phenprocoumon and Venous-Thrombosis

Neonatal renal vein thrombosis is a recognised cause of renal and inferior caval vein atresia (IVCA). However, the long-term impact of the condition is underrecognized with a high burden of morbidity for the patient, especially in adulthood. IVCA has been shown to be an independent risk factor for deep venous thrombosis (DVT) with a high risk of recurrence. The acronym KILT for kidney and inferior vena cava anomaly with leg thrombosis summarizes the pathological situation.. We present the case of a 40-year-old patient with pain in the right lower limb resulting from acute thrombophlebitis. No risk factors could be identified. His history was remarkable with two episodes of deep venous thrombosis first of the left, then the right leg 22 years earlier; at that time also, no risk factor was identified. Because of the idiopathic character of that thrombosis, the patient remained on long-term anticoagulation with phenprocoumon. The present thrombophlebitis occurred while the INR was not therapeutic in the preceding weeks. A CT with contrast showed atresia of the inferior vena cava and of the right kidney, and presence of numerous collaterals. A thorough medical history revealed a renal vein thrombosis as a neonate. Anticoagulation was intensified, and stent placement became necessary after a further 2 years.. KILT syndrome is a rare but underrecognized condition. Complications may arise in young adulthood only, and it is of prime importance to instruct parents of the pediatric patient of the possible consequences of renal vein thrombosis and to assure guidance from the treating physicians throughout adulthood. Diagnosis of IVCA is by CT with contrast or by MRI, and lifelong anticoagulation may be necessary. Since the KILT syndrome is widely underdiagnosed, we challenge the clinicians to keep it in mind when confronted with thrombophlebitis or thrombosis of the young, male and with no other identifiable risk factors for deep vein thrombosis.

Topics: Abbreviations as Topic; Adult; Anticoagulants; Follow-Up Studies; Humans; Infant, Newborn; Kidney; Leg; Male; Pain; Phenprocoumon; Renal Veins; Syndrome; Thrombophlebitis; Time Factors; Tomography, X-Ray Computed; Vascular Malformations; Vena Cava, Inferior; Venous Thrombosis

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

Topics: Administration, Oral; Adult; Anticoagulants; Female; Humans; Leg; Pelvis; Phenprocoumon; Stockings, Compression; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color; Vena Cava, Inferior; Venous Thrombosis

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

Essentials Prospective studies of pharmacogenetic-guided (PG) coumarin dosing produced varying results. EU-PACT acenocoumarol and phenprocoumon trials compared PG and non-PG dosing algorithms. Sub-analysis of EU-PACT identified differences between trial arms across VKORC1-CYP2C9 groups. Adjustment of the PG algorithm might lead to a higher benefit of genotyping.. Background The multicenter, single-blind, randomized EU-PACT trial compared the safety and efficacy of genotype-guided and non-genetic dosing algorithms for acenocoumarol and phenprocoumon in patients with atrial fibrillation or deep vein thrombosis. The trial showed no differences in the primary outcome between the two dosing strategies. Objectives To explore possible reasons for the lack of differences between trial arms by performing a secondary analysis of EU-PACT data in order to evaluate the performance of both dosing algorithms across VKORC1-CYP2C9 genetic subgroups. Patients/Methods Anticoagulation control measured according to an International Normalized Ratio (INR) below (INR of < 2), within (INR of 2-3) and above (INR of > 3) the therapeutic range was compared across VKORC1-CYP2C9 subgroups. Owing to a low number of patients in each subgroup, trials for acenocoumarol and phenprocoumon were combined for analysis. Results Four weeks after therapy initiation, genotype-guided dosing increased the mean percentage of time in the therapeutic INR range (PTIR) in the VKORC1 GG-CYP2C9*1*1 subgroup as compared with the non-genetic dosing (difference of 14.68%, 95% confidence interval [CI] 5.38-23.98). For the VKORC1 AA-CYP2C9*1*1 subgroup, there was a higher risk of under-anticoagulation with the genotype-guided algorithm (difference of 19.9%; 95% CI 11.6-28.2). Twelve weeks after therapy initiation, no statistically significant differences in anticoagulation control between trial arms were noted across the VKORC1-CYP2C9 genetic subgroups. Conclusions EU-PACT genetic-guided dose initiation algorithms for acenocoumarol and phenprocoumon could have predicted the dose overcautiously in the VKORC1 AA-CYP2C9*1*1 subgroup. Adjustment of the genotype-guided algorithm could lead to a higher benefit of genotyping.

