phenprocoumon and Pulmonary-Embolism

Topics: Ambulatory Care; Anticoagulants; Atrial Fibrillation; Blood Coagulation Tests; Drug Monitoring; General Practice; Heart Valve Prosthesis Implantation; Hemorrhage; Humans; International Normalized Ratio; Phenprocoumon; Postoperative Complications; Pulmonary Embolism; Thromboembolism; Venous Thrombosis

Postmenopausal bleeding (PMB) can have various causes and malignancy must always be excluded. Extramedullary manifestations of a haematological disease in the female genital tract are rare. We present the case of a woman with PMB as the first sign of an acute myelogenous leukaemia (AML). An 81-year-old patient presented with PMB. Manual and colposcopic examination raised suspicion of a cervical carcinoma, but histopathology and cervical Pap smear altered the diagnosis to granulocytic sarcoma (GS), an extramedullary manifestation of AML. The patient had a normal blood count 2 weeks prior to the examination, but at the time of presentation her leukocytes had risen to 116000/microl. The patient died 3 days later due to a pulmonary embolism, most probably as a result of leukostasis. In this case, GS of the cervix was the first sign of the AML with simultaneous appearance of leukocytosis and peripheral blasts. PMB was the reason for presentation. GS of the female genital tract is very rare and diagnosis is challenging, especially on the basis of the Pap smear. Abnormal inflammatory cells must be a warning sign and an indication for further examinations. GS as the presenting sign of AML has a poor prognosis with only 6% of patients surviving for more than 2 years.

Topics: Aged, 80 and over; Anticoagulants; Carcinoma; Colposcopy; Diagnosis, Differential; Fatal Outcome; Female; Humans; Phenprocoumon; Pulmonary Embolism; Sarcoma, Myeloid; Thrombophilia; Uterine Cervical Neoplasms; Uterine Hemorrhage

Antithrombotic medication can be performed by means of heparins (non-fractionated heparin, low molecular heparins) or the pentasaccharide Fondaparinux as well as with oral vitamin K antagonists. The use of a low molecular heparin is initially recommended for the sake of practicability and safety in case of patients suffering from deep venous thrombosis of the leg and pelvis with subsequent long-term oral medication using a vitamin K antagonist (Marcumar) for anticoagulation. The most frequent indications for long-term anticoagulation are deep leg and pelvis thromboses, pulmonary embolism with atrial fibrillation, artificial prosthetic valves and open oval foramen with ischaemic cerebral infarction. In case of patients with chronic atrial fibrillation it is expedient to initiate permanent anticoagulation according to a risk score. For the purpose of controlling oral anticoagulation it is recommended to employ the INR value in place of Quick's value because these data are better comparable. In case of atherothrombotic diseases secondary prevention will always indicate administration of a thrombocyte aggregation inhibitor. In such cases acetylsalicylic acid is recommended as the standard preparation.

Topics: Administration, Oral; Adult; Age Factors; Aged; Aged, 80 and over; Anticoagulants; Aspirin; Atherosclerosis; Atrial Fibrillation; Blood Coagulation Tests; Cerebral Infarction; Drug Therapy, Combination; Female; Fibrinolytic Agents; Fondaparinux; Heart Valve Prosthesis; Hemorrhage; Heparin; Heparin, Low-Molecular-Weight; Humans; Male; Middle Aged; Phenprocoumon; Platelet Aggregation Inhibitors; Polysaccharides; Preoperative Care; Prevalence; Primary Prevention; Pulmonary Embolism; Risk Factors; Sex Factors; Stroke; Time Factors; Venous Thrombosis

A 51-year-old obese woman who had just undergone a second osteotomy for arthrosis of the hip joint was given unfractionated heparin, 7,500 IU subcutaneously three times daily, as thrombosis prophylaxis. Signs of fulminant pulmonary embolism occurred on the 16th postoperative day with a platelet count of 33,000/microliters. Suspected heparin-induced thrombocytopenia and thrombosis (HITT) was confirmed by platelet tests. When heparin had been discontinued immunoglobulin G was administered, seven times 5 g intravenously, in view of the immunological genesis of HITT. In addition thrombolysis treatment with streptokinase combined with phenprocoumon was undertaken, until satisfactory anticoagulation was achieved after 4 days. Platelet count rose to 136,000/microliters within 20 hours of the first immunoglobulin dose. Complete clinical normality was restored, scintigraphy showed no perfusion deficit in the lungs.

