vitamin-k-semiquinone-radical and Hematuria

Vitamin K antagonists (VKA) are the most widely used anticoagulants for the prevention of thrombotic events. Several renal adverse effects have been associated with the use of VKA. The main aim of our study was to explore the association between international normalized ratio (INR) levels and microscopic hematuria in patients with VKA.. We performed a cross-sectional study of patients treated with VKA that attended the outpatient clinic for routine INR control. A simple urinalysis was performed on the day of the INR control and the precise number of red cells in the urine sediment was quantified. Demographic data, kidney function tests, comorbidities, anticoagulant dose and concomitant treatment were registered.. A total of 337 patients were included with median INR levels of 2.6 (IQR 2.1-3.3). 11.9% of the patients presented microscopic hematuria (≥14 RBCs/µl). There was a significant correlation between INR levels and the number of red blood cells in the urine sediment (r = 0.201, p = 0.024). In the univariate analysis, microscopic hematuria was associated with having an INR >3.5 (19% vs. 10.2%, p = 0.046), bacteriuria (15.2% vs. 3.6%, p = 0.015), leukocyturia (14.8% vs. 6.6%, p =  0.026), hypertension (16.2% vs. 9.5%, p = 0.053), and the use of renin-angiotensin system (RAS) blockers (6.9% vs. 17.2%, p = 0.004). Multivariate logistic regression showed an association between microscopic hematuria and RAS blockade (OR 0.38, CI 95% 0.163-0.886, p = 0.025), independent from INR levels, hypertension, leukocyturia or bacteriuria.. INR overdose was significantly associated with the presence of microscopic hematuria. RAS blockade is an independent protective factor for the presence of microscopic hematuria in anticoagulated patients.

Topics: Anticoagulants; Bacteriuria; Cross-Sectional Studies; Fibrinolytic Agents; Hematuria; Humans; Hypertension; International Normalized Ratio; Vitamin K

Following hematuria, it is uncertain to what extent a vitamin K antagonist (VKA) or non-VKA oral anticoagulant (NOAC) is resumed, and the risks of ischemic stroke/systemic embolism and major bleeding associated with NOAC and VKA resumption are unknown. A cohort study was conducted using electronic medical records collected from 2009 to 2017 at a multicenter healthcare provider in Taiwan. The cohort included 4155 atrial fibrillation patients receiving anticoagulant therapy with hematuria (age: 71.4 ± 11.2 years; 48.8% female). Within 90 days following hematuria, 3287 patients (79.1%) resumed oral anticoagulants including VKA (n = 1554, 37.4%) and NOACs (n = 1733, 41.7%), whereas 868 patients did not resume anticoagulant. Follow-up was initiated 90 days after the occurrence of hematuria, and time-varying multiple Cox regression analyses were used for comparisons between the resumption of NOAC and VKA. The event rates per 100 person-years in the VKA resumption and NOAC resumption groups were 3.04 and 3.28 for ischemic stroke/systemic embolism, and 2.63 and 2.92 for major bleeding, respectively. Patients resuming NOAC had similar risks of ischemic stroke/systemic embolism (hazard ratio 1.14, 95% CI 0.75-1.74) and major bleeding (hazard ratio 1.12, 95% CI 0.72-1.74) compared with those resuming VKA. Since 2011, the proportion of NOAC resumption has increased, whereas the proportions of VKA resumption and non-resumption have decreased. In conclusion, more and more patients who suffer a hematuria while on oral anticoagulant therapy resume NOAC. Patients resuming NOAC have similar risks of ischemic stroke/systemic embolism and major bleeding compared with those resuming VKA.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Factor Xa Inhibitors; Female; Hematuria; Hemorrhage; Humans; Incidence; Ischemic Stroke; Male; Middle Aged; Retrospective Studies; Risk Factors; Taiwan; Vitamin K