Topics: Acenocoumarol; Aged; Algorithms; Anticoagulants; Atrial Fibrillation; Cytochrome P-450 CYP2C9; Data Interpretation, Statistical; Female; Genotype; Humans; International Normalized Ratio; Male; Middle Aged; Pharmacogenetics; Phenprocoumon; Prospective Studies; Single-Blind Method; Treatment Outcome; Venous Thrombosis; Vitamin K; Vitamin K Epoxide Reductases

Vitamin K1 (VK1) reverses the effects of vitamin K antagonists (VKAs). The literature shows that the bioavailability from solutions might be higher than that from tablets, possibly resulting in different effects.. To compare the bioavailability and effect on the International Normalized Ratio (INR) of 5-mg VK1 tablets and solution in three randomized clinical trials.. The bioavailability was determined in a crossover trial with 25 healthy volunteers. VK1 plasma concentrations were assessed at 0, 2, 4, 5, 6, 8, 10 and 24 h, and the area under the curve was higher in the solution group than in the tablet group (mean difference 365 μg L(-1) h, 95% confidence interval [CI] 230-501, P < 0.0001). In the other two trials, the effects of both formulations on the INR were measured at 0, 24 and 48 h. In the second trial, on 72 patients on phenprocoumon with planned invasive procedures, both formulations were similarly effective, because all patients reached an INR of < 2.0, which was the primary endpoint. In the last trial, on 72 patients on phenprocoumon with an INR of 7.0-11.0, the INR decreased slightly more in the solution group (4.7, 95% CI 4.3-5.1) than in the tablet group (4.2, 95% CI 3.8-4.6). The solution group had a 3.3-fold increased likelihood (95% CI 0.7-15.1) of reaching an INR of < 2.0 at 48 h. Additionally, the increases in VK1 concentrations were similar (tablets, 3.2 μg L(-1) ; solution, 3.4 μg L(-1) ; P = 0.99) after 24 h.. VK1 tablets are at least as clinically effective as the solution in countering VKAs.

Topics: Administration, Oral; Adult; Aged; Antifibrinolytic Agents; Atrial Fibrillation; Biological Availability; Cross-Over Studies; Female; Healthy Volunteers; Humans; International Normalized Ratio; Likelihood Functions; Male; Middle Aged; Phenprocoumon; Tablets; Venous Thrombosis; Vitamin K 1

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

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

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: Anticoagulants; Cecum; Colonoscopy; Female; Humans; Liver Cirrhosis, Alcoholic; Magnetic Resonance Imaging; Mesenteric Ischemia; Middle Aged; Phenprocoumon; Portal Vein; Ultrasonography, Doppler, Duplex; Varicose Veins; Venous Thrombosis

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

A 59-year-old male patient suffered three life-threatening instent thromboses after an initial resuscitation due to an ST-segment elevation myocardial infarction of the anterior cardiac wall. With a high-risk profile for heparin-induced thrombocytopenia (HIT), he was placed on argatroban after the second reinfarction. Under this apparently appropriate treatment, a third reinfarction occurred, and the patient had to undergo high-risk cardiac bypass surgery. Later on, a deep vein thrombosis and an intracardiac thrombus formed. Despite a positive screening test for HIT and a single positive result in the heparin-induced platelet aggregation test, we are not convinced that HIT was the only underlying cause for this 'catastrophic thrombotic syndrome'. We speculate that a massive generation of thrombin, reflected in consistently high D dimers and the need of copious amounts of a direct thrombin inhibitor, triggered the set of events. With this case report, we want to raise awareness for cardiac complications in patients with complex clotting disorders and share our experience in the diagnostic and therapeutic management of such an unusual scenario.