Topics: Blood Cell Count; Combined Modality Therapy; Female; Heparin; Humans; Immunoglobulins, Intravenous; Middle Aged; Phenprocoumon; Postoperative Care; Pulmonary Embolism; Streptokinase; Syndrome; Thrombocytopenia; Thrombolytic Therapy; Thrombosis; Time Factors

To meet growing demand for oral anticoagulation worldwide there has been increased dependence on computer-assistance in dosage although the safety and effectiveness of any of the individual computer-assisted dosage programs has not previously been established. This randomised multicentre clinical end-point study assessed a new version of the PARMA 5 program. It compared PARMA 5 safety and effectiveness with manual dosage by experienced medical staff at 19 centres with a known interest in oral anticoagulation. Target recruitment was 8000 patient-years, randomised to medical staff or PARMA-5 assisted dosage. Safety and effectiveness of the PARMA 5 program was compared with manual dosage. A total of 10,421 patients were recruited (15,369 patient-years) in the 5-year study. International normalised ratio (INR) tests numbered 167,791 with manual and 160,078 with PARMA 5 dosage. With parma 5 there was overall a non-significant reduction in clinical events but in the 2542 patients with deep vein thrombosis/pulmonary embolism, clinical events were significantly reduced (P = 0.005). Success in achieving 'time in target INR range' was also significantly greater with PARMA 5 compared with the dosage by experienced medical staff. This study demonstrated the safety and effectiveness of PARMA 5-assisted dosage.

Topics: Acenocoumarol; Administration, Oral; Adult; Aged; Aged, 80 and over; Algorithms; Anticoagulants; Drug Therapy, Computer-Assisted; Female; Follow-Up Studies; Humans; International Normalized Ratio; Male; Middle Aged; Phenprocoumon; Pulmonary Embolism; Software; Software Design; Treatment Outcome; Venous Thrombosis; Warfarin

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Care; Anticoagulants; Feasibility Studies; Heparin, Low-Molecular-Weight; Humans; Middle Aged; Nadroparin; Outpatients; Phenprocoumon; Pulmonary Embolism; Risk; Treatment Outcome

The modality and duration of anticoagulation before, during, and after cardioversion of atrial fibrillation--either with or without guidance by transesophageal echocardiography (TEE)--is still an unresolved issue. Intravenous infusion of unfractionated heparin until effective anticoagulation with phenprocoumon or warfarin is used as the standard therapy. However, this approach may be associated with several days of hospitalization because of the necessity for intravenous heparin administration. Moreover, there may be an increased risk of bleeding complications or, conversely, episodes of undercoagulation. Low-molecular weight heparin is an attractive alternative as it not only provide a safe and predictable level of anticoagulation with fewer side effects but can also be administered safely on an outpatient basis. In addition, no anticoagulation monitoring is needed. The ACE study (Anticoagulation in Cardioversion using Enoxaparin) is a randomized, prospective, open-label multicenter trial comparing the safety and efficacy of subcutaneous enoxaparin with intravenous heparin/oral phenprocoumon before and after cardioversion (stratified to TEE guidance or no TEE guidance). This article presents the rationale, design and status of the ACE study.