To investigate the influence of type of anticoagulation - direct oral anticoagulants (DOAC) vs vitamin K antagonists (VKA) - on length of hospital stay (LOS) and hospitalization rates in patients with visible hematuria, as visible hematuria in anticoagulated patients can be distressing, difficult to control and even life-threatening.. This retrospective cohort study was conducted at the emergency department (ED) of a tertiary university hospital in Switzerland. All patients admitted with visible hematuria from January 1, 2013 to December 31, 2016 were included. We compared the primary clinical outcome parameters (hospitalization rate and LOS) as well as secondary outcomes (ICU admission, ED LOS, and in-hospital mortality) in patients with visible hematuria on either DOAC therapy, VKA therapy or no anticoagulants.. We included 811 (100%) patients with visible hematuria; 53 (6.5%) patients were on DOAC, compared to 85 (10.5%) on VKA and 673 (83.0%) patients without any anticoagulation. In confounder-adjusted multivariable testing, there were fewer hospitalizations (odds ratio: 2.2, 95% confidence interval [CI]: 1.1-4.9, P = .028) and shorter LOS (geometric mean ratio: 2.2, 95% CI: 1.3-4.0, P = .006) on DOAC than on VKA. The secondary outcomes were not significantly associated with the anticoagulation groups. No differences were found between the DOAC and no-anticoagulant groups for any outcome.. Visible hematuria in patients on DOAC therapy is associated with shorter hospital stays and fewer hospitalizations compared to VKA.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anticoagulants; Cohort Studies; Female; Hematuria; Hospitalization; Humans; Length of Stay; Male; Middle Aged; Retrospective Studies; Vitamin K

In March and April 2018, more than 150 patients presented to hospitals in Illinois with coagulopathy and bleeding diathesis. Area physicians and public health organizations identified an association between coagulopathy and synthetic cannabinoid use. Preliminary tests of patient serum samples and drug samples revealed that brodifacoum, an anticoagulant, was the likely adulterant.. We reviewed physician-reported data from patients admitted to Saint Francis Medical Center in Peoria, Illinois, between March 28 and April 21, 2018, and included in a case series adult patients who met the criteria used to diagnose synthetic cannabinoid-associated coagulopathy. A confirmatory anticoagulant poisoning panel was ordered at the discretion of the treating physician.. A total of 34 patients were identified as having synthetic cannabinoid-associated coagulopathy during 45 hospitalizations. Confirmatory anticoagulant testing was performed in 15 of the 34 patients, and superwarfarin poisoning was confirmed in the 15 patients tested. Anticoagulant tests were positive for brodifacoum in 15 patients (100%), difenacoum in 5 (33%), bromadiolone in 2 (13%), and warfarin in 1 (7%). Common symptoms at presentation included gross hematuria in 19 patients (56%) and abdominal pain in 16 (47%). Computed tomography was performed to evaluate abdominal pain and revealed renal abnormalities in 12 patients. Vitamin K. Our data indicate that superwarfarin adulterants of synthetic cannabinoids can lead to clinically significant coagulopathy. In our series, in most of the cases in which the patient presented with bleeding diathesis, symptoms were controlled with the use of vitamin K

Topics: 4-Hydroxycoumarins; Abdominal Pain; Adult; Anticoagulants; Blood Coagulation Disorders; Blood Transfusion; Cannabinoids; Female; Hematuria; Hemorrhage; Humans; Illinois; International Normalized Ratio; Male; Middle Aged; Patient Readmission; Vitamin K; Warfarin

Long-acting anticoagulant rodenticides, also called superwarfarins, are known for their greater potency, longer half-life and delayed onset of symptoms. Cases of superwarfarin poisoning can pose a diagnostic and clinical challenge due to a wide array of presentations and prolonged severe coagulopathy requiring months of high-dose oral vitamin K therapy. The most common presentation of long-acting anticoagulant rodenticide poisoning is mucocutaneous bleeding, with other common presentations including haematuria, gingival bleeding, epistaxis and gastrointestinal bleeding. We discuss a case of deliberate self-poisoning with long-acting anticoagulant rodenticides presenting with haematuria and coagulation values above measurable limits. This case is important as it required immediate and maintenance therapy in order to prevent profound bleeding, as well as the evaluation of the patient's psychosocial factors to ensure medical compliance and to prevent refractory complications or repeated self-harm.

