vitamin-k-semiquinone-radical and Hematoma

Use of non-vitamin K oral anticoagulants (NOACs) has rapidly increased worldwide. We aimed to systematically assess the available evidence regarding the safety and efficacy of NOACs in patients undergoing cardiac implantable electronic device (CIED) surgery.. We performed a systematic literature search. Eligible randomised controlled trials and cohort studies were included. The primary outcome measures were clinically significant device-pocket haematoma and thromboembolic events.. Use of NOACs at the time of CIEDs surgery appears to be safe, and either strategy of peri-procedure continuation or interruption might be reasonable. However, continuation of NOAC seems to be associated with a numerically higher rate of bleeding complications. Certainty of the evidence is low, and further studies are required to confirm these findings.

Topics: Administration, Oral; Anticoagulants; Atrial Fibrillation; Hematoma; Humans; Thromboembolism; Vitamin K

The objective of this paper is to assess the clinical outcomes between non-traumatic intracerebral hemorrhage(ICH) in patients using direct oral anticoagulants(DOAC) versus vitamin K antagonists(VKA) for non-valvular atrial fibrillation. We also evaluated the predictors of the poor post-ICH outcomes.. We have performed pooled meta-analysis to assess long-term clinical outcomes in patients with DOAC-ICH as compared to those with VKA-ICH. A systematic literature search was conducted by searching the full-text English literature in PubMed, EMBASE, and Cochrane databases for observational studies reporting outcomes on interest. MOOSE guidelines were used to collect data till December 31, 2019 and random effects analysis was carried out to account for heterogeneity. For outcomes, risk ratios(RR) and the mean differences were pooled using a random-effects model and weighted mean differences (WMDs), respectively.. Seventeen studies met the inclusion criteria (n = 25,354 patients; DOAC-ICH arms = 5,631; VKA-ICH arm = 19,273). Patients with DOAC-ICH had smaller hematoma volumes (WMD=-9.59; 95%CI=-15.33--3.85; I2 = 68.6%) and reduced mortality rate at discharge (RR = 0.82; 95%CI = 0.71-0.96; I2 = 9.4%). There was no significant difference between the two groups in rate of hematoma expansion (RR = 0.79; 95%CI = 0.56-1.11; I2 = 50.9%), unfavorable functional outcome(Modified Rankin Scale) at discharge (RR = 0.82; 95%CI = 0.56-1.18; I2 = 80.2%), unfavorable outcome at 3-months (RR = 0.77; 95%CI = 0.56-1.06; I2 = 63.9), and mortality at 3-months (RR = 0.90; 95%CI = 0.73-1.10; I2 = 35∙8%). Multivariate meta-regression revealed that the average age of patient population had a significantly negative correlation with(RR=-0.202; p = 0.017) hematoma expansion.. We conclude that use of DOAC is associated with reduced hematoma volume and mortality rate at discharge. Age is a predictor of the poor outcome of hematoma expansion.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Cerebral Hemorrhage; Female; Hematoma; Humans; Male; Treatment Outcome; Vitamin K

To obtain precise estimates of age, haematoma volume, secondary haematoma expansion (HE) and mortality for patients with intracerebral haemorrhage (ICH) taking oral anticoagulants [Vitamin K antagonists (VKA-ICH) or non-Vitamin K antagonist oral anticoagulants (NOAC-ICH)] and those not taking oral anticoagulants (non-OAC ICH) at ICH symptom onset.. We conducted a systematic review and meta-analysis of studies comparing VKA-ICH or NOAC-ICH or both with non-OAC ICH. Primary outcomes were haematoma volume (in ml), HE, and mortality (in-hospital and 3-month). We calculated odds ratios (ORs) using the Mantel-Haenszel random-effects method and corresponding 95% confidence intervals (95%CI) and determined the mean ICH volume difference.. We identified 19 studies including data from 16,546 patients with VKA-ICH and 128,561 patients with non-OAC ICH. Only 2 studies reported data on 4943 patients with NOAC-ICH. Patients with VKA-ICH were significantly older than patients with non-OAC ICH (mean age difference: 5.55 years, 95%CI 4.03-7.07, p < 0.0001, I. This meta-analysis confirms, refines and expands findings from prior studies. We provide precise estimates of key prognostic factors and outcomes for VKA-ICH, which has larger haematoma volume, increased rate of HE and higher mortality compared to non-OAC ICH. There are insufficient data on NOACs.

Topics: Anticoagulants; Cerebral Hemorrhage; Hematoma; Humans; Vitamin K

Direct Oral Anticoagulants (DOAC) are increasingly used as an alternative to vitamin-K antagonists (VKA) for anticoagulation and have shown lower rates of intracranial hemorrhage; however, there is disagreement in the literature over the outcomes of the intraparenchymal hemorrhages (IPH) associated with DOACs, and clinical concern regarding the lack of standardized reversal strategies for DOACs. Thus, the aim of this meta-analysis was to compare mortality, hematoma volume, and risk of hematoma expansion in patients who developed an IPH on DOACs versus VKA. A systematic review of the literature was conducted in accordance with the PRISMA guidelines. Studies were selected that reported on mortality, hematoma expansion, and hematoma volume in DOAC-associated IPH. Pooled risk ratios (RR) were calculated for mortality and hematoma expansion and pooled mean difference (MD) was calculated for hematoma volume (ml) using random-effect models. 15 studies reporting on 1238 patients were included in the systematic review. Eleven of these compared DOAC-IPH to VKA-IPH and were pooled quantitatively. DOAC-IPH was not associated with increased mortality risk (RR: 0.95, 95%-CI: 0.72 -1.27) or increased hematoma expansion risk (RR: 0.92; 95%-CI: 0.75-1.12) compared to VKA-IPH. The hematoma volume of DOAC- IPH was statistically significantly smaller than VKA-IPH (MD: -12.14 ml; 95%-CI: -15.38; -8.89). In conclusion, DOAC-IPH was not associated with increased mortality or hematoma expansion compared to VKA-IPH and may be associated with a smaller hematoma volume.

Topics: Administration, Oral; Anticoagulants; Blood Coagulation; Cerebral Hemorrhage; Hematoma; Humans; Male; Risk Factors; Vitamin K

The characteristics and natural history of acute non-vitamin K antagonists oral anticoagulants (NOAC)-associated intracerebral haemorrhage (ICH) are largely unknown. We performed a comprehensive systematic review and meta-analysis to compare baseline ICH volume, haematoma expansion and clinical outcomes between NOAC-ICH versus vitamin K antagonists-ICH (VKA-ICH).. We searched PubMed and conference abstracts for observational studies comparing baseline characteristics and outcomes in patients with NOAC-ICH versus VKA-ICH using an appropriate keyword/MeSH term search strategy. Data were extracted following PRISMA and MOOSE guidelines. The main outcome measures were mortality and unfavourable functional outcome (modified Rankin Score: 4-6) at discharge and at 3 months, as well as ICH volumes and haematoma expansion rates in the two groups. Random-effects models with DerSimonian-Laird weights were used for pooled estimates calculation.. Twelve studies including 393 NOAC-ICH and 3482 VKA-ICH were pooled in meta-analysis. There was no difference in mean ICH-volume between the two groups (standard mean difference: -0.24; 95% CI -0.52 to 0.04, p=0.093). The rates of haematoma expansion were comparable in NOAC-ICH versus VKA-ICH (OR: 0.76; 95% CI 0.49 to 1.19, p=0.236). We did not find any difference between patients with NOAC-ICH versus VKA-ICH in all-cause mortality at discharge (OR: 0.66; 95% CI 0.42 to 1.05, p=0.077) and unfavourable functional outcome at discharge (OR: 0.77; 95% CI 0.41 to 1.44, p=0.413). The 3-month outcome was also comparable between the two ICH groups. Moderate-to-substantial statistical heterogeneity was noted.. Our results confirm that ICH volume, haematoma expansion, mortality and functional outcome appear to be similar for NOAC-ICH versus VKA-ICH. Large prospective cohorts and updated meta-analyses are needed to provide more precise estimates.

Topics: Anticoagulants; Antithrombins; Cerebral Hemorrhage; Dabigatran; Factor Xa Inhibitors; Hematoma; Humans; Mortality; Odds Ratio; Phenprocoumon; Pyrazoles; Pyridines; Pyridones; Rivaroxaban; Severity of Illness Index; Thiazoles; Vitamin K; Warfarin

Hematoma expansion (HE), defined as a greater than 33% increase in intracerebral hemorrhage (ICH) volume within the first 24 hours, results in significant neurological deficits, and enhancement of ICH-induced primary and secondary brain injury. An escalation in the use of oral anticoagulants has led to a surge in the incidences of oral anticoagulation-associated ICH (OAT-ICH), which has been associated with a greater risk for HE and worse functional outcomes following ICH. The oral anticoagulants in use include vitamin K antagonists, and direct thrombin and factor Xa inhibitors. Fibrinolytic agents are also frequently administered. These all act via differing mechanisms and thus have varying degrees of impact on HE and ICH outcome. Additionally, antiplatelet medications have also been increasingly prescribed, and result in increased bleeding risks and worse outcomes after ICH. Aspirin, thienopyridines, and GPIIb/IIIa receptor blockers are some of the most common agents in use clinically, and also have different effects on ICH and hemorrhage growth, based on their mechanisms of action. Recent studies have found that reduced platelet activity may be more effective in predicting ICH risk, hemorrhage expansion, and outcomes, than antiplatelet agents, and activating platelets may thus be a novel target for ICH therapy. This review explores how dysfunctions or alterations in the coagulation and platelet cascades can lead to, and/or exacerbate, hematoma expansion following intracerebral hemorrhage, and describe the mechanisms behind these effects and the drugs that induce them. We also discuss potential future therapy aimed at increasing platelet activity after ICH.

