients treated with NOACs compared with phenprocoumon.

Topics: Administration, Oral; Aged; Anticoagulants; Catheter Ablation; Cohort Studies; Cryosurgery; Female; Follow-Up Studies; Hematoma; Humans; Male; Middle Aged; Phenprocoumon; Postoperative Complications; Pulmonary Veins; Suture Techniques; Thromboembolism; Treatment Outcome

In a total of 171 surgical procedures for lesions in the head and neck region in patients in whom phenprocoumon therapy was not stopped, 16 (9%) postoperative bleeding events were observed over a follow-up period of two weeks. Local measures were sufficient in all cases except one severe case where blood transfusion was needed and anticoagulant treatment was stopped for 7 days. The bleeding risk was significantly higher for the surgical procedures of the nose than those in other areas (21% versus 6%, P = 0.014), but was not influenced by the international normalized ratio (INR) of blood coagulation, size, site and type of the lesion, surgical procedure, and sex and age of the patients. The bleeding rate in patients not on any anticoagulation therapy was significantly lower (6/211 = 3%). Across both groups, just over 80% of the bleeding episodes were within the first two days (55% on the same day and 32% on the next day) of the surgery. No bleeding was recorded after 5 days. Our data suggest that cutaneous surgery in the head and neck region can be safely performed with continued phenprocoumon therapy in most cases in an INR range of 1.3-3.4, but rarely severe bleeding does occur and can be managed with a close-contact follow-up and with 24-h on call services during the first two days postoperatively.

Topics: Aftercare; Age Factors; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Anticoagulants; Bandages; Blood Transfusion; Dermatologic Surgical Procedures; Female; Follow-Up Studies; Head and Neck Neoplasms; Hematoma; Hemostasis, Surgical; Humans; International Normalized Ratio; Male; Mohs Surgery; Nose; Phenprocoumon; Plastic Surgery Procedures; Postoperative Hemorrhage; Risk Assessment; Surgical Flaps

Topics: Accidents, Occupational; Diagnosis, Differential; Female; Hematoma; Hemorrhage; Humans; Leg Injuries; Middle Aged; Muscle, Skeletal; Phenprocoumon; Pigmentation Disorders; Ultrasonography, Doppler, Duplex; Venous Thrombosis

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

Topics: Adult; Anticoagulants; Antithrombin III; Antithrombin III Deficiency; Factor IX; Hematoma; Humans; Male; Muscular Diseases; Mutation; Phenprocoumon; Protein Precursors; Venous Thrombosis; Vitamin K

Topics: Administration, Oral; Anticoagulants; Arterial Occlusive Diseases; Contrast Media; Diagnosis, Differential; Follow-Up Studies; Hematoma; Humans; Image Processing, Computer-Assisted; Liver Diseases; Male; Middle Aged; Phenprocoumon; Tomography, X-Ray Computed

We report the case of a 83-year-old female patient with ST elevation myocardial infarction who developed a rectus sheath hematoma during treatment with antiplatelet medication and systemic anticoagulants following cough attacks. The patient presented with progressive pain in the left lower abdomen associated with a palpable mass and anaemia. Abdominal sonography and computed tomography revealed a rectus sheath hematoma. We discuss pathogenesis, clinical findings, diagnostic workup and therapy. Moreover, we review the current related literature.

Topics: Abdomen, Acute; Aged, 80 and over; Anticoagulants; Aspirin; Atrial Fibrillation; Clopidogrel; Colonic Pseudo-Obstruction; Comorbidity; Cough; Dalteparin; Diagnosis, Differential; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Hematoma; Humans; Intracranial Embolism; Phenprocoumon; Rectus Abdominis; Ticlopidine

Phenprocoumon is a derivative of coumarin, used as a preventative anticoagulant and in the treatment of thromboembolisms. On account of its pharmacodynamic and pharmacokinetic properties, strict surveillance of the patient is necessary. We report on two cases of undocumented administration of this active pharmaceutical ingredient. A 57-year-old woman was discovered by her husband in an inanimate state. The post-mortem examination revealed many extensive haematomas. On account of a suspicion of third-party negligence, an autopsy was performed the same day, during which was established that the cause of death was a clotting abnormality, the cause of which remained unclear. Toxicological analyses revealed a concentration of phenprocoumon of 7.8 mg/l. A 76-year-old man admitted himself to hospital immediately upon returning from a stay abroad. In hospital, extensive haematomas and a massive clotting abnormality (prothrombin ratio<10%) were discovered. A blood sample taken the following day yielded evidence of a phenprocoumon concentration of 3.1 mg/l. According to his general practitioner, no corresponding medications had been prescribed. Suspicion of foul play in the introduction of this active agent resulted in a police investigation. Both cases demonstrate the necessity of toxicological analyses in cases of clotting abnormalities.