Topics: Abdominal Pain; Anticoagulants; Antifibrinolytic Agents; Anxiety Disorders; Blood Coagulation; Blood Coagulation Disorders; Chronic Pain; Comorbidity; Delayed-Action Preparations; Gastrointestinal Hemorrhage; Hematuria; Humans; Male; Middle Aged; Referral and Consultation; Suicide, Attempted; Treatment Outcome; Vitamin K; Warfarin

Topics: Acute Kidney Injury; Aged; Anti-Inflammatory Agents; Antifibrinolytic Agents; Diagnosis, Differential; Disease Progression; Hematuria; Humans; Male; Methylprednisolone; Practice Guidelines as Topic; Thrombocytopenia; Vitamin K

Disseminated intravascular coagulation (DIC) is a pathological systemic condition resulting from aberrant activation of the coagulation system. It is characterised by the release and activation of procoagulants into the blood, with an associated consumption coagulopathy. Its association with solid and haematological malignancies is well described in literature. This case describes an elderly man, known to have prostate cancer, who following transurethral resection of the prostate developed DIC with haematuria, spontaneous ecchymoses and mucosal bleeding. Subsequent investigations revealed a prostate-specific antigen (PSA) >1000 µg/L, and staging CT showed multiple sclerotic metastatic lesions affecting the thoracic and lumbar vertebra, as well as infiltration into his left femur. Coagulation normalised with blood products and vitamin K within 1 week, and the patient responded to antiandrogen therapy with a reduction in pain and PSA on discharge.

Topics: Aged, 80 and over; Androgen Antagonists; Antifibrinolytic Agents; Biomarkers, Tumor; Diagnosis, Differential; Disseminated Intravascular Coagulation; Hematuria; Humans; Male; Prostate-Specific Antigen; Prostatic Neoplasms; Spinal Neoplasms; Treatment Outcome; Vitamin K

Vitamin K intake is considered as a controllable contributor to warfarin sensitivity. It is restricted in warfarin-treated patients. However, little study has assessed the vitamin K status in warfarin-treated patients. We directly measured plasma vitamin K in warfarin-treated patients and evaluated its effect on anticoagulation.. A total of 302 plasma vitamin K concentrations were assessed using high-performance liquid chromatography for 203 outpatients with atrial fibrillation under warfarin treatment. Clinical and laboratory information including warfarin dosage, plasma warfarin concentrations, prothrombin time international normalized ratio (PT INR) and CYP2C9/VKORC1 genotypes was reviewed retrospectively. The anticoagulation stability (intra-individual variability, frequency of PT INR tests and complications) was investigated in 163 patients with long-term warfarin therapy. Plasma vitamin K was measured in 40 healthy subjects and in 40 patients before and after initial warfarin treatment.. Vitamin K concentrations were significantly decreased after the initiation of warfarin treatment (before treatment: 1.72 ng/ml; after treatment: 0.59 ng/ml, P<0.05). There was a large inter-individual variability in vitamin K levels (0.2-4.2 ng/ml) in warfarin-treated patients. PT INR was more frequently checked in patients with low plasma vitamin K levels than in those with high vitamin K levels (9.5 times/year vs 7.5 times/year, P=0.029). Two patients with gross hematuria showed very low vitamin K levels (<0.4 ng/ml).. We found high inter- and intra-individual variability in vitamin K concentration in warfarin-treated patients. Low vitamin K concentration in warfarin-treated patients suggested excessive dietary restriction. Plasma vitamin K measurement would be helpful for dietary control and anticoagulation stability.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Diet; Drug Monitoring; Enzyme Inhibitors; Female; Food-Drug Interactions; Hematuria; Humans; International Normalized Ratio; Male; Middle Aged; Nutritional Status; Republic of Korea; Retrospective Studies; Vitamin K; Vitamin K Deficiency; Vitamin K Epoxide Reductases; Warfarin

A 61-year old woman with atrial fibrillation developed macrohaematuria during anticoagulant treatment with a direct oral factor Xa inhibitor for stroke prevention. Abnormal results of coagulation assays were first interpreted as an effect of the anticoagulant. However, upon further testing diagnosis of vitamin K deficiency was established. After vitamin K supplementation, coagulation tests normalized and macrohaematuria disappeared. Treatment with broad spectrum antibiotics for urinary tract infection was finally established as a rare cause for vitamin K deficiency in the patient.

Topics: Administration, Oral; Anti-Bacterial Agents; Anticoagulants; False Positive Reactions; Female; Hematuria; Humans; Middle Aged; Phenprocoumon; Treatment Outcome; Vitamin K; Vitamin K Deficiency

Topics: 4-Hydroxycoumarins; Antifibrinolytic Agents; Female; Follow-Up Studies; Hematuria; Humans; Pregnancy; Rodenticides; Stillbirth; Vitamin K; Young Adult

We report the case of a 71-year-old male patient who presented at the emergency room with episodes of epistaxis and jaundice. The patient was on therapy with phenprocoumon, atorvastatin and perindopril. Findings on admission included prominent elevation of transaminases and bilirubin and a high INR due to impaired liver function and oral anticoagulation. After exclusion of other causes like viral or autoimmune hepatitis and after having obtained a liver biopsy, a diagnosis of drug induced liver damage (DILI) was made. Epidemiology, pathophysiology and clinical signs of DILI are discussed with a special focus on coumarines, statins and ACE-inhibitors.