Topics: Anticoagulants; Antithrombins; Arginine; Awareness; Blood Coagulation Tests; Coronary Artery Bypass; Heparin; Humans; Male; Middle Aged; Phenprocoumon; Pipecolic Acids; Platelet Aggregation Inhibitors; ST Elevation Myocardial Infarction; Sulfonamides; Thrombocytopenia; Thrombosis; Treatment Outcome; Ultrasonography; Venous Thrombosis

Risk scores for patients who are at high risk for major bleeding complications during treatment with vitamin K antagonists (VKAs) do not perform that well. BLEEDS was initiated to search for new biomarkers that predict bleeding in these patients.. To describe the outline and objectives of BLEEDS and to examine whether the study population is generalizable to other VKA treated populations.. A cohort was created consisting of all patients starting VKA treatment at three Dutch anticoagulation clinics between January-2012 and July-2014. We stored leftover plasma and DNA following analysis of the INR.. Of 16,706 eligible patients, 16,570 (99%) were included in BLEEDS and plasma was stored from 13,779 patients (83%). Patients had a mean age of 70 years (SD 14), 8713 were male (53%). The most common VKA indications were atrial fibrillation (10,876 patients, 66%) and venous thrombosis (3920 patients, 24%). 326 Major bleeds occurred during 17,613 years of follow-up (incidence rate 1.85/100 person years, 95%CI 1.66-2.06). The risk for major bleeding was highest in the initial three months of VKA treatment and increased when the international normalized ratio increased. These results and characteristics are in concordance with results from other VKA treated populations.. BLEEDS is generalizable to other VKA treated populations and will permit innovative and unbiased research of biomarkers that may predict major bleeding during VKA treatment.

Topics: Acenocoumarol; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Female; Fibrinolytic Agents; Follow-Up Studies; Hemorrhage; Humans; International Normalized Ratio; Longitudinal Studies; Male; Middle Aged; Phenprocoumon; Prognosis; Risk Factors; Venous Thrombosis; Vitamin K

Topics: Adolescent; Appendectomy; Appendicitis; Contraceptives, Oral, Hormonal; Disability Evaluation; Expert Testimony; Female; Germany; Heparin; Humans; Malpractice; Phenprocoumon; Postoperative Complications; Risk Factors; Stockings, Compression; Venous Thrombosis

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

Thrombosis of cerebral veins and sinus (cerebral venous thrombosis) is a rare stroke pathogenesis. Pharmaceutical treatment is restricted to heparin and oral anticoagulation with vitamin K antagonists (VKAs).. Between January 2012 and December 2013, we recorded data from our patients with cerebral venous thrombosis. The modified Rankin scale was used to assess clinical severity; excellent outcome was defined as modified Rankin scale 0 to 1. Recanalization was assessed on follow-up MR angiography. Patients were then divided into 2 treatment groups: phenprocoumon (VKA) and a novel factor Xa inhibitor. Clinical and radiological baseline data, outcome, recanalization status, and complications were retrospectively compared.. Sixteen patients were included, and 7 were treated with rivaroxaban. Overall outcome was excellent in 93.8%, and all patients showed at least partial recanalization. No statistical significant differences were found between the groups, except the use of heparin before start of oral anticoagulation (P=0.03). One patient in the VKA and 2 patients in the factor Xa inhibitor group had minor bleeding (P=0.55) within the median (range) follow-up of 8 months (5-26).. Factor Xa inhibitor showed a similar clinical benefit as VKA in the treatment of cerebral venous thrombosis. Further systematic prospective evaluation is warranted.

Topics: Adolescent; Adult; Aged; Anticoagulants; Factor Xa Inhibitors; Female; Humans; Male; Middle Aged; Morpholines; Phenprocoumon; Rivaroxaban; Sinus Thrombosis, Intracranial; Thiophenes; Treatment Outcome; Venous Thrombosis; Young Adult

Topics: Administration, Oral; Colonic Neoplasms; Drug Administration Schedule; Drug Substitution; Heparin, Low-Molecular-Weight; Humans; International Normalized Ratio; Male; Middle Aged; Phenprocoumon; Recurrence; Venous Thrombosis

We report the case of a 28-year old woman with extensive red-black colored lesions of the skin on the left thigh, which appeared without trauma. The disease arrived during longterm coumarin therapy because of a deep vein thrombosis and an antiphospholipid syndrome. After consideration of the differential diagnoses and due to the typical clinical picture we made the diagnosis of coumarin necrosis. We review the clinical and therapeutic features for this rare complication.