Topics: Administration, Oral; Adult; Aged; Ambulatory Care; Atrial Fibrillation; Dose-Response Relationship, Drug; Drug Administration Schedule; Echocardiography, Transesophageal; Electric Countershock; Enoxaparin; Female; Heparin; Humans; Infusions, Intravenous; Injections, Subcutaneous; Male; Middle Aged; Phenprocoumon; Prospective Studies; Pulmonary Embolism; Risk Factors; Treatment Outcome; Venous Thrombosis

Type II of heparin-associated thrombocytopenia (HAT) is well known, but the cardinal symptom, thrombocytopenia, is rarely adequately considered. Serious and potential lethal complications such as pulmonary embolism, cerebral stroke, or limb gangrene are often falsely regarded as insufficient anticoagulation. Guided diagnosis and therapy are of vital importance for the patient's outcome. Based on the experience of patients with HAT Type II treated in the intensive care unit, a diagnostic and therapeutic approach to the cardinal symptom thrombocytopenia is presented. A recently developed heparin-induced platelet activation assay (HIPAA) seems to be a highly sensitive laboratory test. The first therapeutic principle in case of presumed and diagnosed HAT is the cessation of unfractioned or low-molecular-weight heparins. ORG 10172 (Orgaran), a low-sulfated heparinoid with a low cross-reactivity (10%) to heparins, can be regarded as the most effective anticoagulant in patients with HAT Type II.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Arterial Occlusive Diseases; Chondroitin Sulfates; Dermatan Sulfate; Diagnosis, Differential; Female; Gangrene; Heparin; Heparitin Sulfate; Humans; Middle Aged; Phenprocoumon; Platelet Activation; Platelet Aggregation; Platelet Count; Pulmonary Embolism; Recurrence; Systemic Inflammatory Response Syndrome; Thrombocytopenia; Thromboembolism; Thrombophlebitis

Topics: Adrenomedullin; Adult; Aged; Ankle Brachial Index; Anticoagulants; Asymptomatic Diseases; Atrial Fibrillation; Atrial Natriuretic Factor; C-Reactive Protein; Cardiovascular Diseases; Carotid Intima-Media Thickness; Female; Fibrinogen; Germany; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Phenprocoumon; Protein Precursors; Pulmonary Embolism; Risk Factors; Stroke; Stroke Volume; Vascular Stiffness; Venous Thrombosis; Warfarin

Topics: Administration, Oral; Amiodarone; Atrial Fibrillation; Drug Administration Schedule; Drug Therapy, Combination; Heparin, Low-Molecular-Weight; Humans; Male; Middle Aged; Parotid Gland; Perioperative Care; Phenprocoumon; Postoperative Complications; Pulmonary Embolism; Rivaroxaban

Calciphylaxis (calcific uremic arteriolopathy) is rare and its pathogenesis is not fully understood. Indeed, Calciphylaxis presents a challenge through the course of its management which involve different specialities but unfortunately this disease so far has a poor prognosis. We herein present, in this case report, a multidisciplinary approach involving plastic surgeons with special regards to reconstructive approach after debridement procedures.. We present a 21 years old male with a BMI of 38,2, who was transferred to our department from another hospital. Calciphylaxis has been diagnosed after receiving anticoagulation with phenprocoumon after a single event of pulmonary embolism. The INR on admission was 1,79. He had necrotic spots on both sides of the abdominal wall and on both thighs medially. During this time he underwent several reconstructive procedures in our department.. It can be suggested that this agonizing disease needs indeed a multidisciplinary approach involving Nephrologists, Dermatologists, Intensive Care Physicians and Plastic Surgeons, taking into consideration that surgical correction can achieve further improvement in a specialized centre. Notwithstanding, further cohort studies should be approached clinically to insight the light on this disease with special regard to the prognosis after this approach.