Topics: Administration, Oral; Aged; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Atorvastatin; Biopsy; Chemical and Drug Induced Liver Injury; Drug Interactions; Drug Therapy, Combination; Hematuria; Heptanoic Acids; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Liver; Liver Function Tests; Male; Perindopril; Phenprocoumon; Pyrroles; Vitamin K

Superwarfarin poisoning is considered a significant public health problem in the US. In 2004, there were 16,054 cases of poisoning; most were accidental ingestions of rat bait by children but 4576 patients required hospital treatment, 23 patients had major adverse outcomes and 1 patient died. Similar information is unavailable for the UK. The National Poisons Information Service is presently auditing cases. The case of a farmer who presented with haematuria, 9 days after spilling a rodenticide containing a superwarfarin over himself is reported here. He was physically well except for mild abdominal tenderness. He had grossly deranged clotting studies (prothrombin time (PT) >200 s, activated partial thromboplastin time (APTT) 56 s) that were rapidly corrected with fresh frozen plasma and vitamin K. He was sent home after 5 days without follow up. Unfortunately, he presented again 2 days later, again with haematuria and an international normalised ratio (INR) >10. He required inpatient treatment with high-dose vitamin K for 1 week. Upon discharge, he required daily vitamin K and INR monitoring for a further month. The original inpatient team had not identified the specific poison (chlorophacinone). They were unaware that superwarfarins are more potent and longer acting than warfarin, with toxic effects for weeks or even months, and that large doses of vitamin K are often required.

Topics: Hematuria; Humans; International Normalized Ratio; Male; Middle Aged; Poisoning; Prothrombin Time; Recurrence; Rodenticides; Vitamin K; Warfarin

Topics: Aged, 80 and over; Anti-Bacterial Agents; Blood Coagulation; Blood Coagulation Factors; Blood Component Transfusion; Cefoperazone; Female; Hematuria; Humans; Infusions, Intravenous; Plasma; Vitamin K; Vitamin K Deficiency

A 25-year-old man presented with macroscopic haematuria associated with a body mass index of 20 kg/m and a severe coagulopathy consistent with vitamin K deficiency. The diagnosis of a profound malabsorption syndrome secondary to coeliac disease was confirmed by small bowel histology and positive coeliac serology.

Topics: Abdominal Pain; Adult; Celiac Disease; Cheilitis; Diagnosis, Differential; Duodenum; Hematuria; Humans; Irritable Bowel Syndrome; Male; Treatment Outcome; Vitamin K; Vitamin K Deficiency; Vomiting

To report a case of warfarin-amoxicillin/clavulanate potassium (AM/CL) interaction resulting in an elevated international normalized ratio (INR) and hematuria.. A 58-year-old Hawaiian/Asian/European woman developed an elevated INR and microscopic hematuria as a result of a drug-drug interaction between warfarin and AM/CL.. Our report of an increased INR with bleeding complications as a result of an interaction between warfarin and AM/CL is consistent with those in the literature. Although the mechanism for this interaction is not fully known, it is suspected that a decrease in vitamin K-producing gut flora with resulting vitamin K deficiency would be the most likely contributing factor. An objective causality assessment revealed that this adverse drug event as a result of the warfarin and AM/CL interaction was possible.. An increased INR secondary to warfarin interactions with various antibacterial agents is a known phenomenon. An increased awareness of warfarin-AM/CL interaction and appropriate monitoring are essential to control the INR levels and prevent bleeding complications.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anticoagulants; Antifibrinolytic Agents; Blood Transfusion; Drug Interactions; Drug Therapy, Combination; Female; Hematuria; Humans; International Normalized Ratio; Middle Aged; Vitamin K; Warfarin

Topics: Follow-Up Studies; Hematuria; Hemorrhage; Humans; Infant, Newborn; Male; Treatment Outcome; Urinary Bladder Diseases; Vitamin K; Vitamin K Deficiency; Vomiting

A man presented with frank haematuria and a grossly prolonged prothrombin time. He was later found to have taken an overdose of difenacoum--a 'superwarfarin' rodenticide. The diagnosis was confirmed by a serum concentration of difenacoum of 0.6 micrograms ml-1. Overdosage with superwarfarins is discussed and the need for prolonged treatment with vitamin K1 highlighted.