Topics: Adult; Anticoagulants; Antiphospholipid Syndrome; Blood Coagulation Tests; Coumarins; Diagnosis, Differential; Drug Administration Schedule; Drug Eruptions; Drug Therapy, Combination; Female; Humans; Leg Dermatoses; Long-Term Care; Necrosis; Phenprocoumon; Skin; Venous Thrombosis; Vitamin K Deficiency

We report on the case of a spontaneous intracranial hypotension with subdural hygroma, as well as cerebral venous thrombosis (CVT), both known complications of intracranial hypotension. The 45-year-old patient was subsequently treated - according to current guidelines for CVT - with anticoagulation, but developed subdural haematoma (SDH), which required neurosurgical treatment. Our case highlights the complex pathophysiological sequelae of intracranial hypotension, as well as the occasionally difficult treatment decisions. Subdural hygroma probably predisposes patients to SDH during anticoagulation. Thus, the potential benefit of anticoagulation needs to be weighed against the risk of SDH on an individual basis.

Topics: Anticoagulants; Brain; Hematoma, Subdural; Humans; Intracranial Hypotension; Intracranial Thrombosis; Magnetic Resonance Imaging; Male; Middle Aged; Neurosurgical Procedures; Phenprocoumon; Subdural Effusion; Venous Thrombosis

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

Topics: Anticoagulants; Exercise; Humans; International Normalized Ratio; Lifting; Male; Phenprocoumon; Secondary Prevention; Venous Thrombosis

A 57-year-old patient suffered head and chest trauma following a bicycle accident. After 12 days in hospital with early mobilization the patient developed a deep vein thrombosis 5 days after being discharged and the family physician diagnosed a non-displaced clavicle fracture. The patient complained that no thrombosis prophylaxis had been carried out during the stay in hospital and the clavicle fracture had been overlooked. The expert opinion from the arbitration board determined that no health limitations had occurred as a result of the missed clavicle fracture. There were no indications for anticoagulation in accordance with the guidelines due to a lack of risk factors and the event was deemed unpreventable.

Topics: Anticoagulants; Athletic Injuries; Bicycling; Brain Concussion; Clavicle; Diagnostic Errors; Expert Testimony; Follow-Up Studies; Fractures, Bone; Germany; Humans; Lumbar Vertebrae; Male; Malpractice; Medical Errors; Middle Aged; Multiple Trauma; Phenprocoumon; Postthrombotic Syndrome; Rib Fractures; Spinal Fractures; Thoracic Injuries; Tomography, X-Ray Computed; Venous Thrombosis

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

Several genetic polymorphisms increase the risk for venous thrombembolism (VTE). In particular, combined oral contraceptives (COCs) are known to enhance the risk for VTE and are therefore contraindicated.. We present here the case of a patient with protein S deficiency, who has used COCs together with anticoagulatory therapy (Phenprocoumon) after suffering from deep venous thromboses for 4 years. At the time of her first consultation at our clinic, the ultrasound examination showed a complete involution of her venous thrombosis.. COCs can be used in patients with thrombogenic mutations and anticoagulatory therapy in individual cases.

Topics: Adult; Anticoagulants; Contraceptives, Oral, Combined; Female; Humans; Phenprocoumon; Protein S Deficiency; Venous Thrombosis

Topics: Anticoagulants; Drug Administration Schedule; Humans; Phenprocoumon; Postoperative Complications; Postoperative Hemorrhage; Practice Guidelines as Topic; Risk Factors; Venous Thrombosis

A 24-year-old patient presented with nonspecific epigastric pain, general feebleness and weakness of both legs. The cardiopulmonary investigations were unremarkable. The abdomen was soft, without muscular resistance or local pressure tenderness. Both legs were moderately swollen without other findings.. The laboratory tests showed an elevated D-dimer and fibrinogen, as well as a heterozygous factor V Leiden mutation. Both duplex ultrasonography and computed tomography revealed thrombosis of the distal inferior vena cava (IVC) and both iliac and femoral veins. A short segment of the IVC between the left renal and intrahepatic veins was a-genetic.. Anticoagulation treatment with phenprocoumon was started for the deep vein thrombosis. At the one-year follow-up no thrombosis of the vena cava and the iliac and femoral veins was detected.. Thrombosis of the IVC in combination with a pelvic vein thrombosis is a rare condition in young patients. If this venous abnormality is found, thrombophilia should be considered in the differential diagnosis. Anticoagulation is the treatment of choice.