Topics: Abdominal Wall; Adult; Anticoagulants; Calciphylaxis; Humans; Male; Phenprocoumon; Plastic Surgery Procedures; Pulmonary Embolism; Skin Transplantation; Thigh; Young Adult

Two trained long-distance runners, aged 53 and 58 years, respectively, presented (independently) at our outpatient department because of an acute reduction in physical performance after considerable exertion. Neither had specific clinical symptoms, particularly no dyspnea.. Neither patient had abnormal findings on physical examination, such as signs for deep venous thrombosis. The electrocardiogram and echocardiography were normal. Exercise tests revealed a significant limitation in physical performance and, in one patient, a reduction in arterial blood oxygen and elevated d-dimers as the only abnormal laboratory test result.. The diagnosis of pulmonary embolism was made by computed tomography, which showed the typical changes. In both patients venous phlebography revealed deep vein thrombosis and signs of post-thrombotic changes. Laboratory tests were unremarkable, with normal blood coagulation and no factor II mutations. Anticoagulants were administered to each patient and they slowly resumed their training program. At a subsequent examination physical performance had improved, but there was still a reduction in arterial oxygen during exercise.. Even endurance-trained sportspersons without thrombophilic risk factors may develop deep vein thrombosis. Even when there are no symptoms, pulmonary embolism should always be included in the differential diagnosis of a sudden and significant reduction in physical performance.

Topics: Acute Disease; Angiography; Anticoagulants; Athletic Performance; Diagnosis, Differential; Electrocardiography; Enoxaparin; Exercise Test; Fibrin Fibrinogen Degradation Products; Follow-Up Studies; Humans; Male; Middle Aged; Oxygen; Phenprocoumon; Physical Endurance; Pulmonary Embolism; Running; Tomography, X-Ray Computed; Venous Thrombosis

We report a case of a 35 year old male with severe deep vein thrombosis of the lower limb on both sides and pulmonary embolism. A Klinefelter's mosaic (47,XXY [81%]/48,XXXY [19%]) was diagnosed. Because no other cause for this thromboembolism was found, we assume that in part, it was caused by the Klinefelter's mosaic. In all male patients presenting with thromboembolism, especially those with an unusual habitus, a Klinefelter's syndrome should be considered as differential diagnosis. Testosterone substitution therapy should be started in all patients with Klinefelter's syndrome to prevent further disease.

Topics: Adult; Anticoagulants; Blood Coagulation Tests; Combined Modality Therapy; Diagnosis, Differential; Humans; In Situ Hybridization, Fluorescence; Karyotyping; Klinefelter Syndrome; Male; Mosaicism; Phenprocoumon; Pulmonary Embolism; Stockings, Compression; Tomography, X-Ray Computed; Ultrasonography, Doppler, Duplex; Venous Thrombosis

Aneurysms of popliteal veins are a rare but silent danger that may involve pulmonary embolism. This case report is of a 63-year-old woman with a venous aneurysm of the left popliteal vein who suffered pulmonary embolism twice during treatment with phenprocoumon. Three days after resection she suffered an embolism of the left popliteal vein. Follow-up at 12 months with duplex showed no signs of thrombosis.

Topics: Anastomosis, Surgical; Aneurysm; Diagnosis, Differential; Female; Humans; Middle Aged; Phenprocoumon; Phlebography; Popliteal Vein; Postoperative Complications; Pulmonary Embolism; Recurrence; Thrombolytic Therapy; Tomography, X-Ray Computed; Ultrasonography, Doppler, Duplex; Venous Thrombosis

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

Recurrent thromboembolism despite oral anticoagulation is primarily suspicious of overt or occult neoplasia. We report on a man (age: 67 years) who presented with severe thrombophilia which was only controlled when the patient was set on a combined anticoagulation with low molecular weight heparin in supratherapeutic dosage and phenprocoumon with a target INR of 2.0. Despite repeated evaluation over about two years, a malignant tumour could never be demonstrated. However, the patient suffered in addition to a protein S deficiency from an antiphosphospholipid syndrome and a chronic myelomonocytic leukaemia. We postulate that the accepted strong thrombogenicity of antiphosphospholipid syndrome was further increased by protein S deficiency and a possibly procoagulatory effect of the abnormal monocytes explaining the severe thrombophilia resistant to standard therapeutic anticoagulation with a vitamin K antagonist and usual therapeutic doses of low molecular weight heparin, respectively.

