vitamin-k-1 and Hematoma

To describe the successful case management of an extradural hematoma secondary to anticoagulant rodenticide toxicity causing spinal compression and paraplegia.. A 3-month-old, female intact, mixed breed dog was presented for a 12-hour history of paraplegia. CBC and biochemistry results were unremarkable, and a coagulation panel revealed prolonged prothrombin time with normal activated partial thromboplastin time. Magnetic resonance imaging revealed an extradural compressive lesion within the vertebral canal extending from T6 to T11, most consistent with an extradural hematoma. Further coagulation testing revealed a coagulopathy caused by vitamin K1 deficiency and confirmed exposure to the anticoagulant rodenticide, diphacinone. The dog was medically managed with fresh frozen plasma, aminocaproic acid, and oral vitamin K1 therapy. A right-sided T6 to T11 hemilaminectomy was later performed for removal of the extradural hematoma and spinal decompression. The dog's neurological status gradually improved postoperatively and, at the time of discharge, was nonambulatory paraparetic with voluntary micturition. Four weeks postoperatively, the dog had normal prothrombin and activated partial thromboplastin times and was nonambulatory paraparetic with strong motor function.. This is the first reported case of a dog with an extradural hematoma secondary to anticoagulant rodenticide causing spinal cord compression and neurological deficits. Surgical management of this case was successful and resulted in improvement of neurological signs. Extradural hematoma should be considered as a potential location of bleeding in rodenticide toxicity as well as a differential diagnosis in patients with neurological deficits.

Topics: Animals; Anticoagulants; Dog Diseases; Dogs; Female; Hematoma; Paraplegia; Rodenticides; Vitamin K 1

A 71-year-old man was stable on warfarin (2.25 mg daily) therapy with an international normalized ratio (INR) of 1.8-2.2 after a heart valve replacement surgery. Recently, he consumed the liquid-like herbal product called shengmai-yin (10 mL daily) against medical advice. Seven days after the daily consumption of shengmai-yin, he was admitted to the intensive care unit because of consciousness disturbance [Glasgow Coma Scale (GCS) score 7] with an INR of 5.08. Head computed topography revealed intracerebral hematoma in the left temporoparietal region. Both warfarin therapy and the herbal product were withdrawn. At the same time, therapy with intravenous vitamin K1 40 mg was started. On the second day of admission, craniectomy was performed to remove the intacerebral hematoma under general anesthesia. He remained confused and restless for 2 days, but then showed progressive recovery in the consciousness level as well as motor and verbal functions. Shengmai-yin contains herbal ingredients that can interact with warfarin. The Drug Interaction Probability Scale (DIPS) indicated that warfarin and shengmai-yin were highly probable causes of intracerebral hematoma. Patients on warfarin therapy should be discouraged from taking herbal medicines, especially preparations that are already known to have antiplatelet and antithrombotic effects.

Topics: Aged; Anticoagulants; Cerebral Hemorrhage; Drug Interactions; Drugs, Chinese Herbal; Hematoma; Humans; Male; Treatment Outcome; Vitamin K 1; Warfarin

Rats received a single subcutaneous dose of the inflammatory agent carrageenin on the top of the skull, followed by oral acenocoumarol for 3 days; in every case, an extensive haematoma was observed on the skull on day 4. The capillary resistance on the depilated dorsal skin was significantly reduced by this combined inflammatory + anticoagulant treatment. Haematoma development was not inhibited by cortisone, non-steroidal anti-phlogistics (piroxicam, proquazone) or benzopyrone derivatives (hesperidin methylchalcone, oligomeric procyanidin). On pretreatment with vitamin K1 for 1 day, followed by daily treatment for 3 days, no haematoma was observed.

Topics: Acenocoumarol; Animals; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Capillaries; Carrageenan; Chromones; Coumarins; Disease Models, Animal; Female; Hematoma; Hemorrhage; Male; Rats; Rats, Inbred Strains; Steroids; Vascular Resistance; Vitamin K 1

In a patient taking oral anticoagulants, the complaint of pharyngeal pain, a change in the voice, dysphagia, respiratory difficulty, or a neck mass should prompt a thorough investigation to rule out hemorrhage into the upper airway. This case report describes an anticoagulated patient who experienced precipitous hemorrhagic upper airway obstruction. She was successfully treated with tracheostomy, plasma infusion, and parenteral vitamin K1.

Topics: Airway Obstruction; Emergencies; Female; Hematoma; Hemorrhage; Humans; Middle Aged; Respiratory Tract Diseases; Thrombophlebitis; Tracheotomy; Vitamin K 1; Warfarin

The retropharyngeal space is a rare site of spontaneous hemorrhage and the formation of a hematoma in this location is a rarer complication of therapy with anticoagulants. Nineteen cases of retropharyngeal hematoma have been reported in the literature, only two of which have been associated with anticoagulation therapy. In the case reported here, a retropharyngeal hematoma developed in a 61-year-old man who had been receiving anticoagulants. The complication was associated with a violent tussive episode. Airway obstruction necessitated a tracheostomy, and the persistent hematoma required external drainage.

Topics: Airway Obstruction; Drainage; Hematoma; Humans; Male; Middle Aged; Pharyngeal Diseases; Vitamin K 1; Warfarin

Topics: Aged; Duodenal Obstruction; Hematoma; Hematuria; Hemoperitoneum; Humans; Laparotomy; Male; Prothrombin Time; Vitamin K 1; Warfarin

Topics: Anticoagulants; Coumarins; Diagnosis, Differential; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestine, Small; Male; Middle Aged; Vitamin K 1

Topics: Anticoagulants; Diagnosis, Differential; Duodenal Ulcer; Gastrointestinal Hemorrhage; Hematoma; Hemorrhage; Humans; Intestinal Obstruction; Intestine, Small; Intestines; Radiography; Toxicology; Vitamin K 1

Topics: Adrenocorticotropic Hormone; Aspirin; Blood Transfusion; Caffeine; Diphenhydramine; Hematoma; Hemorrhagic Disorders; Hypoprothrombinemias; Mouth; Phenacetin; Salicylates; Toxicology; Vitamin K 1