Topics: Adult; Anticoagulants; Factor V; Femoral Vein; Fibrinogen; Heterozygote; Humans; Iliac Vein; Male; Mutation; Phenprocoumon; Tomography, X-Ray Computed; Ultrasonography, Doppler, Duplex; Vena Cava, Inferior; Venous Thrombosis

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

Drug therapy should be individualized according to criteria of efficacy, adverse effects, and treatment adherence. This is particularly important at the interface of inpatient and ambulatory care. Aspects of drug approval (labeling) and individual refunding by health care insurance should also be taken into account.. A patient (male, 61 years, painter) showed elevated transaminases after treatment with phenprocoumon because of a deep vein thrombosis in 1999. Transaminases normalized completely after discontinuation of phenprocoumon. Other reasons for the elevated transaminases could be excluded. After a recurrent thrombosis in 2003 phenprocoumon was prescribed again followed by recurrent elevation of transaminases and subsequent cholestatic hepatitis progressing to fulminant hepatic failure that required liver transplantation. After transplantation the patient's general state of health was good and liver function nearly normal. Anticoagulation was indicated beyond the postoperative phase because of recurrent deep vein thrombosis and atrial fibrillation. A low-molecular-weight heparin was chosen for long-term treatment.. A low-molecular-weight heparin appears to be the most appropriate way to maintain effective and safe anticoagulation in this patient. Coumarins carry a residual risk of an extrahepatic, immunologically mediated cross-sensitization. Long-term use of ximelagatran may also cause liver damage. For heparinoids, hirudins, and other drugs affecting coagulation like platelet aggregation inhibitors, therapeutic evidence is not sufficient. Though subcutaneous application of heparin is a disadvantage for the patient, therapeutic alternatives do not have better documented efficacy or less hepatotoxic potential. The low-molecular-weight heparin fulfills the criteria for refunding set by federal jurisdiction.

Topics: Anticoagulants; Atrial Fibrillation; Drug Approval; Heparin, Low-Molecular-Weight; Humans; Injections, Subcutaneous; Liver Failure; Liver Function Tests; Liver Transplantation; Long-Term Care; Male; Middle Aged; Phenprocoumon; Postoperative Complications; Recurrence; Treatment Outcome; Venous Thrombosis

Prophylactic treatment against deep vein thrombosis has become a routine part of surgical treatment. The indications and the form of prophylaxis selected depend on the patient's individual risk profile, which is determined in turn by a combination of exposing and predisposing risk factors. The exposing risk factors depend on the type of surgery and trauma the patient is exposed to, while the predisposing risks are determined by factors peculiar to the patient. This review deals with the modalities of prophylaxis currently available, pharmacological details relating to these, and their clinical significance. In addition, evidence-based data, recommendations for the duration of prophylaxis derived from official guidelines, and medicolegal aspects are discussed. The development of new anticoagulants is expanding the range of prophylactic methods, which means further information is needed.

Topics: Anticoagulants; Bandages; Evidence-Based Medicine; Fibrinolytic Agents; Fondaparinux; Heparin; Humans; Phenprocoumon; Polysaccharides; Postoperative Care; Postoperative Complications; Practice Guidelines as Topic; Risk Assessment; Risk Factors; Surgery Department, Hospital; Venous Thrombosis

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

Several genetic liver diseases can be treated by liver transplantation (LT). However, some genetic defects also may be acquired by this procedure. We describe a patient who developed recurrent deep-vein thromboses after LT for hepatitis C virus-associated hepatocellular carcinoma on the basis of a homozygous Leiden mutation of the factor V gene in the donor liver. Liver donors with a history of venous thrombosis should be screened for the presence of activated protein C (APC) resistance. In addition, we recommend looking for APC resistance in liver recipients who develop venous thromboembolic disease in the post-LT course. Molecular analysis of donor tissue may be necessary to make a definite diagnosis of factor V Leiden mutation in these patients. As a consequence, intensified postoperative thromboprophylaxis or lifelong anticoagulant therapy may be necessary if this thrombophilic gene defect is detected.

Topics: Activated Protein C Resistance; Anticoagulants; Factor V; Female; Humans; Liver Transplantation; Living Donors; Middle Aged; Phenprocoumon; Recurrence; Venous Thrombosis

Topics: Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Drug Therapy, Combination; Heparin; Phenprocoumon; Phenylbutazone; Research; Venous Thrombosis

A case of a 44-year-old patient with recurrent deep venous thrombosis (DVT) caused by congenital dysgenesis of the inferior vena cava (IVC) in coincidence with heterozygous factor V Leiden mutation is presented. The IVC malformation was a fortuitous finding because the vascular malformation of the collateral draining thoracic veins were suspected to be a malignant mass in chest X-ray. This vascular abnormality is a rare finding but recent epidemiological research suggests that there may be an association between the congenital absence of the IVC and DVT. In our case, the patient is even at higher risk combining the malformation probably affecting venous blood flow and the hypercoagulabilic state by heterozygous presence of the factor V Leidenmutation.