Topics: Anticoagulants; Cerebral Hemorrhage; Factor Xa Inhibitors; Fibrinolytic Agents; Hematoma; Humans; Platelet Activation; Platelet Aggregation Inhibitors; Thrombin; Vitamin K

Warfarin is commonly used for prevention of embolic events. Bleeding is the main side effect of warfarin. Lingual and sublingual haematoma are rare. In the literature, nine cases have so far been reported. We report the case of a 70-year-old Caucasian woman who developed spontaneous lingual and sublingual haematomas while on warfarin therapy. Spontaneous lingual and sublingual haematoma are rare, but can be potentially life-threatening complications as they cause airway obstruction. To the best of our knowledge, this is the first reported case of earliest haematoma after warfarin use.

Topics: Aged; Anticoagulants; Antifibrinolytic Agents; Diagnosis, Differential; Female; Follow-Up Studies; Hematoma; Humans; Mouth Floor; Plasma; Rare Diseases; Tongue; Treatment Outcome; Vitamin K; Warfarin

Topics: Acenocoumarol; Amino Acid Substitution; Anticoagulants; Factor IX; Hematoma; Hemothorax; Humans; International Normalized Ratio; Laryngeal Diseases; Male; Middle Aged; Mutation, Missense; Pedigree; Radiography; Vitamin K

Current understanding of oral anticoagulant treatment and related intracerebral haemorrhage remains rather limited as compared to that of spontaneous intracerebral haemorrhage. Although intracerebral haemorrhage is the most serious complication of oral anticoagulant treatment, standardized treatment guidelines are still lacking. The currently employed treatments are aimed at normalization of the iatrogenic coagulation impairment, and are not based on randomized controlled trials evidence. Since most patients with oral anticoagulant treatment-intracerebral haemorrhage are at high risk of cardio-embolism and often myocardial infarction, it is uncertain whether the use of procoagulant treatments for oral anticoagulant treatment-intracerebral haemorrhage may increase their risk of thrombotic complications. Patients who receive chronic oral anticoagulant treatment urgently require effective treatments for acute oral anticoagulant treatment-intracerebral haemorrhage, and therefore controlled clinical trials are needed.

Topics: Administration, Oral; Anticoagulants; Cerebral Hemorrhage; Clinical Trials as Topic; Factor VIIa; Hematoma; Humans; Iatrogenic Disease; Plasma; Prothrombin; Recombinant Proteins; Risk; Risk Factors; Vitamin K

Topics: Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Belgium; Factor X; Fibrinolytic Agents; Hematoma; Heparin, Low-Molecular-Weight; Humans; Nerve Block; Platelet Aggregation Inhibitors; Thrombin; Thrombosis; Vitamin K

Topics: Adult; Aged; Anticoagulants; Antithrombin III Deficiency; Blood Coagulation Tests; Critical Care; Drug Interactions; Hematoma; Hemorrhage; Humans; Middle Aged; Vitamin K

Perioperative management with reduced-dose warfarin is of potential interest by eliminating the need for bridging while still maintaining a degree of anticoagulation. The outcomes of this regimen have not been well determined.. In a randomized controlled trial we compared two regimens for management of anticoagulation with warfarin in patients with implantation of a pacemaker or defibrillator. Half dose of warfarin for 3-6 days, depending on the baseline international normalized ratio (INR), before surgery aiming at an INR of ≤ 1.7 was compared with interrupted warfarin for 5 days with preoperative bridging with low-molecular-weight heparin (LMWH) at therapeutic dose for 2.5 days. Main safety outcome was pocket hematoma. Secondary outcomes were major bleeding, thromboembolism - all within 1 month, days of hospitalization and number of patients requiring correction of INR with vitamin K.. The study was planned for 450 patients but it was discontinued prematurely due to a change in practice. Pocket hematoma occurred in 4 of 85 patients (5%) randomized to the bridged regimen and in 3 of 86 patients (3%) randomized to reduced-dose warfarin. One pocket hematoma in each group was severe. There were no major hemorrhages or thromboembolism within the 1-month window. Duration of hospitalization was similar in the two groups. Correction of INR the day before surgery with vitamin K had to be used for significantly more patients in the reduced-dose warfarin group (41%) than in the bridged regimen group (6%).. The reduced-dose warfarin regimen appeared to have similar safety after device implantation as interrupted warfarin with preoperative LMWH bridging. Due to premature discontinuation no firm conclusion can be drawn. The reduced-dose warfarin regimen often failed to achieve the intended preoperative INR. ClinicalTrials.gov Identifier: NCT 02094157.

Topics: Anticoagulants; Defibrillators, Implantable; Female; Hematoma; Hemorrhage; Heparin, Low-Molecular-Weight; Humans; International Normalized Ratio; Male; Pacemaker, Artificial; Preoperative Care; Preoperative Period; Thromboembolism; Vitamin K; Warfarin

Topics: Africa; Birth Injuries; Blood Transfusion; Clinical Trials as Topic; Craniocerebral Trauma; Female; Hematoma; Humans; Hyperbilirubinemia; Infant, Newborn; Male; Pregnancy; Scalp; Vitamin K; Vitamin K Deficiency Bleeding

Scientific data on emergency operations during ongoing treatment with vitamin K antagonists or with direct oral anticoagulants (DOAC) are lacking, because interruption or bridging of this treatment is routinely performed for up to several days. To reduce time delays and to simplify this procedure, we perform operations of distal radial fractures immediately and without interruption of antithrombotic medication.. For this retrospective and monocentric study, we included only patients with distal radial fractures treated within 12 h after diagnosis with open reduction and volar plating and who received anticoagulation with a vitamin K antagonist or DOAC. Primary aim of the study was evaluation of specific complications, such as revision due to bleeding or hematoma formation and secondary aims were thromboembolic events or infections. The endpoint was 6 weeks after the operation.. Between 2011 and 2020, 907 consecutive patients with distal radial fractures were operatively treated. Of these, 55 patients met the inclusion criteria. The mean age was 81.5 Jahre (63-94 years) and women (n = 49) were primarily affected. All operations were performed without tourniquets. With a study endpoint 6 weeks after operation, no revisions were performed for bleeding, hematoma, or infection and primary wound healing was assessed for all patients. One revision was performed for fracture dislocation. Thromboembolic events were also not documented.. In this study the treatment of distal radial fractures within 12 h and without interruption of antithrombotic treatment was not associated with any imminent systemic complications. This applies to both vitamin K antagonists and DOAC; however, higher case numbers must confirm our results.. HINTERGRUND: Die wissenschaftliche Datenlage zu operativen notfallmäßigen Eingriffen unter laufender Therapie mit einem Vitamin-K-Antagonisten oder einem der direkten oralen Antikoagulanzien (DOACs) ist bisher gering, weil grundsätzlich ein rechtzeitiges Absetzen oder Bridging von bis zu mehreren Tagen durchgeführt wird. Um aufwendige zeitliche Verzögerungen in der Behandlung zu vermeiden, wurden distale Radiusfrakturen unter dieser laufenden Therapie frühzeitig operativ versorgt.. Einschlusskriterien für diese retrospektive und monozentrische Studie waren Patienten mit distaler Radiusfraktur, welche innerhalb von 12 h nach der Diagnosestellung eine operative Versorgung mittels volarer Plattenosteosynthese erhielten – unter laufender Antikoagulanzientherapie mit Marcumar oder DOACs. Primäres Ziel war die Erhebung der spezifischen Komplikationsrate wie Revisionen aufgrund von Blutung oder Hämatombildung, sekundäres Ziel die Erhebung allgemeiner Komplikationen wie thrombembolischer Ereignisse oder Infektionen. Endpunkt der Studie war hierzu die ambulante Befunderhebung 6 Wochen postoperativ.. Zwischen 2011 und 2020 wurden konsekutiv 907 Patienten mit distaler Radiusfraktur operativ versorgt, hiervon konnten 55 Patienten eingeschlossen werden, welche die genannten Einschlusskriteren erfüllten. Das mittlere Alter betrug 81,5 Jahre (63 bis 94 Jahre), überwiegend wurden Frauen operiert (n = 49). Alle Operationen wurden ohne Blutsperre durchgeführt. Mit Endpunkt 6 Wochen postoperativ wurde keine operative Revision aufgrund eines Hämatoms, einer akuten Nachblutung oder Infektion durchgeführt, bei durchwegs primärer Wundheilung. Eine Revision erfolgte in Form einer Reosteosynthese bei Frakturdislokation. Thrombembolische Ereignisse wurden ebenfalls nicht dokumentiert.. Die operative Versorgung der distalen Radiusfraktur innerhalb von 12 h zeigte in dieser Studie keine systemimmanenten Komplikationen unter laufender Antikoagulanzientherapie mit Marcumar oder DOACs. Höhere Fallzahlen müssen diese Ergebnisse allerdings noch bestätigen.