Topics: Aged; Anticoagulants; Antiphospholipid Syndrome; Blood Coagulation Tests; Heparin, Low-Molecular-Weight; Humans; Male; Phenprocoumon; Pulmonary Embolism; Recurrence; Thrombosis; Tomography, X-Ray Computed

Topics: Anticoagulants; Heparin; Humans; Phenprocoumon; Phenylbutazone; Pulmonary Embolism; Randomized Controlled Trials as Topic; Treatment Failure; Vena Cava Filters; Venous Thrombosis

Topics: Heparin; Humans; Phenprocoumon; Phenylbutazone; Pulmonary Embolism; Randomized Controlled Trials as Topic; Survival Rate; Venous Thrombosis

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

A 79-year old man was admitted because of increasing dyspnoea. At physical examination he had dyspnoea at rest, auscultation of the lung was unremarkable and there was no peripheral oedema or unilateral swelling of a leg to suggest venous thrombosis.. Chest radiogram was unremarkable. Perfusion scintigraphy of the lung, performed to exclude pulmonary embolism, revealed several defects typical of emboli. Duplex sonography revealed an isolated thrombosis of the left profunda femoris vein, while the deep veins were patent.. Anticoagulation with heparin followed by phenprocoumon rapidly improved the symptoms and the patient was discharged after 10 days.. Thrombosis of the profunda femoris vein can cause clinically relevant pulmonary embolism. While this vessel cannot be visualized by phlebography, duplex sonography easily establishes the diagnosis and should be used routinely in the investigation of suspected thrombosis of the leg veins.

Topics: Aged; Anticoagulants; Dyspnea; Femoral Vein; Heparin; Humans; Male; Phenprocoumon; Pulmonary Embolism; Radionuclide Imaging; Thrombosis; Ultrasonography, Doppler, Color

Topics: Anticoagulants; Coumarins; Female; Fibrinolytic Agents; Heparin; Hirudin Therapy; Hirudins; Humans; Middle Aged; Phenprocoumon; Pulmonary Embolism; Recombinant Proteins; Thrombocytopenia; Thrombophlebitis; Time Factors

A serious retroperitoneal bleeding occurred in a 56-year-old male patient receiving unfractionated heparin due to multiple pulmonary embolism. After reducing the heparin dose, the patient developed a new pulmonary embolism and a large thrombus in the right atrium. Concomitantly, the platelet count dropped to a value of 29 g/l. Heparin-induced thrombocytopenia (HIT) was confirmed by a functional assay, the heparin-induced platelet activation (HIPA) assay, whereas the results of a platelet factor 4/heparin complex ELISA were repeatedly negative. This indicated that the patient's HIT antibodies were directed towards an antigen other than platelet factor 4/heparin complexes. For treatment of the atrial thrombus, an ultra-low-dose lysis with rt-PA (2 mg/h, intravenously) was administered for a period of 52 h, overlapping with systemic treatment with recombinant hirudin (Lepirudin, Refludan, 0.06-0.14 mg/kg/h intravenously). The aim was to enhance lysis of the thrombus without increasing the haematoma, and at the same time keep the risk of fulminant pulmonary embolism due to thrombus fragmentation as low as possible. The cardiac thrombus disappeared within 48 h, without new signs of pulmonary embolism. Platelet counts normalized within nine days.

Topics: Anticoagulants; Arrhythmias, Cardiac; Autoimmune Diseases; Heart Atria; Heart Diseases; Hemorrhage; Heparin; Hirudin Therapy; Hirudins; Humans; Male; Middle Aged; Phenprocoumon; Plasminogen Activators; Pulmonary Embolism; Recombinant Proteins; Retroperitoneal Space; Thrombocytopenia; Thrombolytic Therapy; Thrombosis; Tissue Plasminogen Activator; Vena Cava Filters