Topics: Adult; Anticoagulants; Factor V; Heterozygote; Humans; Male; Mutation; Phenprocoumon; Recurrence; Tomography, X-Ray Computed; Vascular Diseases; Vena Cava, Inferior; Venous Thrombosis

To investigate long-term clinical and morphological outcome of patients with subclavian-axillary vein thrombosis treated with systemic thrombolysis compared to anticoagulation in a retrospective, nonrandomised study.. We studied 95 consecutive inpatients with subclavian-axillary vein thrombosis treated either with systemic urokinase thrombolysis and subsequent oral anticoagulation (n=33) or with anticoagulation only (n=62). Anticoagulation was performed with heparin and phenprocoumon. Patients were followed for median 40 months (IQR 14 to 94) for symptomatic upper extremity post-thrombotic syndrome and for venous recanalisation by duplex ultrasound.. Primary technical success rate of the systemic thrombolysis was 88% (n=29) with seven peri-intervention bleeding complications (21%). No complication was observed in patients with anticoagulation only (p<0.0001). At the time of follow-up, duplex sonography showed a thrombotic subclavian vein in 40 of 83 patients (48%), but only 9 of 95 patients (10%) had a symptomatic upper extremity post-thrombotic syndrome. Patients with systemic thrombolysis exhibited a 60% adjusted reduced risk for a thrombotic subclavian vein at the time of follow-up compared to patients with anticoagulation only (95% CI: 0.2 to 0.9, p=0.03). However, the frequency of symptomatic post-thrombotic syndrome after thrombolysis and anticoagulation was similar (adjusted p=0.6).. Systemic thrombolysis of subclavian-axillary vein thrombosis has an acceptable primary technical success rate and improves venous recanalisation rates compared to anticoagulation. However, the high rate of complications during thrombolysis and the lack of clinical benefit suggest that conservative treatment may be favoured.

Topics: Adult; Anticoagulants; Axillary Vein; Female; Follow-Up Studies; Hemorrhage; Heparin; Humans; Male; Middle Aged; Phenprocoumon; Postphlebitic Syndrome; Retrospective Studies; Subclavian Vein; Thrombolytic Therapy; Treatment Outcome; Ultrasonography; Upper Extremity; Urokinase-Type Plasminogen Activator; Venous Thrombosis

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 19-year-old, otherwise asymptomatic man presented to the hospital of orthopaedic surgery with acute severe pain like lumbago. Symptomatic treatment was performed after extensive orthopaedic diagnostic procedures. On the third day after admission he showed clinical signs of deep vein thrombosis with painful swelling and livid discoloration of both legs. Colour duplex ultrasound revealed complete thrombosis of the leg and pelvic veins bilaterally, but the cranial extent was not clear. Contrast-enhanced helical computer tomography of the abdomen and the pelvis confirmed deep pelvic vein thrombosis and showed extension into the inferior vena cava. Moreover, the study revealed the agenesis of the renal segment of the inferior vena cava with collateral flow through dilated lumbar veins to enlarged azygous and hemiazygous, through vertebral and paravertebral venous plexus. The renals were drained via dilated capsular veins. The agenesis of renal vena cava is a very rare anomaly causing acute thrombosis of the deep leg and pelvic veins. Other risk factors of thromboembolic disease were not found. The patient was treated successfully with systemic thrombolysis. Therefore we used ultra-high streptokinase infusion (9 million units over 6 hours). Colour duplex ultrasound revealed good flow into deep leg and pelvic veins after three cycle of lysis. Magnetic resonance angiography of the abdomen and pelvis was performed to evaluate the successful fibrinolysis with complete recanalisation of the pelvic veins and to demonstrate the venous anatomy. Permanent oral anticoagulation with phenprocoumon is indicated to decrease the high rate of recurrent thrombosis. Compression stockings were prescribed. To prevent thrombosis, additional risk factors like smoking, immobilization and unusual physical activity should be strictly avoided.