Topics: Aged; Aged, 80 and over; Anticoagulants; Female; Fibrinolytic Agents; Hematoma; Hemorrhage; Humans; Male; Middle Aged; Radius Fractures; Retrospective Studies; Thromboembolism; Vitamin K

Biliary atresia (BA) is a rare cause of persistent jaundice in infants that can result in vitamin K malabsorption and vitamin K deficiency bleeding (VKDB). We present an infant with BA who developed a rapidly growing intramuscular hematoma in her upper arm after a vaccination which caused a radial nerve palsy.. An 82-day-old girl was referred to our hospital because of a rapidly growing left upper arm mass. She had received three doses of oral vitamin K before age 1 month. At age 66 days, she received a pneumococcal vaccination in her left upper arm. On presentation, she showed no left wrist or finger extension. Blood examination revealed direct hyperbilirubinemia, liver dysfunction, and coagulation abnormalities, indicating obstructive jaundice. Magnetic resonance imaging showed a hematoma in the left triceps brachii. Abdominal ultrasonography revealed an atrophic gallbladder and the triangular cord sign anterior to the portal vein bifurcation. BA was confirmed on cholangiography. VKDB resulting from BA in conjunction with vaccination in the left upper arm were considered the cause of the hematoma. The hematoma was considered the cause of her radial nerve palsy. Although she underwent Kasai hepatic portoenterostomy at age 82 days, the obstructive jaundice did not sufficiently improve. She then underwent living-related liver transplantation at age 8 months. The wrist drop was still present at age 1 year despite hematoma resolution.. Delayed detection of BA and inadequate prevention of VKDB can result in permanent peripheral neuropathy.

Topics: Biliary Atresia; Female; Hematoma; Humans; Infant; Jaundice, Obstructive; Radial Neuropathy; Vitamin K

The objective of this study was to evaluate clinical outcomes associated with time to administration and dose of four-factor prothrombin complex concentrate (4F-PCC) in patients with ICH on warfarin.. This was a single-center retrospective analysis of patients with ICH on warfarin who received 4F-PCC.. The site of the study was a large, Level I trauma, academic medical center with a dedicated neurologic intensive care unit and an emergency department (ED) that has approximately 72,000 visits annually.. Patients were included if they were ≥18 years of age, diagnosed with ICH, had an INR >1 due to warfarin use, and received both 4F-PCC and IV vitamin K for anticoagulation reversal. Exclusion criteria included patients who were less than 18 years of age, were not currently taking warfarin, had a bleeding site other than ICH, were pregnant or incarcerated, had an inadequate medical record, had a left ventricular assist device, had known liver disease with Child-Pugh Class C, received anticoagulation with heparin therapy within 24 h of anticoagulation reversal, or did not receive vitamin K within 24 h of hospital admission.. Our primary outcome was a composite of hematoma expansion or death due to neurologic injury. Treatment groups were defined as receipt of 4F-PCC within 0-30, 31-60, 61-90, 91-120 min, or greater than 120 min. Hematoma expansion was defined as any increase in hematoma size as assessed by a radiologist via standard 6-h CT. Death due to neurologic injury was defined as death prior to a repeat CT being performed or documentation of a neurologic cause of death. Adequate INR reversal (INR ≤1.3 on repeat INR) vs. inadequate INR reversal and weight-based vs. fixed-dose 4F-PCC were also assessed.. A total of 94 patients met the inclusion criteria. Forty-one patients (43.6%) met the composite endpoint, including 60% of the 31-60 min group, 47.6% of the 61-90 min group, 71.4% of the 91-120 min group, and 30.6% of the >120-min group. A significant difference in primary outcome occurred between the 91-120 min and >120-min groups (71.4% vs. 30.6%; p= 0.005), but this difference was not observed when accounting for disparities in Glasgow Coma Scale (GCS). Patients with adequate INR reversal were less likely to meet the primary endpoint than those with inadequate INR reversal (28.1% vs. 58.6%; p= 0.0059). There was less failure of anticoagulation reversal with weight-based dosing compared with fixed dosing (24.2% vs. 65.0%; p< 0.001).. No difference in clinical outcomes among 4F-PCC dosing strategies or time windows to administration was observed in patients with GCS <15. Rates of repeat INR ≤1.3 were higher with weight-based dosing, suggesting investigation of populations in which fixed dosing may be inappropriate is warranted.

Topics: Anticoagulants; Blood Coagulation Factors; Factor IX; Hematoma; Humans; International Normalized Ratio; Intracranial Hemorrhages; Retrospective Studies; Vitamin K; Warfarin

This study aimed to determine the impact of the approval of prothrombin complex concentrates on the treatment of vitamin K antagonist-related intracerebral hemorrhage.. We retrospectively studied all patients with vitamin K antagonist-related intracerebral hemorrhage treated with prothrombin complex concentrate at our institutes between January 2010 and June 2021. Before approval, prothrombin complex concentrate was administered as either 500 or 1000 IU at the physician's discretion (previous dose group). After approval, we adopted the manufacturer's recommended regimen (recommended dose group). The primary outcome was post-administration international normalized ratio. Secondary outcomes were the amount of prothrombin complex concentrate administered and proportion of post-administration international normalized ratio <1.5, hematoma expansion, thrombotic events within 30 days, modified Rankin scale 0-3 at discharge, and in-hospital mortality.. Thirty-two and 19 patients in the previous and recommended dose groups, respectively, were included. The post-administration international normalized ratio significantly differed between groups. The prothrombin complex concentrate dose and proportion of patients achieving post-administration international normalized ratio <1.5 were significantly higher in the recommended dose group than in the previous dose group (1500 IU vs. 500 IU, p<0.001 and 100% vs. 68%, p = 0.008). The proportions of hematoma expansion, thromboembolic events, modified Rankin scale 0-3, and mortality did not differ between groups.. After prothrombin complex concentrate approval, prothrombin time-international normalized ratio correction was more effective with a significant increase in the prothrombin complex concentrates dose for vitamin K antagonist-associated intracerebral hemorrhage; however, there was no apparent difference in clinical outcomes.

Topics: Anticoagulants; Blood Coagulation Factors; Cerebral Hemorrhage; Fibrinolytic Agents; Hematoma; Humans; International Normalized Ratio; Prothrombin; Retrospective Studies; Vitamin K

This study determined the influence of age on bleeding characteristics and clinical outcomes in primary spontaneous (non-OAC), vitamin K antagonist-related (VKA-) and non-vitamin K antagonist oral anticoagulant-related (NOAC-) ICH.. Pooled individual patient data of multicenter cohort studies were analyzed by logistic regression modelling and propensity-score-matching (PSM) to explore the influence of advanced age on clinical outcomes among non-OAC-, VKA-, and NOAC-ICH. Primary outcome measure was functional outcome at three months assessed by the modified Rankin Scale, dichotomized into favorable (mRS = 0-3) and unfavorable (mRS = 4-6) functional outcome. Secondary outcome measures included mortality, hematoma characteristics, and frequency of invasive interventions.. In VKA-ICH 33.5% (670/2001), in NOAC-ICH 44.2% (69/156) and in non-OAC-ICH 25.2% (254/1009) of the patients were ≥80 years. After adjustment for treatment interventions and relevant parameters, elderly ICH patients comprised worse functional outcome at three months (adjusted odds ratio (aOR) in VKA-ICH: 1.49 (1.21-1.84); p < 0.001; NOAC-ICH: 2.01 (0.95-4.26); p = 0.069; non-OAC-ICH: 3.54 (2.50-5.03); p < 0.001). Anticoagulation was significantly associated with worse functional outcome below the age of 70 years, (aOR: 2.38 (1.78-3.16); p < 0.001), but not in patients of ≥70 years (aOR: 1.21 (0.89-1.65); p = 0.217). The differences in initial ICH volume and extent of ICH enlargement between OAC-ICH and non-OAC-ICH gradually decreased with increasing patient age.. As compared to elderly ICH-patients, in patients <70 years OAC-ICH showed worse clinical outcomes compared to non-OAC-ICH because of larger baseline ICH-volumes and extent of hematoma enlargement. Treatment strategies aiming at neutralizing altered coagulation should be aware of these findings.