Topics: Aged; Anticoagulants; Blood Coagulation Disorders; Female; Forensic Pathology; Forensic Toxicology; Hematoma; Humans; Male; Middle Aged; Phenprocoumon; Prothrombin Time

Topics: Aged, 80 and over; Anticoagulants; Duodenal Diseases; Female; Hematoma; Humans; Jaundice, Obstructive; Magnetic Resonance Imaging; Phenprocoumon; Tomography, X-Ray Computed; Ultrasonography

Topics: Aged, 80 and over; Airway Obstruction; Anticoagulants; Atrial Fibrillation; Cough; Deglutition Disorders; Drug Overdose; Hematoma; Humans; Male; Neck; Phenprocoumon; Prothrombin Time; Skin Diseases; Venous Insufficiency

We report about the sudden onset of a median nerve neuropathy in an anticoagulated patient eight weeks after uneventful carpal tunnel release. Several differential diagnosis have to be considered: compression syndrome as well as iatrogenic damage of the median nerve due to the preliminary procedure or even concomitant disease can generate symptoms of peripheral neuropathy. We diagnosed an intraneural haematoma through surgical exploration. This rare complication of oral anticoagulation therapy occurred spontaneously and was treated successfully by interfascicular neurolysis.

Topics: Aged; Anticoagulants; Atrial Flutter; Carpal Tunnel Syndrome; Diagnosis, Differential; Hematoma; Heparin, Low-Molecular-Weight; Humans; Male; Median Neuropathy; Neurologic Examination; Pacemaker, Artificial; Phenprocoumon; Postoperative Complications; Reoperation

Thrombolytic therapy is a well-defined treatment option for arterial and venous thrombosis in adults. In contrast, uniform recommendations regarding the indication, route of administration, and dosing of thrombolytic therapy in children are not available. The authors report the successful resolution of bilateral pulmonary embolism and popliteal artery thrombosis in an 11-year-old girl and 13-year-old girl, respectively, by catheter-directed thrombolysis with low-dose recombinant tissue plasminogen activator. Catheter-directed low-dose thrombolysis is an efficient treatment option for severe venous and arterial thrombosis in children.

Topics: Adolescent; Age Factors; Anticoagulants; Arthroscopy; Child; Dose-Response Relationship, Drug; Drug Therapy, Combination; Estrogens; Female; Fibrinolytic Agents; Hematoma; Heparin; Humans; Injections, Intra-Arterial; Knee Injuries; Lupus Erythematosus, Systemic; Phenprocoumon; Popliteal Artery; Postoperative Complications; Progesterone; Pulmonary Artery; Pulmonary Embolism; Recombinant Proteins; Sex Chromosome Disorders; Thrombolytic Therapy; Thrombophilia; Thrombosis; Tissue Plasminogen Activator; Trisomy

Topics: Administration, Oral; Aged; Diagnosis, Differential; Hematoma; Heparin, Low-Molecular-Weight; Humans; Inflammation; Male; Pain; Phenprocoumon; Popliteal Cyst; Rupture, Spontaneous; Thrombophlebitis; Ultrasonography, Doppler, Duplex; Venous Thrombosis

Two patients with severe bleeding complications under oral anticoagulant treatment are presented, in one case caused by pharmacokinetic drug interference (phenylbutazone), in the other by genetic predisposition to bleeding induced by coumarin anticoagulants. Another patient with decreasing INR due to drug interference (rifampicin) is presented as well. The possibility of drug interferences with coumarin anticoagulants has to be anticipated, whenever the medication of an orally anticoagulated patient is changed. A founder mutation of the factor IX propeptide constitutes a genetic predisposition to bleeding in patients put on coumarins. Its presence should be excluded in any patient suffering from hemorrhagic complications after starting anticoagulation when INR values are in the target range.