Topics: Acute Disease; Adult; Anticoagulants; Blood Coagulation Tests; Collateral Circulation; Femoral Vein; Fibrinolytic Agents; Follow-Up Studies; Humans; Iliac Vein; Leg; Magnetic Resonance Angiography; Male; Pelvis; Phenprocoumon; Streptokinase; Thrombophlebitis; Time Factors; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color; Vena Cava, Inferior; Venous Thrombosis

Two men and one woman developed typical symptoms of a thrombosis in the arms after unusual physical effort at their work place (a coal miner after a bad fall, a radiographer after having to catch a patient, a painter after jerkily moving a heavy piece of furniture).. In all three patients a thrombosis of the subclavian vein was demonstrated by duplex scans or phlebography. In two patients tests for hypercoagulability were unremarkable. None of the patients had a thoracic outlet syndrome.. After initial local thrombolytic or heparin therapy alone, phenprocoumon treatment over several months was given in two cases, and in one case low-molecular-weight heparin was administered over several months. All three patients complained of strain-related residual symptoms in the affected arm (pain, swelling, easy fatigability). In all three cases, the accident insurer recognized the incident to be a work-related accident.. Patients with a Paget-Schroetter syndrome resulting from a sudden and unusual physical effort at work, which is covered by statutory accident insurance, must be reported to the accident insurer as a work-related accident in order to safeguard individual medical claims of the patient and for general medical and epidemiological reasons.

Topics: Accidents, Occupational; Adult; Anticoagulants; Axillary Vein; Coal Mining; Drug Therapy, Combination; Female; Fibrinolytic Agents; Health Personnel; Heparin; Humans; Insurance, Accident; Male; Phenprocoumon; Phlebography; Subclavian Vein; Syndrome; Ultrasonography, Doppler, Color; Venous Thrombosis

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Ambulatory Care; Anticoagulants; Female; Follow-Up Studies; Heparin, Low-Molecular-Weight; Hospitalization; Humans; Male; Middle Aged; Patient Selection; Phenprocoumon; Prospective Studies; Venous Thrombosis

Physicians face a therapeutic dilemma in patients with acute hemorrhagic stroke requiring long-term, high-intensity anticoagulants because this treatment increases the risk of intracranial hemorrhage (ICH) 8- to 11-fold. We retrospectively studied 15 patients with ICH which occurred under anticoagulation with phenprocoumon, with an international norrmalized ratio (INR) of 2.5-6.5 on admission. Hemispheric, thalamic, cerebellar, intraventricular, or subarachnoid hemorrhage without aneurysm occurred. Absolute indications for anticoagulation were double, mitral, or aortic valve replacement, combined mitral valve failure with atrial fibrillation and atrial enlargement, internal carotid artery-jugular vein graft, frequently recurring deep vein thrombosis with risk of pulmonary embolism, and severe nontreatable ischemic heart disease. As soon as the diagnosis of ICH was established, INR normalization was attempted in all patients by administration of prothrombin complex, fresh frozen plasma, or vitamin K. After giving phenprocoumon antagonists (and neurosurgical therapy in four patients) heparin administration was started. Nine patients received full-dose intravenous and six low-dose subcutaneous heparin. The following observations were made: (a) All patients with effective, full-dose heparin treatment with a 1.5- to 2-fold elevation in partial thromboplastin time after normalization of the INR were discharged without complication. (b) Three of four of the patients with only incomplete correction of the INR (> 1.35) experienced relevant rebleeding within 3 days (all patients with an INR higher than 1.5), two of whom were on full-dose heparin. (c) Three of seven of the patients with normalized INR and without significant PTT elevation developed severe cerebral embolism. Although our data are based on a retrospective analysis, they support treatment with intravenous heparin (partial thromboplastin time 1.5-2 times baseline value) after normalization of the INR in patients with an ICH and an urgent need for anticoagulation.

Topics: Aged; Anticoagulants; Cardiovascular Diseases; Cerebral Hemorrhage; Female; Heparin; Humans; Male; Middle Aged; Partial Thromboplastin Time; Phenprocoumon; Retrospective Studies; Stroke; Venous Thrombosis

Carbamazepine inhibits warfarin and dicoumarol anticoagulation through induction of cytochrome P450-enzymes. Inhibition of phenprocoumon anticoagulation by carbamazepine has been supposed in some reviews, however, without hard empirical evidence. We report a patient who was anticoagulated with phenprocoumon in whom carbamazepine produced a dramatic increase in prothrombin time ratio (Quick). After discontinuation of carbamazepine, Quick-values returned to therapeutic levels. Valproate did not affect phenprocoumol's anticoagulant properties. The potentially hazardous carbamazepine-phenprocoumon interaction should be emphasized in reference drug manuals.