Topics: Administration, Oral; Aged; Anticoagulants; Cerebral Hemorrhage; Hematoma; Humans; Stroke; Vitamin K

Factor V inhibitors are a rare cause of life-threatening bleeding. We present a case of an acquired factor V inhibitor likely caused by coronavirus disease 2019 infection. Bleeding was manifested by severe anemia requiring frequent red-cell transfusion, left psoas muscle hematoma, and left retroperitoneal cavity hematoma. Factor V activity was less than 1% and the factor V inhibitor titer was 31.6 Bethesda units. Severe acute respiratory syndrome coronavirus 2 RNA testing of the nasopharynx was positive 2 weeks before presentation and continued to be positive for 30 days. The patient failed treatment with intravenous immunoglobulin and dexamethasone. Three cycles of plasmapheresis with fresh frozen plasma replacement resulted in correction of the bleeding and laboratory coagulopathy. This is the first reported case of a factor V inhibitor in a coronavirus disease 2019 patient and suggests that plasmapheresis may be a successful treatment strategy.

Topics: Aged, 80 and over; Anemia; Antibodies, Viral; Antibody Specificity; Autoantibodies; Combined Modality Therapy; Comorbidity; COVID-19; Delayed Diagnosis; Dexamethasone; Erythrocyte Transfusion; Factor V; Female; Hematoma; Hemorrhagic Disorders; Humans; Immunoglobulins, Intravenous; Lupus Coagulation Inhibitor; Octreotide; Plasma; Plasmapheresis; SARS-CoV-2; Vitamin K

Vitamin K antagonists (VKA) based oral anticoagulation, is widely used for the prevention and treatment of thromboembolic disease. The major complication of this therapy is bleeding, and sometimes it can occur in unsuspected areas. Spontaneous pectoral hematoma is one of the rare complications due to over anticoagulation by VKA therapy, with only a few cases reported in the literature. Concomitant use of this therapy with commonly used antibiotic, especially in the elderly with multiple comorbidities, can increase the risk of bleeding. Herein, we report a case of a 72-year-old woman under VKA for the treatment of atrial fibrillation, who presented with a spontaneous massive pectoral hematoma, while using antibiotic to treat a respiratory tract infection, who was successfully managed.

Topics: Acenocoumarol; Aged; Anticoagulants; Atrial Fibrillation; Female; Hematoma; Hemorrhage; Humans; Thromboembolism; Vitamin K

Hematoma enlargement (HE) is associated with clinical outcomes after supratentorial intracerebral hemorrhage (ICH). This study evaluates whether HE characteristics and association with functional outcome differ in deep versus lobar ICH.. Pooled analysis of individual patient data between January 2006 and December 2015 from a German-wide cohort study (RETRACE, I + II) investigating ICH related to oral anticoagulants (OAC) at 22 participating centers, and from one single-center registry (UKER-ICH) investigating non-OAC-ICH patients. Altogether, 1954 supratentorial ICH patients were eligible for outcome analyses, which were separately conducted or controlled for OAC, that is, vitamin-K-antagonists (VKA, n = 1186) and non-vitamin-K-antagonist-oral-anticoagulants (NOAC, n = 107). Confounding was addressed using propensity score matching, cox regression modeling and multivariate modeling. Main outcomes were occurrence, extent, and timing of HE (>33%/>6 mL) and its association with 3-month functional outcome.. Occurrence of HE was not different after deep versus lobar ICH in patients with non-OAC-ICH (39/356 [11.0%] vs. 36/305 [11.8%], P = 0.73), VKA-ICH (249/681 [36.6%] vs. 183/505 [36.2%], P = 0.91), and NOAC-ICH (21/69 [30.4%] vs. 12/38 [31.6%], P = 0.90). HE extent did not differ after non-OAC-ICH (deep:+59% [40-122] vs. lobar:+74% [37-124], P = 0.65), but both patients with VKA-ICH and NOAC-ICH showed greater HE extent after deep ICH [VKA-ICH, deep: +94% [54-199] vs. lobar: +56% [35-116], P < 0.001; NOAC-ICH, deep: +74% [56-123] vs. lobar: +40% [21-49], P = 0.001). Deep compared to lobar ICH patients had higher HE hazard during first 13.5 h after onset (Hazard ratio [HR]: 1.85 [1.03-3.31], P = 0.04), followed by lower hazard (13.5-26.5 h, HR: 0.46 [0.23-0.89], P = 0.02), and equal hazard thereafter (HR: 0.96 [0.56-1.65], P = 0.89). Odds ratio for unfavorable outcome was higher after HE in deep (4.31 [2.71-6.86], P < 0.001) versus lobar ICH (2.82 [1.71-4.66], P < 0.001), and only significant after small-medium (1st volume-quarter, deep: 3.09 [1.52-6.29], P < 0.01; lobar: 3.86 [1.35-11.04], P = 0.01) as opposed to large-sized ICH (4th volume-quarter, deep: 1.09 [0.13-9.20], P = 0.94; lobar: 2.24 [0.72-7.04], P = 0.17).. HE occurrence does not differ among deep and lobar ICH. However, compared to lobar ICH, HE after deep ICH is of greater extent in OAC-ICH, occurs earlier and may be of greater clinical relevance. Overall, clinical significance is more apparent after small-medium compared to large-sized bleedings.

Topics: Aged; Aged, 80 and over; Anticoagulants; Cerebral Hemorrhage; Cerebral Intraventricular Hemorrhage; Cerebrum; Clinical Trials as Topic; Cohort Studies; Female; Germany; Hematoma; Humans; Male; Middle Aged; Registries; Single-Blind Method; Vitamin K

A 91-year-old Caucasian man on warfarin for atrial fibrillation presented in view of sudden-onset haemoptysis with fresh bleeding with clots immediately after having eaten a piping-hot traditional cheesecake (pastizz) and burning the soft-palate of his mouth. The haemoptysis had resolved by the time that the patient had arrived to hospital. On examination, a 2 cm by 2 cm dark red, solitary mass could be seen just anterior to the uvula. This was not causing any pain or discomfort to the patient. Blood results were mostly unremarkable except for a raised international normalised ratio (INR) of 3.53. The patient was administered 5 mg vitamin K orally in attempt to lower the INR level and warfarin was subsequently omitted for 7 days. He was also prescribed oral steroids on discharge. The lesion resolved in 7 days and warfarin was restarted then with no further consequences.

Topics: Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Blood Coagulation; Burns; Food; Hematoma; Hemoptysis; Hot Temperature; Humans; International Normalized Ratio; Male; Palate, Soft; Uvula; Vitamin K; Warfarin

Topics: 4-Hydroxycoumarins; Acute Disease; Aged; Duodenal Diseases; Duodenum; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Indenes; Male; Middle Aged; Pancreatitis; Vitamin K

Recent studies indicated that functional outcome after intracranial hemorrhage (ICH) related to direct oral anticoagulation (DOAC-ICH) is similar, if not better, than vitamin K antagonist (VKA)-related ICH (VKA-ICH) due to a smaller initial hematoma volume (HV). However, the association with hematoma expansion (HE) and location is not well understood.. We retrospectively analyzed 102 consecutive patients with acute non-traumatic ICH on oral anticoagulation therapy to determine HV and HE stratified by hematoma location, and the relation to the 90-day outcome.. DOAC-ICH (n = 25) and VKA-ICH (n = 77) had a similar admission HV and HE (unadjusted p > 0.05, each). Targeted reversal strategies were used in 93.5% of VKA-ICH versus 8% of DOAC-ICH. After adjustment, an unfavorable 90-day functional outcome (modified Rankin scale score 4-6) was independently associated with a lower admission Glasgow Coma Scale score (OR 1.63; 95% CI 1.26-2.10; p < 0.001) and greater HV (OR 1.03; 95% confidence interval (CI) 1.00-1.05; p = 0.046). After exclusion of patients without follow-up head computed tomography to allow for adjustment by occurrence of HE, VKA-ICH was associated with an approximately 3.5 times greater odds for a poor 90-day outcome (OR 3.64; 95% CI 1.01-13.09; p = 0.048). However, there was no significant association of the oral anticoagulant strategy with 90-day outcome in the entire cohort (OR 2.85; 95% CI 0.69-11.86; p = 0.15).. DOAC use did not relate to worse HE, HV, and functional outcome after ICH, adding to the notion that DOAC is a safe alternative to VKA even in the absence of access to targeted reversal strategies (which are still not universally available).

Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Female; Hematoma; Humans; Intracranial Hemorrhages; Male; Radiography; Retrospective Studies; Stroke; Vitamin K

This study evaluated the safety and efficacy of venous figure-of-eight (FoE) suture to achieve femoral venous hemostasis after radiofrequency (RF) catheter ablation (CA) for atrial fibrillation (AF).Methods and Results:We retrospectively examined 517 consecutive patients undergoing RFCA for AF. The control group (n=247) underwent manual compression for femoral venous hemostasis after sheath removal with 6 h of bed rest. The FoE group (n=270) underwent FoE suture technique with 4 h of bed rest. All patients achieved successful hemostasis within 24 h after CA. Although the incidence of hematoma was similar between the groups, the incidence of rebleeding was lower in the FoE group than in the control group (FoE vs. control, 3.7% vs. 18.6%, P<0.001). The post-procedural use of analgesic and/or anti-emetic agents was less frequent in the FoE group (19.3% vs. 32.0%, P<0.001). On multiple logistic regression analysis after adjustment for age and sex, the use of a vitamin K antagonist (OR, 2.42; 95% CI: 1.18-4.99, P=0.02) and the FoE suture technique (OR, 0.17; 95% CI: 0.08-0.35, P<0.001) were independent predictors of rebleeding after CA.. FoE suture technique effectively achieved femoral venous hemostasis after RFCA for AF. It reduced the risk of rebleeding, shortened bed rest duration, and relieved patient discomfort.