A 23-year-old woman with deep (leg) vein thrombosis was hospitalised because the Quick value had not decreased despite administration of phenprocoumon. Two years previously she had sustained an anterior wall myocardial infarction and a scar on her right kidney had been an incidental sonographic finding. There was bluish, fine reticular discoloration over the toes of both legs. Physical examination was otherwise unremarkable except for obesity.. The concentration of creatine kinase was raised to 250 U/l and that of lactate dehydrogenase to 300 U/l. The platelet count was decreased to 75/nl. The level of IgG anti-cardiolipin antibodies was raised (204 U/l) and the test for lupus anticoagulant positive. A biopsy of the skin from a toe revealing livedoid vasculitis, primary antiphospholipid syndrome (PAPS) was diagnosed.. Noncompliance, excessive vitamin K ingestion, drug interaction and malabsorption were excluded as cause of the lacking action of phenprocoumon. Despite anti-coagulation with high-dosage low-molecular heparin and inhibition of platelet aggregation with ticlopidine and finally also immunosuppressive treatment with cyclophosphamide, skin necroses developed on the toes and she had recurrent pulmonary embolisms of which she died.. Standard treatment of PAPS is effective anti-coagulation with coumarin derivatives. Secondary resistance to coumarin is a rare occurrence: its cause remains unknown.

Topics: Adult; Anticoagulants; Blood Coagulation Disorders; Drug Resistance; Fatal Outcome; Female; Humans; Phenprocoumon; Pulmonary Embolism; Syndrome

Over a period of several months a 33-year-old man had recurrent pulmonary emboli. No thromboses could be demonstrated in the peripheral venous system. Transoesophageal echocardiography showed two spherical space-occupying structures in the right ventricle which were removed operatively under the suspected diagnosis of multilobular myxomas. However, their histological examination revealed pure thrombi that had grown by apposition. This unusual findings of right-ventricular thrombi could not be explained pre- and intraoperatively by any local thrombi-favouring changes in the right heart. Tests of clotting mechanisms demonstrated lupus anticoagulant (kaolin-clotting-time mixture test: LA index 21.7 [normal: < 15]), as well as an increased IgG cardiolipin antibody concentration of 19.3 U/l). As no underlying disease was discovered, the diagnosis was by definition primary antiphospholipid syndrome. No further thrombo-embolism has occurred during continuing oral anticoagulation with phenprocoumon.

Topics: Adult; Antiphospholipid Syndrome; Diagnosis, Differential; Heart Diseases; Heart Neoplasms; Heart Ventricles; Humans; Lupus Coagulation Inhibitor; Male; Myxoma; Phenprocoumon; Pulmonary Embolism; Recurrence; Thrombosis

As the passage of phenprocoumon into human milk has not been studied yet, mothers on oral anticoagulation with Phenprocoumon are advised to stop breastfeeding in order to avoid the potential hazards of vitamin K deficiency haemorrhage in their babies. We analysed the passage of Phenprocoumon into human milk in a breastfeeding mother of a premature baby (gestational age 32 weeks), who required oral anticoagulation on day 19 post partum. The mother was advised to continue collecting her milk with an electric pump, and to resume breastfeeding, if a significant passage of the drug was excluded. Milk Sampling (fore and hind milk pairs (n = 2), for milk (n = 4), 24 h pooled collections) for the Phenprocoumon analyses with an HPLC method was performed on days 27, 28, and 31 when the Quick's Prothrombin time was stable in the therapeutic range (Phenprocoumon plasma concentrations: 1.8-2.2 micrograms/ml).. Phenprocoumon was higher in hind than in foremilk. With constant plasma concentrations the variability between different foremilk samples was 26-76 ng/ml. The Phenprocoumon concentration in the 24 h pooled sample was 33 ng/ml. Estimates of the Phenprocoumon secretion into human breast milk should be from pooled milk samples of a 24 h collection. Phenprocoumon in human milk is only about 1/50 of the corresponding maternal plasma concentrations. The estimated daily Phenprocoumon intake from maternal milk in a baby drinking about 200 ml/kg/day is 6-8 micrograms/kg. This is much less the average maintenance requirement for anticoagulation with Phenprocoumon in children (about 50 micrograms/kg/day).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Adult; Breast Feeding; Chromatography, High Pressure Liquid; Dose-Response Relationship, Drug; Female; Humans; Infant, Newborn; Milk, Human; Phenprocoumon; Puerperal Disorders; Pulmonary Embolism

