phenprocoumon and Thrombophilia

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

Cerebral venous sinus thrombosis (CVST) is a rare but potentially life-threatening medical condition. We describe a case of a 47-year-old woman who presented with headache, speech defects, and visual disturbances, and was later diagnosed with cerebral venous sinus thrombosis. The article describes a possible risk of such thrombotic events with exposure to high altitude environment in patients with coagulation defects such as Factor V Leiden mutation. Besides, such neurological conditions can occur independent of altitude illness and need to be recognized as their management differs.

Topics: Altitude; Anticoagulants; Enoxaparin; Factor V; Female; Humans; Middle Aged; Phenprocoumon; Radiography; Sinus Thrombosis, Intracranial; Thrombophilia

Topics: Aged; Anticoagulants; Aryl Hydrocarbon Hydroxylases; Atrial Fibrillation; Comorbidity; Cytochrome P-450 CYP2C9; Denmark; Drug Monitoring; Female; Genotype; Humans; International Normalized Ratio; Linear Models; Male; Middle Aged; Outpatient Clinics, Hospital; Phenprocoumon; Prospective Studies; Severity of Illness Index; Stress, Psychological; Surveys and Questionnaires; Thrombophilia; Vitamin K; Warfarin

Topics: Adult; Anticoagulants; Collateral Circulation; Diagnosis, Differential; Genetic Predisposition to Disease; Heparin, Low-Molecular-Weight; Humans; Iliac Vein; Magnetic Resonance Imaging; Male; Phenprocoumon; Phlebography; Stockings, Compression; Testis; Thrombophilia; Thrombosis; Tomography, X-Ray Computed; Varicose Veins; Vena Cava, Inferior

Topics: Anticoagulants; Drug Administration Schedule; Factor Xa Inhibitors; Female; Fibrin; Fondaparinux; Humans; Middle Aged; Perioperative Care; Phenprocoumon; Polysaccharides; Postoperative Hemorrhage; Surgical Procedures, Operative; Thromboembolism; Thrombophilia; Venous Thrombosis; Vitamin K

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

In portal vein thrombosis, various hypercoagulable conditions and inherited or acquired thrombophilias have already been described as predisposing factors. In a 33-year-old man admitted to a hospital with upper abdominal pain, a partial portal vein and upper mesenteric vein thrombosis, respectively, and a complete splenic vein thrombosis were diagnosed. Further diagnostic procedures showed no evidence for local precipitating factors or any underlying infectious, paraneoplastic or inflammatory disease. Thrombophilia screening demonstrated elevated factor VIII levels (206 %) and von Willebrand factor levels (> 440 %). An acute-phase reaction was excluded. Oral anticoagulant therapy with phenprocoumon was started. Factor VIII and von Willebrand factor were reproducibly elevated to high activity levels over a period of 12 months in absence of acute or chronic inflammatory reaction. Increased levels of factor VIII and von Willebrand factor may play a pathogenetic role in the development of portal, splenic, and mesenteric thrombosis.

Topics: Adult; Chronic Disease; Diagnosis, Differential; Factor VIII; Humans; Magnetic Resonance Angiography; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Phenprocoumon; Portal Vein; Thrombophilia; Thrombosis; von Willebrand Factor

Topics: 3' Untranslated Regions; Activated Protein C Resistance; Anticoagulants; Chemical and Drug Induced Liver Injury; Female; Genetic Predisposition to Disease; Heparin, Low-Molecular-Weight; Heterozygote; Humans; Hypoprothrombinemias; Liver Function Tests; Middle Aged; Phenprocoumon; Prothrombin; Recurrence; Thrombophilia; Venous Thrombosis

Dysfibrinogenemia accounts for approximately 0.7% of thrombophilia in patients with venous thromboembolic disease. In 20% of these patients, plasma thrombophilic dysfibrinogen is below 1.0 mg/ml, defining hypodysfibrinogenemia. We describe a young female patient, in whom hypodysfibrinogenemia was the cause of several severe thromboembolic events which occurred even under oral anticoagulation monitored by a standard prothrombin time (PT) test. In this patient, the standard PT test according to Quick underestimated the plasma coagulability in vivo, presumably due to the low levels of dysfunctional fibrinogen as the substrate of the thromboplastin reagent. A PT test supplemented with bovine plasma fibrinogen (Thrombotest) revealed lower fibrinogen-independent international normalized ratio (INR) values in the proposita on oral anticoagulation compared to a control group with eufibrinogenemia. Monitoring therapy with the fibrinogen-independent Thrombotest secured safe anticoagulation in this patient. We suggest to consider PT tests with exogenous fibrinogen (e.g. Thrombotest) to monitor oral anticoagulation in the rare thrombophilic patients with hypodysfibrinogenemia.

Topics: Adult; Blood Coagulation Tests; Disease Management; Female; Fibrinogens, Abnormal; Heparin; Humans; International Normalized Ratio; Phenprocoumon; Thrombophilia; Thrombosis

Topics: Adult; Anticoagulants; Chemical and Drug Induced Liver Injury; Diagnosis, Differential; Factor V; Female; Humans; Mutation; Phenprocoumon; Protein C; Thrombophilia