Topics: Aged; Analgesics; Atrial Fibrillation; Bed Rest; Case-Control Studies; Catheter Ablation; Female; Femoral Vein; Hematoma; Hemorrhage; Hemostasis; Humans; Male; Middle Aged; Retrospective Studies; Suture Techniques; Treatment Outcome; Vitamin K

According to the International Society on Thrombosis and Haemostasis (ISTH), intramuscular hematoma without other severity criteria is not considered a major bleeding.. In a large cohort of reversed vitamin K antagonist (VKA) patients admitted to the emergency unit for muscular hematoma, we assess frequency, severity, and anticoagulation management based on whether ISTH criteria were met or not.. We performed a retrospective single-center study involving patients admitted to an emergency unit for VKA-induced intramuscular hematoma whose bleeding was reversed with prothrombin complex concentrates.. During the study period, 631 VKA-induced bleeding events occurred in our emergency unit, of which 73 (11.6%) were intramuscular hematomas and half met ISTH criteria. The mean age was 75.5years (95% CI=72.6-78.3). Admission blood tests showed that patients with ISTH criteria had higher international normalized ratio (7.0±4.6 vs. 4.1±3.0, p=0.002) and lower hemoglobin (8.1±1.8 vs. 11.9±2.2, p<0.001) than those without. Patients with ISTH criteria were more likely to have intramuscular hematoma in the iliopsoas, gluteal, and pectoral muscles than those without. Interestingly, two-thirds of rectus sheath hematomas involved patients without ISTH criteria. However, patients with or without ISTH criteria exhibited a similar hospitalization duration and rate of re-bleeding.. We showed that half of the patients admitted with intramuscular hematoma could not be qualified as having ISTH-criteria major bleeding. Interestingly, these patients displayed a similar hospitalization duration and rate of re-bleeding to those with ISTH-criteria major bleeding.

Topics: Aged; Anticoagulants; Blood Coagulation Factors; Emergency Service, Hospital; Female; Follow-Up Studies; Hematoma; Humans; Inpatients; Male; Muscular Diseases; Prognosis; Retrospective Studies; Vitamin K

Topics: Airway Obstruction; Antifibrinolytic Agents; Blood Coagulation Factors; Ecchymosis; Factor X Deficiency; Factor XI Deficiency; Female; Hematoma; Humans; Laryngoscopy; Middle Aged; Treatment Outcome; Vitamin K; Vitamin K Deficiency Bleeding

Background and Purpose- The aim of this study was to prospectively validate our prior findings of smaller hematoma volume and lesser neurological deficit in nonvitamin K oral anticoagulant (NOAC) compared with Vitamin K antagonist (VKA)-related intracerebral hemorrhage (ICH). Methods- Prospective 12-month observational study in 15 tertiary stroke centers in the United States, Europe, and Asia. Consecutive patients with premorbid modified Rankin Scale score of <2 with acute nontraumatic anticoagulant-related ICH divided into 2 groups according to the type of anticoagulant: NOAC versus VKA. We recorded baseline ICH volume, significant hematoma expansion (absolute [12.5 mL] or relative [>33%] increase), neurological severity measured by National Institutes of Health Stroke Scale score, 90-day mortality, and functional status (modified Rankin Scale score). Results- Our cohort comprised 196 patients, 62 NOAC related (mean age, 75.0±11.4 years; 54.8% men) and 134 VKA related (mean age, 72.3±10.5; 73.1% men). There were no differences in vascular comorbidities, antiplatelet, and statin use; NOAC-related ICH patients had lower median baseline hematoma volume (13.8 [2.5-37.6] versus 19.5 [6.6-52.0] mL; P=0.026) and were less likely to have severe neurological deficits (National Institutes of Health Stroke Scale score of >10 points) on admission (37% versus 55.3%, P=0.025). VKA-ICH were more likely to have significant hematoma expansion (37.4% versus 17%, P=0.008). NOAC pretreatment was independently associated with smaller baseline hematoma volume (standardized linear regression coefficient:-0.415 [95% CI, -0.780 to -0.051]) resulting in lower likelihood of severe neurological deficit (odds ratio, 0.44; 95% CI, 0.22-0.85) in multivariable-adjusted models. Conclusions- Patients with NOAC-related ICH have smaller baseline hematoma volumes and lower odds of severe neurological deficit compared with VKA-related ICH. These findings are important for practicing clinicians making anticoagulation choices.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Cerebral Hemorrhage; Female; Hematoma; Humans; Male; Middle Aged; Neuroimaging; Prospective Studies; Treatment Outcome; Vitamin K; Warfarin

Topics: Abdominal Injuries; Accidents, Traffic; Adult; Anticoagulants; Computed Tomography Angiography; Female; Hematoma; Humans; Lacerations; Liver; Pulmonary Embolism; Tomography, X-Ray Computed; Vena Cava, Inferior; Venous Thrombosis; Vitamin K; Wounds, Nonpenetrating

Spontaneous hematoma of transverse mesocolon is a rare complication of anticoagulant treatment with vitamin K. We report the case of spontaneous hematoma of right angle of the transverse mesocolon associated with a hemoperitoneum in a 32-year-old patient treated by fluindione for pulmonary embolism. The diagnosis must be made urgently. The abdominal ultrasound and the scanning confirm the diagnosis. It is important to note that surgery is indicated only in the case of complications such as the risk of rupture of the hematoma.

Topics: Adult; Anticoagulants; Female; Hematoma; Hemoperitoneum; Humans; Mesocolon; Phenindione; Pulmonary Embolism; Vitamin K

Topics: Anticoagulants; Blood Coagulation Factors; Hematoma; Humans; International Normalized Ratio; Vitamin K

Topics: Anticoagulants; Blood Coagulation Factors; Hematoma; Humans; Vitamin K

Topics: Anticoagulants; Hematoma; Humans; Vitamin K

Vitamin K antagonists (VKA) are widely used for the prevention and curative treatment of thromboembolic events. This study aims to describe the epidemiological, clinical and evolutionary aspects of overdose in Vitamin K antagonists administration and determine its hemorrhagic factors. We conducted a monocentric cross-sectional descriptive study at the Principal Hospital in Dakar. All patients with an INR greater than 5 were included. We studied patients' gender and age, VKA used, drug use period, indications, INR value, associated drugs, presence of hemorrhage, immediate management and evolution. We enrolled 154 patients. Acenocoumarol was the most prescribed VKA. Sex ratio favoured women. The average age was 63 years. Overdose was asymptomatic in 43% of patients. Hemorrhagic symptoms were mainly represented by gingival bleeding, epistaxis. Major bleeding episodes were found in 8.6% of patients and they were represented by melena in 6 patients (3.9%), deep muscle hematoma in 2 patients (1.3%) and intracerebral parenchymal hematoma in 2 patients. Two patients had cardiovascular collapse associated with deglobulisation. Nonsteroidal anti-inflammatory drugs (NSAIDs) assumption was noted in 21% of patients. VKA assumption was suspended transiently in all patients. Mortality was 2%, due to intracranial hemorrhage. The reduction in VKA overdose requires caregivers to manage overdose factors and provide proper patient education.

Topics: Acenocoumarol; Adult; Aged; Aged, 80 and over; Anticoagulants; Cross-Sectional Studies; Drug Overdose; Female; Hematoma; Hemorrhage; Humans; International Normalized Ratio; Intracranial Hemorrhages; Male; Middle Aged; Senegal; Vitamin K; Young Adult

Topics: 4-Hydroxycoumarins; Adult; Anticoagulants; Biopsy; Blood Coagulation; Blood Component Transfusion; Duodenal Diseases; Hematoma; Humans; Intestinal Obstruction; Jejunal Diseases; Male; Risk Factors; Rodenticides; Tomography, X-Ray Computed; Treatment Outcome; Vitamin K

We report the case of late vitamin K deficiency bleeding (VLDB), with appropriate but insufficient prophylaxis, secondary to extrahepatic cholestasis. Late VKDB is rare today but serious, with a risk of intracranial hemorrhage in more than half of the cases. The diagnosis, causes and prevention of this disease are discussed.