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bandages; Combined Modality Therapy; Female; Follow-Up Studies; Heparin; Heparin, Low-Molecular-Weight; Humans; Injections, Subcutaneous; Male; Middle Aged; Phenprocoumon; Prospective Studies; Pulmonary Embolism; Radionuclide Angiography; Thrombophlebitis

Topics: Administration, Oral; Blood Coagulation Tests; Crohn Disease; Drug Therapy, Combination; Female; Heparin; Humans; Middle Aged; Phenprocoumon; Platelet Count; Prednisone; Pulmonary Embolism; Substance Withdrawal Syndrome; Sulfasalazine; Thrombocytopenia; Thrombophlebitis

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

Patients with intracoronary stent implantation are treated with aggressive anticoagulant and antiplatelet therapy consisting of high-dose heparin, phenprocoumon, acetylsalicylic acid, dipyridamole, and the infusion of dextran to prevent a subacute thrombotic occlusion of the stented segment. In an effort to optimize this treatment by reducing both imminent bleeding complications and subacute thrombotic occlusion, the concentrations of prothrombin fragment 1 + 2 (F 1 + 2) were determined after intracoronary Palmaz-Schatz stent implantation in 19 consecutive patients. The F 1 + 2 concentrations after stent implantation and before the initiation of oral anticoagulant therapy (OAT) were 0.35 nm/l and 0.25-0.53 nm/l (median and 25th-75th percentile), versus 0.74 nm/l and 0.52-0.78 nm/l, in healthy subjects and 0.61 nm/l and 0.30-1.02 nm/l in 15 patients with ongoing proximal DVT. Nine days after initiation of OAT, F 1 + 2 concentrations in both patient groups had not yet reached levels observed in patients with OAT in the stable state (0.16 nm/l, 0.12-0.26 nm/l; n = 76; P less than 0.0001 compared with healthy subjects; INR 2.0-4.5). Despite an INR greater than 2.0, accompanying heparinization was terminated on day 9. In two stented patients a minor bleeding complication arose after the removal of the arterial catheter. Subacute thrombotic occlusions were not observed. Since F 1 + 2 concentrations did not exceed the upper limit of normal range (1.11 nm/l) in any of the 19 patients, the therapeutic regimen was not changed. Monitoring F 1 + 2 may thus be helpful in introducing a more individual treatment if aggressive anticoagulation has to be performed.

Topics: Administration, Oral; Adult; Aged; Angioplasty, Balloon, Coronary; Anticoagulants; Female; Heart Valve Prosthesis; Heparin; Humans; Male; Middle Aged; Peptide Fragments; Phenprocoumon; Prothrombin; Pulmonary Embolism; Stents; Thrombophlebitis

Topics: Female; Humans; Middle Aged; Necrosis; Phenprocoumon; Pulmonary Embolism; Skin; Streptokinase; Thrombolytic Therapy; Thrombophlebitis; Urokinase-Type Plasminogen Activator

Severe heparin-induced thrombocytopenia (HIT) is a complication of heparin treatment with a frequency of about 0.5% of the treated patients. It is attributed to an immune mechanism leading to the production of heparin-associated antibodies which bind to the platelets and cause their elimination through consumption, sometimes accompanied by thromboembolic episodes. Therapeutically HIT represents a dilemma since heparin administration must be stopped immediately, whereas anticoagulation is acutely indicated in order to avoid thrombotic complications. Two such cases with this dilemma are illustrated. The diagnosis of HIT was made using platelet aggregation studies and flow cytometry techniques for the detection of heparin-associated platelet antibodies. Therapeutically, low molecular weight heparins were administered with success. Besides the diagnostic problems other available therapeutic solutions are discussed.

