thromboplastin and Pain

Superwarfarins are anticoagulant rodenticides similar to warfarin, but which have various substituted phenyl groups replacing the terminal methyl group, resulting in a fat-soluble, long-acting anticoagulant that is nearly 100 times more potent than the parent compound. Since their development, many accidental and intentional cases of consumption have been reported. We describe two cases of consumption, one related to unknown etiology, and the other related to utilization of the superwarfarin to potentiate a drug of abuse. The clinical manifestations including bleeding symptoms and abnormal coagulation assays are discussed. The differential diagnosis is quite broad, and includes all causes of vitamin K deficiency, factor deficiency or inhibitor, disseminated intravascular coagulation (DIC), and liver disease. Differentiating superwarfarin ingestion from the other causes can be quite difficult, but extremely important, as management requires prolonged administration of vitamin K. Other treatment options are discussed as well including, fresh frozen plasma (FFP), and recombinant factor VIIa. Finally, the significance of "lacing" drugs of abuse with superwarfarin to potentiate their effect is discussed, as well as the complications that could develop from such a habit.

Topics: 4-Hydroxycoumarins; Adult; Blood Coagulation Disorders; Diagnosis, Differential; Humans; Male; Middle Aged; Pain; Platelet Count; Prothrombin Time; Thromboplastin; Time Factors; Vitamin K Deficiency

Topics: Angioedema; Blood Coagulation; Complement C1 Inactivator Proteins; Factor XII; Fibrinolysin; Humans; Inflammation; Kallikreins; Kinins; Pain; Thromboplastin

Increased numbers of CD146-defined circulating endothelial cells (CECs), as are present in the peripheral blood of patients suffering acute coronary syndromes, imply injury to the endothelium. Endothelial damage can also be assessed by the measurement of plasma levels of von Willebrand factor (vWf). Increased levels of procoagulant plasma tissue factor (TF), arising from monocytes/macrophages and endothelial cells, is present in atherosclerosis. We hypothesised increased CECs in patients with ischaemic rest pain (IRP) of the lower limb due to peripheral atherosclerosis and comparable to that seen in patients with acute myocardial infarction (AMI), when compared to patients with intermittent claudication (IC) or healthy controls that would correlate with vWf and TF.. We recruited 20 patients in each of four groups: (i) IRP of the lower limb; (ii) AMI; (iii) 'stable' IC; and (iv) healthy controls. CD146-expressing CECs were measured by immumomagnetic separation and counting under a fluorescence microscope; plasma vWf and TF by ELISA.. In IRP, median (IQR) CEC levels were 3.5 (2.0-5.8) cells/ml, in IC were 1.1 (0.6-2.9) cells/ml, and in healthy controls were 1.0 (0.5-1.7) cells/ml (p<0.001). The levels of vWf (p=0.034) and TF (p=0.007) were also significantly different between the groups, with the highest levels in patients with IRP. Levels of CECs correlated with vWf (rs=0.4, p=0.002) and TF ( rs=0.296, p=0.021 ). In AMI, CEC levels were higher than those in IRP at 4.9 (3.6-8.4) cells/ml (p=0.0385).. This study demonstrates evidence of direct endothelial cell injury (i.e. raised CECs) in patients with IRP that correlated with vWf and TF, but that this is less severe than in AMI.

Topics: Aged; Analysis of Variance; Antigens, CD; Arteriosclerosis; CD146 Antigen; Endothelial Cells; Endothelium, Vascular; Enzyme-Linked Immunosorbent Assay; Female; Humans; Intermittent Claudication; Ischemia; Leg; Male; Membrane Glycoproteins; Middle Aged; Myocardial Infarction; Neural Cell Adhesion Molecules; Pain; Thromboplastin; von Willebrand Factor

Topics: Leadership; Pain; Pharmacology; Research; Skin; Thromboplastin; Thyroid Hormones

Topics: Growth Hormone; Human Growth Hormone; Leadership; Pain; Pharmacology; Research; Skin; Thromboplastin

Topics: Databases, Genetic; Pain; Pharmacology; Research; Skin; Testosterone; Thromboplastin

Topics: Contraceptive Agents, Female; Estradiol; Estradiol Congeners; Estrogens; Female; Hormones; Humans; Pain; Pharmacology; Progesterone; Research; Skin; Thromboplastin

Topics: Disease; Humans; Muscles; Muscular Diseases; Myalgia; Pain; Potassium; Thromboplastin