Topics: Back; Bile Acids and Salts; Bilirubin; Breast Feeding; Child Abuse; Cholestasis, Extrahepatic; Diagnosis, Differential; Hematoma; Humans; Infant; Liver Function Tests; Male; Medication Adherence; Vitamin D; Vitamin K; Vitamin K Deficiency Bleeding

Reversal of anticoagulation is recommended to correct the international normalised ratio (INR) for patients with intracranial haemorrhage (ICH) associated with vitamin K antagonists (VKA). However, the validity of such treatment is debated. We sought to identify, prospectively, the prognostic effect of VKA-ICH treatment in a cohort of patients (n=71; median age 78 years, range 20-89; 52% males). Data collated were: baseline characteristics, treatments, baseline and post-treatment INR, haematoma volume, and haematoma enlargement. Treatment effects and prognostic factor assessment were in relation to mortality and functional outcomes. On admission, the patients had a median score of 9 [p25; p75 of 5; 20] on the National Institute of Health Stroke Scale (NIHSS) and a mean INR of 2.7 (range: 0.9 - 10.8). Haematoma volume (34.6 cm³; SD: 24.9) correlated with NIHSS (r = 0.55; p<0.001) but not with INR. Anticoagulation reversal treatment was administered in 83% of patients. INR <1.5 was achieved in 60.7% of cases. Death or dependency at three months was 76%. Neither baseline INR, anticoagulation reversal nor haematoma enlargement were related to mortality or functional outcome. The only independent prognostic factor was clinical severity on admission. Baseline NIHSS predicted mortality (OR: 1.18; 95%CI: 1.09-1.27), independence (OR: 0.83; 95%CI: 0.74-0.94) and neurological recovery (NIHSS 0-1) (OR: 0.83; 95%CI: 0.73-0.95). The data indicate that VKA-ICH had a poor prognosis. Treatment and INR correction did not appear to affect outcomes.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Cerebral Hemorrhage; Cohort Studies; Hematoma; Humans; International Normalized Ratio; Male; Middle Aged; Prognosis; Prospective Studies; Survival Analysis; Treatment Outcome; Vitamin K; Young Adult

Vitamin K antagonist (VKA) treatment is associated with significant risks and requires strict monitoring by measuring the international normalized ratio (INR), either by conventional methods or by self-measurement under medical supervision. We present a case of blindness occurring secondary to a moderate head injury, in a pediatric setting with no VKA therapeutic education.. A 7-year-old child with a single ventricle had been operated on for a total cavopulmonary shunt at the age of 5 years. He took VKA therapy with an INR target between 2 and 3. After a head trauma, he had a frontal hematoma. His parents did not request a medical exam and did not check his INR. Six days after the injury, the INR was 2.23. The parents went to the emergency ward because the child had bilateral orbital hematoma. At admission, the INR was 5.6. The orbital hematoma was surgically evacuated in the emergency setting. Unilateral blindness occurred and remains a sequelae of the overdose.. VKA treatment requires close supervision to prevent overdose, whose complications such as internal bleeding can have terrible consequences such as the case of blindness reported herein. This case report is a strong argument in favor of an educational program for children with VKA treatment.

Topics: Anticoagulants; Blindness; Child; Craniocerebral Trauma; Drug Overdose; Heart Defects, Congenital; Hematoma; Humans; Male; Monitoring, Physiologic; Patient Education as Topic; Prognosis; Retrobulbar Hemorrhage; Thromboembolism; Treatment Failure; Treatment Outcome; Vitamin K

Intracerebral hemorrhage (ICH) is the most serious bleeding complication of vitamin K antagonist (VKA) therapy, carrying a high mortality. Rapid reversal of VKA in ICH is critical. Plasma therapy, the standard of care in the US, is not optimal. The ideal prothrombin complex concentrate (PCC) containing all vitamin K-dependent factors (VKDFs) is not available in the US. Therefore, the authors developed a Trauma Coumadin Protocol (TCP) consisting of a 3-factor PCC available in the US (which contains insufficient factor VII [FVII]) with a low-dose recombinant FVIIa to rapidly reverse VKA.. Forty-six patients treated with the TCP were retrospectively analyzed. Fourteen patients had pre- and post-TCP plasma samples collected to assess their VKDF increment. Eleven patients had measurable intraparenchymal hematomas, which were evaluated for expansion.. The mean pre- and post-TCP international normalized ratios (INRs) were 3.4 (median 2.9) and 1.0 (median 0.9), respectively. Once corrected, INR was maintained at < 1.3 during a patient's hospital stay. The pre-TCP median values of FII, FVII, FIX, and FX were 28%, 21%, 45%, and 20%, respectively; post-TCP median values increased to 144%, 417%, 102%, and 143%, respectively. Four of the 11 patients with measurable intraparenchymal hemorrhage had expansion at 24 hours after TCP. One patient probably (8 hours post-TCP) and 1 patient possibly (3 days post-TCP) had thrombotic complications.. The TCP was very effective in rapidly reversing VKA-associated coagulopathy; however, this protocol should be used cautiously in patients at high risk for thrombosis.

Topics: Adult; Aged; Anticoagulants; Blood Coagulation Factors; Cerebral Hemorrhage; Clinical Protocols; Drug Combinations; Factor VIIa; Female; Hematoma; Humans; International Normalized Ratio; Male; Middle Aged; Recombinant Proteins; Retrospective Studies; Vitamin K; Warfarin

Anticoagulation therapy with vitamin K antagonist (VKA) or heparin, even properly applied, may lead to occurrence of differently localized hematomas, including rectus sheath hematoma (RSH). This uncommon complication of anticoagulation is often misdiagnosed. In the presented case of a 72-year-old man, with a history of VKA use for permanent atrial fibrillation, an additional factor which might predispose to RSH formation was intensive cough during respiratory tract infection. Hematoma was detected with delay on abdominal ultrasonography and visualized topographically on computed tomography Conservative treatment was performed. During a 5-month period, gradual reabsorption of RSH was observed on control ultrasonography examinations.

Topics: Aged; Anticoagulants; Atrial Fibrillation; Hematoma; Humans; Male; Radiography; Rectus Abdominis; Ultrasonography; Vitamin K

Iliopsoas haematoma is a rare complication that occurs in patients receiving anticoagulant therapy. The clinical manifestation of iliopsoas haematoma is non-specific. It can mimic orthopaedic or neurological disorders, including paraesthesia or paresis of the thigh and leg due to compression of the nerve plexus. Among the many available diagnostic modalities, computed tomography is the most useful radiological method for diagnosis. Treatment approaches for iliopsoas haematoma include conservative therapy, surgical intervention, or transcatheter arterial embolisation. Conservative therapy consists of bed rest, restoration of circulating volume, and drug discontinuation for correcting underlying coagulopathy. Although a conservative approach is the first choice, transcatheter arterial embolisation and surgical intervention may be required in patients with hemodynamically unstable and active bleeding. The report described a case of iliopsoas haematoma due to anticoagulant therapy with paraesthesia in the left leg who was successfully treated by conservative approach.

Topics: Abdominal Pain; Aged; Anticoagulants; Female; Femoral Nerve; Hematoma; Humans; Paresis; Psoas Muscles; Rare Diseases; Tomography, X-Ray Computed; Treatment Outcome; Vitamin K; Warfarin

Sublingual hematoma secondary to excessive anticoagulation is a rare, life-threatening condition. Reports in the literature have emphasized the importance of a prompt reversal of the causative coagulopathy by intravenous administration of vitamin K and fresh frozen plasma. In the event of an unstable airway, surgical intervention via tracheostomy or cricothyroidectomy is advocated. We report a case of sublingual hematoma that was treated conservatively, and we discuss the presentation and management of this entity.

Topics: Blood Transfusion; Diagnosis, Differential; Female; Hematoma; Humans; International Normalized Ratio; Ludwig's Angina; Middle Aged; Mouth Floor; Plasma; Vitamin K; Warfarin

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

Topics: Blood Coagulation Factors; Drug Hypersensitivity; Factor IX; Heart Valve Prosthesis Implantation; Hematoma; Hemophilia B; Hemorrhage; Hemostasis; Humans; Male; Middle Aged; Mutation, Missense; Vitamin K

Acenocumarol is widely used in long-term anticoagulant treatment. Overdose of this drug may result in suffusions in various parts of the body. In three cases, we observed suffusion in the rectus sheath, which is an unusual site of hematomas. At early stage, the lack of discoloration of the abdominal wall may lead to problems in differential diagnosis. Chronic anticoagulant treatment in a patient's history in combination with a palpable abdominal mass facilitate the correct diagnosis. In addition, high INR also makes hemorrhagic complications more likely. In simple cases, suggestive past medical history, abdominal palpation, INR and ultrasound examination can be sufficient to make a diagnosis. However, in more complicated cases, further assessment by CT is required to set up the diagnosis; while, in a further case discussed in this article, we could only establish an accurate diagnosis with laparoscopy. Decreased plasma prothrombin levels were always normalized with vitamin K.

Topics: Acenocoumarol; Aged; Anticoagulants; Antifibrinolytic Agents; Diagnosis, Differential; Drug Overdose; Female; Hematoma; Humans; International Normalized Ratio; Laparoscopy; Male; Middle Aged; Palpation; Rectus Abdominis; Tomography, X-Ray Computed; Vitamin K

Bleeding of the ureteral wall during an anticoagulant treatment is a rare complication. We report the case of a 57-year-old white woman presented with macroscopic haematuria and lumbar pain with an overdose of anticoagulant treatment. Computed tomographic scan revealed the bleeding of the ureteral wall. Clinical improvement was excellent after correction of the haemostasis disorder.