Topics: Aged; Female; Heparin; Heparin, Low-Molecular-Weight; Humans; Male; Myocardial Infarction; Phenprocoumon; Platelet Aggregation; Platelet Count; Pulmonary Embolism; Thrombocytopenia

Heparin-associated thrombocytopenia (HAT) is a rarely described adverse reaction of systemic administration of heparin that may be complicated by thrombosis, embolism and bleeding. Unfractionated heparin as well as low molecular weight heparin may provoke HAT. A case of HAT complicated by thrombosis and pulmonary embolism is described that came about during preventive postoperative anticoagulation with the low molecular weight heparin enoxaparin. Pathogenesis, diagnosis, prophylaxis and therapy of HAT are discussed.

Topics: Aged; Aspirin; Blood Coagulation Tests; Carcinoma, Renal Cell; Heparin, Low-Molecular-Weight; Humans; Kidney Neoplasms; Male; Nephrectomy; Phenprocoumon; Platelet Aggregation; Platelet Count; Postoperative Complications; Pulmonary Embolism; Thrombocytopenia; Thrombophlebitis

In three patients painful reddening of a well-circumscribed area of the skin occurred within five days of starting anticoagulant treatment with phenprocoumon (Marcumar), and within a short time it developed into a full-blown picture of coumarin necrosis. The indication for phenprocoumon was, in the first patient (a 29-year-old mother lying-in after her second child had been born) an increased platelet count and the presence of high risk factors for thromboembolism. In the second patient (25-year-old man) and the third one (45-year-old woman) it was secondary prophylaxis after pulmonary embolus and deep-vein thrombosis, respectively. All three patients were very obese and had a drug allergy, as well as other allergies (bronchial asthma in Cases 1 and 2; allergic rhinitis in Case 3). Phenprocoumon was at once discontinued in all three patients and low-dose heparin administration (Cases 1 and 3) or dextran infusion (Case 2: heparin intolerance) started. All three needed excision of the necrotic tissue with grafting to the skin defect. The coexistence of obesity and allergic diathesis may thus present an especially high risk for coumarin necrosis.

Topics: Adult; Coumarins; Drug Hypersensitivity; Drug Therapy, Combination; Female; Heparin; Humans; Middle Aged; Necrosis; Obesity; Phenprocoumon; Pulmonary Embolism; Risk Factors; Skin Diseases; Thrombophlebitis; Time Factors

Topics: 4-Hydroxycoumarins; Aged; Female; Forefoot, Human; Humans; 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

Plasma cells are occasionally encountered in peripheral blood during fibrinolytic treatment with streptokinase. Leukaemoid plasmocytosis and increase of immunoglobulins were observed in a 44-year-old patient in connection with streptokinase treatment. Mature stages of plasma cells could be demonstrated in peripheral blood. The observed phenomena are considered as exaggerated immune response to foreign protein. They are of no disease value as they are only concomitant reactions to streptokinase treatment. Spontaneous regression occurred.

Topics: Adult; Humans; Hypergammaglobulinemia; Leukemoid Reaction; Male; Phenprocoumon; Plasma Cells; Pulmonary Embolism; Streptokinase

In a 62-year-old female patient petechial haemorrhages of the right breast were observed after the 4th day of treatment with phenprocoumon. Within a few hours large cutaneous necroses developed. Histology showed lymphocytic vasculitis with vessel wall destruction and erythrocytic extravasates as well as necrobiotic changes of the middle and lower corium. High-dosage treatment with prednisolone was started after withdrawal of phenprocoumon. Progression of the necrosis to the left breast could be prevented. However, necrosis of the haemorrhagic area of the right breast could not be arrested. Aetiology and pathomechanisms of coumarin-induced necrosis have to date not been ascertained. Allergic precipitating mechanisms probably were of no importance in our patient.

Topics: 4-Hydroxycoumarins; Breast Diseases; Bromhexine; Cimetidine; Female; Furosemide; Humans; Middle Aged; Necrosis; Phenprocoumon; Prednisolone; Pulmonary Embolism; Urticaria; Vasculitis

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