Topics: Anticoagulants; Antimanic Agents; Carbamazepine; Drug Interactions; Dysthymic Disorder; Female; Humans; Middle Aged; Phenprocoumon; Prothrombin Time; Venous Thrombosis

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

The diagnosis of pyoderma gangraenosum (PG) was made in a 33-year-old woman with ulcerative (palm-sized) skin changes and pain of the lower leg that had developed over two weeks and was accompanied by fever (39 degrees C). Treatment with prednisolone and azathioprine was initiated. As soon as the medication was reduced new skin changes developed. Two months after onset of the illness she had to be hospitalized because of fever, epigastric pain on pressure and deteriorating general condition. Physical examination provided no significant further information. LABORATORY RESULTS: The differential count demonstrated leucocytosis (15.5 Gpt/l) with a marked monocytosis (25%) as well as anaemia (haemoglobin concentration 5.2 mmol/l). C-reactive protein was elevated (120.20 mg/l). Thromboplastin time was 60%, D-dimer 1000 micrograms/l, thrombin-antithrombin-III complex 9.7 micrograms/l. ADDITIONAL INVESTIGATIONS: Sonography and computed tomography of the upper abdomen revealed splenomegaly, ascites, thrombosis of the portal, splenic and superior mesenteric veins. Bone marrow puncture showed marked increase in blasts (14%) and monocytes (10%).. The findings indicated chronic myelomonocytic leukaemia with PG and the described venous thromboses. The cutaneous changes completely receded on administration of hydroxyurea (1.0 g/d). Other causes of the skin eruption were excluded. Phenprocoumon (INR between 2 and 3) was given in treatment of the thromboses.. When PG is diagnosed, intensive search for an underlying cause must be undertaken, because of its frequent association with serious systemic disease. Only early specific treatment will improve the skin condition.

Topics: Adult; Anti-Inflammatory Agents; Anticoagulants; Antineoplastic Agents; Ascites; Azathioprine; Bone Marrow Cells; Bone Marrow Examination; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Hydroxyurea; Immunosuppressive Agents; Leukemia, Myelomonocytic, Chronic; Mesenteric Veins; Phenprocoumon; Portal Vein; Prednisolone; Pyoderma Gangrenosum; Splenic Vein; Splenomegaly; Tomography, X-Ray Computed; Venous Thrombosis

A 52-year-old woman was admitted because of pain for several days in the lower left leg and increasing pretibial swelling with livid discoloration. Six months before she had undergone a bilateral adnexectomy with removal of the omentum and subsequent chemotherapy for ovarian cancer.. Duplex sonography on the day of admission revealed thrombosis of the left popliteal vein with an unobstructed femoral vein. Both the quick value (89%) and partial thromboplastin time (PTT, 35.9 s) were within normal limits. Computed tomography and sonography were highly suspicious of a local recurrence of the ovarian cancer with peritoneal carcinomatosis.. PTT-effective heparinization (heparin-Na) was initiated together with overlapping anticoagulation with phenprocoumon (thromboplastin time 20-30%). On the 9th day after starting phenprocoumon painful, black necrotic changes began to appear on the skin of the left first to fourth toes. Assuming these to be due to phenprocoumon, anticoagulation was switched to low-molecular heparin (Enoxaparin), and antithrombin III and protein C were administered. A few days later thrombosis of the right iliac vein occurred, probably caused by local recurrence of the ovarian cancer. No palliative chemotherapy was undertaken in view of the thrombotic complications. The patient died a few months later from the cancer.. If there is an underlying malignancy, chemotherapy and therapeutic vitamin-K antagonism in the presence of thromboembolic complications increases the risk of lowering protein C activity and may cause the rare complication of skin necrosis, induced by phenprocoumon.

Topics: Anticoagulants; Chemotherapy, Adjuvant; Fatal Outcome; Female; Humans; Iliac Vein; Middle Aged; Necrosis; Neoplasm Recurrence, Local; Ovarian Neoplasms; Phenprocoumon; Popliteal Vein; Skin; Venous Thrombosis