warfarin and Abdominal-Injuries

Portal vein thrombosis (PVT) is caused by several conditions including infection, malignancies, surgery, medications, and coagulation disorders. However, PVT caused by low-energy injury is very rare. A 51-year-old man visited a clinic with a 2-day history of abdominal pain following blunt abdominal trauma. Contrast-enhanced computed tomography (CT) revealed thrombosis in both the portal vein and splenic vein, and he was transferred to our hospital with a diagnosis of PVT. Anticoagulant therapy was initiated using unfractionated heparin. A repeat CT scan revealed enlargement of the thrombus, which occluded the main trunk and first right branch of the portal vein. Laboratory data before heparin administration suggested low protein C activity. Anticoagulation therapy was continued with intermittent assessment of the size of the thrombus and degree of coagulation. On day 23, enhanced CT showed marked shrinkage of the thrombus compared with that on day 8. On day 30, the patient was discharged with a therapeutic prothrombin time-international normalized ratio. Here we present a case of PVT caused by low-energy trauma of the upper abdomen in a patient with a background of low protein C activity that was successfully treated without invasive surgery.

Topics: Abdominal Injuries; Anticoagulants; Drug Therapy, Combination; Heparin; Humans; Male; Middle Aged; Portal Vein; Protein C Deficiency; Venous Thrombosis; Warfarin; Wounds, Nonpenetrating

A 70-year-old woman on warfarin was transported to the emergency department after a ground-level fall, injuring her left backside. Criteria for geriatric trauma activation was not met. An episode of haematuria created suspicion for an intra-abdominal injury, prompting a point-of-care ultrasound (POCUS) Focused Assessment with Sonography for Trauma scan, which was positive. Subsequent pan-scanning discovered a multitude of injuries, including low-grade left renal and splenic lacerations, multiple left rib fractures and a haemothorax. Patient also had a supratherapeutic International Normalized Ratio (INR), which was reversed with 4-factor Prothrombin Complex Concentrate (4F-PCC). She was admitted to the intensive care unit, underwent urgent thoracostomy and had a complicated hospital course. Moreover, an incidental large staghorn calculus in the left kidney might have contributed shearing forces. In summary, under triage of this patient emphasised the importance of performing detailed primary and secondary surveys, including POCUS, for all geriatric ground-level fall patients on anticoagulants to allow for rapid diagnosis and treatment of potential serious injuries.

Topics: Abdominal Injuries; Aged; Anticoagulants; Blood Coagulation Disorders; Blood Coagulation Factors; Female; Humans; International Normalized Ratio; Retrospective Studies; Staghorn Calculi; Warfarin

We queried our Trauma Quality Improvement Program registry for patients who presented between 6/1/2011 and 9/1/2015 with severe (injury severity score (ISS)>15) blunt traumatic injury during anticoagulant use. Patients were then grouped into those prescribed warfarin and patients prescribed any of the available novel Direct Oral Anticoagulants (DOAC) medications. We excluded severe (AIS≧4) head injuries.. There were no differences between DOAC and warfarin groups in terms of age, gender mean ISS, median hospital or intensive care unit lengths of stay, complication proportions, numbers of complications per patient, or the proportion of patients requiring transfusion. Finally, excluding patients who died, the observed proportion of discharge to skilled nursing facility was similar. In our sample of trauma patients, DOAC use was associated with significantly lower mortality (DOAC group 8.3% vs. warfarin group 29.5%, p<0.015). The ratio of units transfused per patient was also lower in the DOAC group (2.8±1.8 units/patient in the DOAC group vs. 6.7±6.4 units per patient in the warfarin group; p=0.001).. In conclusion, we report an association with decrease in mortality and a decrease in transfused blood products in severely injured trauma patients with likely minimal or no head injury taking novel DOACs over those anticoagulated with warfarin for outpatient anticoagulation.

Topics: Abdominal Injuries; Aged; Anticoagulants; Blood Coagulation Tests; Craniocerebral Trauma; Female; Hemorrhage; Humans; International Normalized Ratio; Male; Quality Improvement; Registries; Retrospective Studies; Trauma Centers; Trauma Severity Indices; United States; Warfarin; Wounds, Nonpenetrating

A 13-year-old adolescent girl with blunt abdominal injury was transferred to our hospital. Enhanced computed tomography (CT) showed not only retroperitoneal hematoma around the inferior vena cava and left common iliac vein but also thrombus extending from the left common iliac vein to the femoral vein.. Enhanced CT performed on the second day revealed no increase in retroperitoneal hematoma and a new small thrombus in the popliteal vein. Anticoagulant therapy was therefore started with administration of unfractionated heparin. Administration of warfarin was started on the 12th day and heparin administration was stopped on the 14th day. The patient was discharged on the 19th day with continuation of warfarin administration. Enhanced CT performed 10 months after injury showed no thrombus, and the administration of warfarin was then stopped.. She was successfully treated with the appropriate start time and control of anticoagulation therapy based on careful evaluation of her general condition.

Topics: Abdominal Injuries; Adolescent; Female; Heparin; Humans; Tomography, X-Ray Computed; Treatment Outcome; Venous Thrombosis; Warfarin; Wounds, Nonpenetrating

A 60-year-old man presented to the accident and emergency department with a 4-day history of abdominal pain following blunt abdominal trauma. An initial CT scan showed thickened walls of the proximal jejunum and thromboses in the portal, splenic and superior mesenteric veins. He was given warfarin and the abdominal pain resolved. A repeat CT scan 1 week later revealed significant resolution of the mural thickening and the portal vein thrombosis. A subsequent thrombophilia screen was negative and he continued taking oral anticoagulants for a total of 6 months. A repeat CT scan 3 months after presentation revealed complete recanalisation the portal venous system.

Topics: Abdominal Injuries; Abdominal Pain; Anticoagulants; Follow-Up Studies; Humans; Male; Middle Aged; Portal System; Portal Vein; Rare Diseases; Risk Assessment; Severity of Illness Index; Splenic Vein; Tomography, X-Ray Computed; Treatment Outcome; Venous Thrombosis; Warfarin; Wounds, Nonpenetrating

Two hundred sixty cases of intestinal intramural hematoma and subsequent bowel obstruction have been reported in the world literature. These cases have been evaluated and seventeen additional cases are reported. Multiple etiologic factors are presented, with trauma and anticoagulant therapy being the most common. Barium x-ray examination is the single most reliable diagnostic study. The mode of therapy for intramural hematoma depends upon thorough evaluation of the patient. Patients on anticoagulant therapy are best treated by observation and cessation of anticoagulants. Should the patient fail to improve or become worse, then surgery may become necessary. When trauma is a factor, prompt operative intervention is indicated.

Topics: Abdominal Injuries; Adolescent; Adult; Child; Child, Preschool; Gastrointestinal Diseases; Hematoma; Heparin; Humans; Infant; Intestinal Obstruction; Middle Aged; Warfarin

Topics: Abdominal Injuries; Autopsy; Cough; Hemorrhage; Humans; Male; Middle Aged; Warfarin