Topics: Administration, Oral; Aged; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Aortic Valve; Blood Coagulation Tests; Drug Interactions; Follow-Up Studies; Genetic Predisposition to Disease; Heart Valve Prosthesis; Hematoma; Hemorrhage; Heparin, Low-Molecular-Weight; Humans; Iatrogenic Disease; Injections, Intramuscular; Low Back Pain; Male; Middle Aged; Mitral Valve; Phenprocoumon; Phenylbutazone; Thrombophlebitis; Time Factors

A patient with a history of tachycardiac atrial fibrillation and pulmonary embolism was admitted to the emergency unit with acute shortness of breath. The patient was on coumarin medication. Pulmonary embolism, heart failure, or pulmonary edema could be ruled out. Laryngoscopy revealed a huge hematoma of both valleculae extending to the lateral pharyngeal wall and the epiglottis. The epiglottic cartilage was displaced to the posterior pharyngeal wall. The INR was > 6. Prothrombin complex, vitamin K1, corticoids, and fresh frozen plasma were administered immediately. The patient was monitored--without tracheotomy--in the intensive care unit and received oxygen. In a patient with dyspnea, impaired ventilation has to be considered besides impaired perfusion or diffusion.

Topics: Aged; Airway Obstruction; Diagnosis, Differential; Dyspnea; Hematoma; Humans; Laryngoscopy; Male; Oropharynx; Phenprocoumon; Pulmonary Embolism

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

A 46-year old nurse complaining of multiple hematomas including bleeding into the tongue was referred for hemostasis evaluation. A very low Quick percentage value, i.e. a severely prolonged prothrombin time with severely depressed vitamin K-dependent coagulation factors (FII:C, FVII:C, FX:C) and normal FV:C and fibrinogen level was found. In the absence of cholestasis, malabsorption and broad-spectrum antibiotic therapy, ingestion of vitamin K antagonists was suspected. Three years previously, she had been on oral anticoagulant treatment with phenprocoumon (Marcoumar) for postoperative pulmonary embolism. She denied having voluntarily ingested anticoagulant drugs. A high plasma level of coumarins was found. To exclude accidental ingestion, the patient's son living in the same household was tested as well. Surprisingly, a low level of coumarin was found also in his plasma. We suspect that the patient voluntarily intoxicated herself and gave a low dose of coumarin anticoagulant to her son as well.

Topics: Anticoagulants; Blood Coagulation Tests; Drug Overdose; Female; Hematoma; Hemorrhagic Disorders; Humans; Middle Aged; Phenprocoumon; Tongue Diseases; Warfarin

Topics: Aged; Anticoagulants; Drug Overdose; Hematoma; Hematuria; Humans; Male; Medication Errors; Phenprocoumon; Retroperitoneal Space; Time Factors

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

After stent implantation there is a high risk of acute stent thrombosis. Therefore, a very aggressive anticoagulation drug regimen is necessary. Two patients developed large hematomas of the upperarm that where presumably caused by automatic blood pressure measuring equipment or by a tourniquet used during blood collection. In one patient a complete paralysis of the ulnar and radial nerves resulted.

Topics: Angioplasty, Balloon, Coronary; Anticoagulants; Arm Injuries; Aspirin; Blood Pressure Monitors; Coronary Disease; Drug Therapy, Combination; Hematoma; Heparin; Humans; Male; Middle Aged; Phenprocoumon; Prothrombin Time; Stents

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

Topics: 4-Hydroxycoumarins; Aged; Female; Hematoma; Humans; Lung Diseases; Phenprocoumon; Radiography

In 4 women patients aged over 60 years under anticoagulation, abdominal pain, which was in part clearly localizable, and signs of acute bleeding suddenly occurred. All were under treatment with marcoumar, while one was also in the transitional phase from parenteral to oral therapy with heparin. Initially, apart from pain on pressure, there were no local signs of bleeding. In the acute stage it was impossible to distinguish clinically between abdominal wall bleeding and intraperitoneal bleeding. Ultrasound provided the diagnosis of abdominal wall bleeding in all cases. All of them were successfully treated by conservative means.

Topics: Abdominal Muscles; Aged; Anticoagulants; Female; Hematoma; Heparin; Humans; Middle Aged; Phenprocoumon; Ultrasonography

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

Topics: 4-Hydroxycoumarins; Anticoagulants; Chronic Disease; Female; Hematoma; Humans; Laryngeal Diseases; Middle Aged; Penicillin G Benzathine; Pharyngeal Diseases; Phenprocoumon; Thrombophlebitis; Tonsillitis

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

Topics: 4-Hydroxycoumarins; Female; Hematoma; Humans; Male; Middle Aged; Muscular Diseases; Nerve Compression Syndromes; Phenprocoumon; Thrombophlebitis

Topics: Female; Femoral Nerve; Hematoma; Heparin; Humans; Male; Middle Aged; Nerve Compression Syndromes; Pelvic Neoplasms; Phenprocoumon; Retroperitoneal Space