Topics: 4-Hydroxycoumarins; Adult; Drug Overdose; Hematuria; Humans; Male; Prothrombin Time; Rodenticides; Vitamin K

Two patients with acute pancreatitis in pregnancy are described. In both, bleeding from vitamin K deficiency occurred after the initial attack of pancreatitis and the bleeding tendency was successfully treated with vitamin K.

Topics: Acute Disease; Adult; Female; Hematuria; Humans; Pancreatitis; Pregnancy; Pregnancy Complications; Vitamin K; Vitamin K Deficiency

A young woman presented with a 2 year history of a severe bleeding disorder and marked deficiencies in all four vitamin-K-dependent factors. Metabolic studies with tracer doses of tritium-labelled vitamin K1 suggested that the patient might be taking an oral anticoagulant; and subsequently her plasma was found to contain a substance identical to phenindione in its spectrophotometric and chromatographic properties. The half-disappearance times of factors II, IX, X were measured after the administration of a concentrate of these factors and were found to conform with published figures. The concentrate controlled the patient's excessive bruising and prolonged skin and gingival bleeding. It would therefore seem that factor VII may not be essential in reversal of the bleeding disorder induced by anticoagulant overdose.

Topics: Adult; Anemia; Blood Coagulation Disorders; Blood Coagulation Factors; Blood Coagulation Tests; Chromatography, Gas; Chromatography, Thin Layer; Diabetes Complications; Female; Glucosephosphate Dehydrogenase; Hematemesis; Hematuria; Humans; Menorrhagia; Phenindione; Self Medication; Spectrum Analysis; Substance-Related Disorders; Vitamin K; Warfarin

Topics: Age Factors; Aged; Anemia; Anti-Bacterial Agents; Anticoagulants; Blood Coagulation Disorders; Blood Coagulation Tests; Ecchymosis; Female; Hematuria; Humans; Liver Diseases; Malabsorption Syndromes; Male; Middle Aged; Vitamin K; Vitamin K Deficiency

Topics: Anticoagulants; Blood Coagulation Disorders; Blood Coagulation Factors; Child; Female; Hematuria; Humans; Hypoprothrombinemias; Lupus Erythematosus, Systemic; Prednisone; Prothrombin; Prothrombin Time; Thromboplastin; Vitamin K

Topics: Adult; Anticoagulants; Blood Coagulation Tests; Blood Transfusion; Factor VIII; gamma-Globulins; Globulins; Hematuria; Hemophilia A; Humans; Immunoelectrophoresis; Injections, Intramuscular; Male; Methods; 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: Adult; Aged; Aminocaproates; Female; Hematuria; Hemostatics; Humans; Male; Middle Aged; Urologic Diseases; Vitamin K

Topics: Animals; Antimetabolites; Hematuria; Rats; Vitamin K

Topics: Blood; Blood Coagulation Tests; Dicumarol; Drug Therapy; Female; Hematuria; Humans; Infant, Newborn; Maternal-Fetal Exchange; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Thrombophlebitis; Toxicology; Uterine Hemorrhage; Vitamin K; Vitamin K 1

Topics: Anticoagulants; Hematuria; Hemoptysis; Humans; Lung Diseases; Male; Middle Aged; Radiography, Thoracic; Vitamin K

Topics: Anticoagulants; Breast Neoplasms; Dicumarol; Hematuria; Humans; Mastectomy; Neoplasms; Thrombosis; Toxicology; Ureteral Obstruction; Urinary Catheterization; Vitamin K

Topics: Anticoagulants; Blood Transfusion; Ecchymosis; Hematoma, Epidural, Spinal; Hematuria; Hemorrhage; Heparin Antagonists; Humans; Myelography; Radiography; Spinal Cord; Spinal Puncture; Toxicology; Vitamin K

Topics: Anti-Glomerular Basement Membrane Disease; Cerebrospinal Fluid Rhinorrhea; Diagnosis, Differential; Glomerulonephritis; Hematuria; Hemoptysis; Hemorrhage; Humans; Hydrocortisone; Lung Diseases; Prednisone; Vitamin K