Topics: 4-Hydroxycoumarins; Anticoagulants; Female; Hematoma; Humans; Indenes; Middle Aged; Ureteral Diseases; Vitamin K

Rectus sheath hematoma (RSH) is a known complication of anticoagulation therapy and a source of potential morbidity and mortality. Early diagnosis and appropriate treatment may help to prevent complications including hemodynamic instability, the abdominal compartment syndrome or multiorgan dysfunction. Although the diagnosis can be made clinically, it can be confirmed with computed tomography of the abdomen. Most patients can be managed conservatively; however, it is often necessary to suspend anticoagulation in the acute setting. Rectus sheath hematoma is not a contraindication to resuming anticoagulation once the hematoma has been adequately managed and the patient has returned to a stable clinical baseline.

Topics: Abdominal Pain; Aged; Anticoagulants; Antifibrinolytic Agents; Blood Coagulation; Erythrocyte Transfusion; Hematoma; Humans; International Normalized Ratio; Male; Rectus Abdominis; Tomography, X-Ray Computed; Vitamin K

Intracerebral hemorrhage (ICH) is the most serious and potentially fatal complication of oral anticoagulant therapy (OAT). Still, there are no universally accepted treatment regimens for patients with OAT-ICH, and randomized controlled trials do not exist. The aim of the present study was to compare the acute treatment strategies of OAT-associated ICH using vitamin K (VAK), fresh frozen plasma (FFP), and prothrombin complex concentrates (PCCs) with regard to hematoma growth and outcome.. In this retrospective study, a total of 55 treated patients were analyzed. Three groups were compared by reviewing the clinical, laboratory, and neuroradiological parameters: (1) patients who received PCCs alone or in combination with FFP or VAK (n=31), (2) patients treated with FFP alone or in combination with VAK (n=18), and (3) patients who received VAK as a monotherapy (n=6). The end points of early hematoma growth and outcome after 12 months were analyzed including multivariate analysis.. Hematoma growth within 24 hours occurred in 27% of patients. Incidence and extent of hematoma growth were significantly lower in patients receiving PCCs (19%/44%) compared with FFP (33%/54%) and VAK (50%/59%). However, this effect was no longer seen between PCC- and FFP-treated patients if international normalized ratio (INR) was completely reversed within 2 hours after admission. The overall outcome was poor (modified Rankin scale 4 to 6 in 77%). Predictors for hematoma growth were an increased INR after 2 hours, whereas administration of PCCs was significantly protective in multivariate analyses. Predictors for a poor outcome were age, baseline hematoma volume, and occurrence of hematoma growth.. Overall, PCC was associated with a reduced incidence and extent of hematoma growth compared with FFP and VAK. This effect seems to be related to a more rapid INR reversal. Randomized controlled trials are needed to identify the most effective acute treatment regimen for lasting INR reversal because increased levels of INR were predisposing for hematoma enlargement.

Topics: Administration, Oral; Aged; Anticoagulants; Blood Coagulation Factors; Blood Component Transfusion; Cerebral Hemorrhage; Critical Care; Female; Hematoma; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Plasma; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Vitamin K

Thyroid hemorrhage is a relatively frequent event that in most cases causes pain and discomfort only, while rarely can cause significant neck swelling. Even more rarely, however, extensive thyroid hemorrhage can result in a rapidly expanding hematoma with airway compromise. We report a case of a rapidly expanding thyroid hemorrhage that occurred secondary to oral anticoagulation therapy in an 80-year-old patient with a previously existing goiter. The patient presented with acute onset of neck pain, dysphagia, and respiratory distress caused by tracheal compression from the thyroid mass. Computed tomography demonstrated a 6 x 9 x 10 cm mass consistent with an intrathyroidal hematoma projecting into the anterior mediastinum and displacing the trachea to the left. Rapid reversal of the coagulopathy was achieved with fresh frozen plasma and vitamin K. Consequently, the patient was managed conservatively with close observation, antibiotics, and steroids because no progression of airway compromise was manifested. Although the diagnosis can be easily established in these patients, no management guidelines of this condition exist. The potential of rapid airway compromise and the risk for exacerbation of bleeding in the light of significant elevation in the international normalized ratio (INR), make any airway management decisions very difficult. The importance of managing the airway and the haemostatic problem with the help of a multidisciplinary team is discussed.

Topics: Administration, Oral; Aged, 80 and over; Airway Obstruction; Anticoagulants; Coumarins; Female; Goiter; Hematoma; Humans; International Normalized Ratio; Respiration Disorders; Thyroid Gland; Tomography, X-Ray Computed; Treatment Outcome; Vitamin K

We report a case of a 50-year-old woman, taking antivitamin K for double mitro-aortic valvular replacement, having presented a clinical picture of acute cholecystitis with marked hypotension. The radiological and biologic exams showed a deep hypocoagulability, vesicular gallstones, a haemoperitoneum and retroperitoneal haematoma. After correction of biological anomalies, the patient was operated. The gallbladder was distended containing large clots and four stones without any evidence of perforation. One of the gallstones led to cystic duct obstruction. Haemocholecyst is a rare complication of anticoagulant therapy, which may occur in the setting of gallbladder stones. The usual complication was the vesicular perforation. In spite of its rarity, haemocholecyst should be suspected when an anticoagulant treated patient presents symptoms of acute cholecystis with or without haemorrhagic shock.

Topics: Adult; Anticoagulants; Bile Ducts; Cholecystitis; Female; Heart Valve Prosthesis Implantation; Hematoma; Hemoperitoneum; Humans; Vascular Diseases; Vitamin K

A 57-year-old man treated with Coumadin for an episode of paroxysmal atrial fibrillation presented to the Emergency Department with progressive dysphagia and odynophagia. Physical examination revealed a large right-sided lateral and posterior pharyngeal wall mass. Laboratory studies were significant for an international normalized ratio (INR) of 5.4 with a white blood cell count of 11,600/muL and a hematocrit of 33.2%. A lateral soft tissue radiograph and computed tomography (CT) scan of the neck demonstrated a retropharyngeal hematoma compromising the airway. Rapid reversal of the coagulopathy was achieved with fresh frozen plasma and vitamin K. Patients with space-occupying retropharyngeal masses present a significant management dilemma. The choice between observation, intubation, or a surgical airway intervention must rely upon knowledge of the natural course and high rate of airway occlusion when faced with a patient who presents with a retropharyngeal hematoma. Once symptoms of airway compromise manifest, the airway must be expeditiously secured before complete obstruction occurs. This diagnosis should be sought when an anticoagulated patient presents with upper airway symptoms.

Topics: Airway Obstruction; Anticoagulants; Atrial Fibrillation; Blood Transfusion; Deglutition Disorders; Disease Progression; Emergency Treatment; Hematocrit; Hematoma; Humans; Laryngoscopy; Leukocyte Count; Male; Middle Aged; Pharyngeal Diseases; Plasma; Risk Factors; Tomography, X-Ray Computed; Vitamin K; Warfarin

Major bleeding is a frequent and hazardous complication associated with thromboprophylaxis using vitamin-K antagonists (VKA). Suggested regimens for control of highly elevated International Normalized Ratio (INR) and hemorrhagic events during VKA treatment include administration of vitamin K, infusion of fresh frozen plasma (FFP) or a prothrombin complex concentrate (PCC). In contrast, this communication present the first report on the efficacious use of recombinant factor VIIa (rFVIIa) as additional therapy in seven patients presenting with central nervous system (CNS) bleeding emergencies. Pre-treatment INRs ranged from 1.7 to 6.6, and 10 min after a single dose of rFVIIa (10-40 microg/kg) all INRs were

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Blood Coagulation; Cerebral Hemorrhage; Computer Systems; Drug Evaluation; Factor VII; Factor VIIa; Female; Hematoma; Hemostatics; Humans; International Normalized Ratio; Male; Middle Aged; Recombinant Proteins; Thrombelastography; Thromboembolism; Treatment Outcome; Vitamin K; Warfarin

The use of replacement FVII is critical to the successful treatment of life-threatening bleeds in newborns and infants with severe FVII deficiency (<1%). However, the clinical efficacy, optimum dosage and pharmacologic recovery of rFVIIa in such children has not been studied systematically. This report is a case of an infant with severe FVII deficiency (FVII:C at 0%) and massive intracranial haemorrhage in which successful use of rFVIIa (NovoSeven) was carefully monitored. The drug was administered by intravenous bolus through a central line every 4 h at each of three dose levels: 15 microg kg-1, 22 microg kg-1 and 30 microg kg-1. FVII:C was >100% between 30 and 180 min after each infusion with mean trough levels above 25% for all three dose levels. There was no evidence of hyper-coagulation as indicated by measurements of the platelet count, D-dimer, plasma protamine paracoagulant and fibrinogen levels in spite of high FVII:C concentration. In this infant, rFVIIa was well-tolerated, maintained effective haemostasis with good clinical outcome, and produced consistent therapeutic mean trough levels above 25% FVII:C even at 15 microg kg-1 every 4 h.

Topics: Antigens; Blood Coagulation Tests; Factor VII; Factor VII Deficiency; Factor VIIa; Fibrin Fibrinogen Degradation Products; Fibrinogen; Hematoma; Hemostasis; Hispanic or Latino; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intracranial Hemorrhages; Male; Platelet Count; Protamines; Prothrombin; Recombinant Proteins; Vitamin K

A 4-year-old Holstein cow from a farm where 2 cows had recently died suddenly was referred for evaluation of acute severe colic. Right flank laparotomy revealed a large mesenteric hematoma. Within 14 layer chromatographic analyses of the moldy hay and blood from the necropsied cow and the hospitalized cow were positive for dicumarol. A diagnosis of sweet vernal poisoning was confirmed on the basis of clinical and toxicologic findings. The cow was treated with supportive therapy, blood transfusions, and vitamin K1 and recovered without complications. Because sweet vernal grass is becoming common in certain areas and the use of round bales is commonplace, practitioners should be aware of the potential for this toxicosis.

Topics: Abdomen; Animals; Anticoagulants; Blood Gas Analysis; Blood Transfusion; Cattle; Cattle Diseases; Chromatography, Thin Layer; Colic; Diagnosis, Differential; Dicumarol; Female; Fluid Therapy; Hematoma; Hemophilia B; Hemorrhagic Disorders; Partial Thromboplastin Time; Plant Poisoning; Poaceae; Pregnancy; Prothrombin Time; Ultrasonography; Vitamin K

Topics: Adult; Anticoagulants; Gastrointestinal Hemorrhage; Hematoma; Humans; Male; Phenprocoumon; Rectal Diseases; Tomography, X-Ray Computed; Vitamin K

A 87-year-old patient developed coagulation abnormality following hip surgery related to the prophylactic use of cefamandole. Cefamandole as others cephalosporins with a methyl-tetrazol-thiol lateral chain interferes with the vitamin K regeneration cycle as do oral anticoagulants. Therefore, the use of others antibiotics or systematic vitamin K1 supplementation or single dose of cefamandole is recommended for patients with renal failure or with malnutrition. Vitamin K1 supplementation is a simple method resulting in complete resolution of the coagulation disorder.

Topics: Aged; Aged, 80 and over; Antibiotic Prophylaxis; Arthroplasty, Replacement, Hip; Cefamandole; Cephalosporins; Female; Femoral Neck Fractures; Hematoma; Hemorrhagic Disorders; Humans; Postoperative Complications; Vitamin K; Vitamin K Deficiency

Topics: Anesthesia, Spinal; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Belgium; Hematoma; Hematoma, Epidural, Cranial; Heparin, Low-Molecular-Weight; Humans; Platelet Aggregation Inhibitors; Thromboembolism; Vitamin K

Topics: 4-Hydroxycoumarins; Abdomen; Acenocoumarol; Aged; Anti-Bacterial Agents; Anticoagulants; Coronary Disease; Cytochrome P-450 Enzyme System; Drug Interactions; Hematoma; Humans; Indenes; Liver; Male; Roxithromycin; Vitamin K

Topics: Airway Obstruction; Hematoma; Humans; Macroglossia; Male; Middle Aged; Platelet Count; Thrombocytopenia; Tongue; Vitamin K

Topics: Aged; Aged, 80 and over; Cervical Vertebrae; Combined Modality Therapy; Dexamethasone; Hematoma; Hemiplegia; Hemorrhage; Humans; Laminectomy; Male; Plasma; Spinal Cord; Spinal Cord Compression; Spinal Cord Diseases; Vitamin K; Warfarin

Acute haemocholecyst is a rare disorder but often reported in patients with gallstones. Rupture of the gallbladder causing hypovolaemic shock secondary to massive intraperitoneal bleeding has been reported in about fifty patients to date. We report a new case of haemocholecyst with rupture of the gallbladder in a patient with gallstones treated by anticoagulant therapy. This case is unusual in terms of the nature of the gallbladder disease: massive gangrene with complicating hemorrhage and destruction of deficient regions of the wall of the gallbladder induced an infrahepatic haematoma without hypovolemic shock, in contrast with the massive intraperitoneal hemorrhage reported in other cases.

Topics: Aged; Anticoagulants; Cholelithiasis; Female; Hematoma; Hemoperitoneum; Humans; Vitamin K

Topics: 4-Hydroxycoumarins; Adolescent; Blood Coagulation Factors; Blood Transfusion; Hematoma; Humans; Male; Partial Thromboplastin Time; Plasma; Prothrombin Time; Rodenticides; Thigh; Time Factors; Vitamin K

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestine, Small; Male; Middle Aged; Prothrombin; Vitamin K

Topics: Duodenoscopy; Duodenum; Hematoma; Humans; Vitamin K

Topics: Aged; Anticoagulants; Female; Hematoma; Hemiplegia; Humans; Spinal Cord Compression; Vitamin K

Topics: Adult; Aged; Blood Coagulation Disorders; Coumarins; Diagnosis, Differential; Female; Gastrointestinal Hemorrhage; Hematoma; Hemophilia A; Humans; Intestinal Diseases; Intestine, Small; Jejunum; Male; Middle Aged; Radiography; Vitamin K

Topics: Anti-Bacterial Agents; Anticoagulants; Coronary Disease; Diabetes Complications; Facial Paralysis; Hematoma; Humans; Infections; Male; Middle Aged; Mouth Diseases; Palate; Parotid Gland; Phenindione; Salivary Gland Diseases; Vitamin K

Topics: Abdominal Muscles; Anticoagulants; Aspirin; Drug Synergism; Gastrointestinal Hemorrhage; Hematoma; Humans; Peritoneum; Vitamin K

Topics: Aged; Colonic Diseases; Coumarins; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestinal Obstruction; Intestine, Small; Male; Middle Aged; Radiography; Vitamin K

Topics: Adult; Angiography; Electrocardiography; Ethambutol; Hematoma; Heparin; Humans; Isoniazid; Male; Phlebitis; Phlebography; Pulmonary Embolism; Radionuclide Imaging; Rifamycins; Streptokinase; Tachycardia; Tuberculosis, Pulmonary; Vena Cava, Inferior; Vitamin K

Topics: Adult; Aged; Anti-Bacterial Agents; Anticoagulants; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestinal Diseases; Intestinal Obstruction; Intestine, Small; Male; Middle Aged; Radiography; Vitamin K

Topics: Aged; Anticoagulants; Colonic Diseases; Gastrointestinal Hemorrhage; Hematoma; Humans; Male; Prognosis; Prothrombin Time; Time Factors; Vitamin K

Topics: Diet Therapy; Ethyl Biscoumacetate; Hematoma; Hemoperitoneum; Humans; Intestinal Obstruction; Jejunum; Male; Middle Aged; Prothrombin; Thrombosis; Vitamin K

Topics: Anticoagulants; Blood Coagulation Tests; Female; Hematoma; Hemorrhage; Humans; Male; Oral Hemorrhage; Prothrombin; Prothrombin Time; Vitamin K

Topics: Birth Injuries; Birth Weight; Craniocerebral Trauma; Female; Hematoma; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Injections, Intramuscular; Male; Punctures; Sex Factors; Vitamin K; Vitamin K Deficiency

Topics: Adrenal Gland Diseases; Adrenal Gland Neoplasms; Adrenal Glands; Adrenalectomy; Congenital Abnormalities; Diagnosis, Differential; Female; Hematoma; Hemorrhage; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kidney Neoplasms; Male; Pregnancy; Prognosis; Vitamin K

Topics: Anemia; Angiography; Animals; Cats; Cerebral Hemorrhage; Dogs; Ecchymosis; Embolism; Fever; Gastrointestinal Hemorrhage; Hematoma; Hematuria; Hemorrhage; Hemothorax; Heparin; Humans; Hypotension; Ischemia; Leukocytosis; Shivering; Streptokinase; Thrombosis; Vitamin K

Topics: Aged; Bronchitis; Femoral Nerve; Hematoma; Humans; Hypertension; Male; Peripheral Nervous System Diseases; Phenindione; Tetracycline; Thrombophlebitis; Vitamin K

Topics: Adrenocorticotropic Hormone; Adult; Aged; Anti-Bacterial Agents; Anticoagulants; Blood Coagulation Factors; Blood Transfusion; Cortisone; Deglutition Disorders; Hematoma; Hemophilia A; Humans; Laryngeal Diseases; Male; Tracheotomy; Vitamin K

Topics: Blood Coagulation Tests; Hematoma; Hemophilia A; Hemorrhagic Disorders; Humans; Infant, Newborn; Infant, Newborn, Diseases; Injections, Intramuscular; Male; Vitamin K; Vitamin K Deficiency

Topics: Anticoagulants; Antifibrinolytic Agents; Hematoma; Heparin Antagonists; Humans; Intestinal Obstruction; Vitamin K

Topics: Abortion, Induced; Capillaries; Capillary Resistance; Cortisone; Female; Hematoma; Humans; Placenta; Pregnancy; Vitamin A; Vitamin K; Vitamins