warfarin and Aortic-Aneurysm--Thoracic

Disseminated intravascular coagulation (DIC) is a critical and rare complication after thoracic endovascular aortic repair (TEVAR) of type B aortic dissection. The optimal treatment of aortic dissection-related DIC remains controversial.. We herein describe the successful management of a 65-year-old man who presented with gingival bleeding and multiple subcutaneous petechiae and was proven to have DIC after TEVAR of aortic dissection. The patient had initially been discharged with improved laboratory tests after anticoagulation treatment followed by oral rivaroxaban for maintenance. However, he was readmitted with recurrent gingival bleeding 17 days later. The DIC was successfully controlled with a combination of anticoagulation and antifibrinolytics. After the patient was discharged, his treatment was switched to oral tranexamic acid and warfarin for maintenance. During a 15-month follow-up, the patient had no recurrence of hemorrhage symptoms and maintained stable coagulative and fibrinolytic parameters.. Aortic dissection-related DIC requires long-term management under conservative treatment. The combination of warfarin and tranexamic acid may be a feasible method for long-term maintenance therapy.

Topics: Aged; Anticoagulants; Aortic Aneurysm, Thoracic; Aortic Dissection; Blood Vessel Prosthesis Implantation; Disseminated Intravascular Coagulation; Endovascular Procedures; Hemorrhage; Humans; Male; Tranexamic Acid; Treatment Outcome; Warfarin

Evidence-based recommendations about anticoagulation in acute type B aortic dissection (TBAD) are completely missing, but there is a diffuse conviction that it could prevent the healing process of the dissected aorta's false lumen. However, several clinical conditions may lead to the necessity to start anticoagulant therapy among patients with acute type B aortic dissection, ranging from atrial fibrillation to more complicated clinical scenarios and the correct management in this kind of patients is still an open issue.. We are presenting a 51-years-old man with multi-infarct encephalopathy referred to us for an acute TBAD and a first diagnosis of ischemic cardiomyopathy complicated by left ventricular (LV) thrombus formation. Coronary angiography revealed a critical stenosis of left anterior descending artery (LAD) treated with drug-eluting stent deployment. The patient was addressed to triple antithrombotic therapy with acetylsalicylic acid, clopidogrel and warfarin with target INR 2.0-2.5. After 6 months, computed tomography angiography revealed the stability of the dissection flap. Cardiac magnetic resonance imaging, however, confirmed the persistence of a small thrombotic formation in LV apex, thus double antithrombotic therapy with warfarin and clopidogrel was instituted. The patient remained asymptomatic during the follow-up period but was advised to suspend his job and physical activities.. Current guidelines do not discuss anticoagulant therapy in the setting of TBAD and large randomized trials are lacking. Despite it is generally considered unsafe to administer anticoagulants in patients with TBAD, we present a case in which triple antithrombotic therapy was well tolerated and did not lead to progression of the intimal flap after 6 months.

Topics: Anticoagulants; Aortic Aneurysm, Thoracic; Aortic Dissection; Aspirin; Clinical Decision-Making; Clopidogrel; Coronary Stenosis; Disease Progression; Drug-Eluting Stents; Dual Anti-Platelet Therapy; Fibrinolytic Agents; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Risk Assessment; Thrombosis; Treatment Outcome; Warfarin

The risk/benefit ratio of warfarin therapy changes in the over 75s, when haemorrhagic side-effects become more common. These may not always be reported in the literature.. A woman of 80 years, on long-term warfarin therapy presented with an acute dissecting thoracic aortic aneurysm; on investigation the only precipitating factor found was an international normalised ratio of 4.8. This patient, who also had an abdominal aortic aneurysm, survived, on discontinuation of her anticoagulant therapy.. We describe a previously unreported complication of warfarin therapy in a patient over 75 years of age, to add to the cautions in prescribing this drug in patients of this age group.

Topics: Aged; Aged, 80 and over; Anticoagulants; Aorta; Aortic Aneurysm, Thoracic; Aortic Dissection; Atrial Fibrillation; Chest Pain; Female; Follow-Up Studies; Humans; Smoking; Tomography, X-Ray Computed; Warfarin

Heparin-induced thrombocytopenia and thrombosis syndrome (type II) is associated with thromboembolic complications and a mortality rate up to 30%. We describe a patient who developed intracardiac and aortic Dacron prosthesis heparin-induced thrombosis after aortic root conservative surgery. Successive transoesophageal echocardiographies demonstrated a progressive regression of intracardiac thrombosis with oral anticoagulation by warfarin and antiplatelet therapy combining aspirin and clopidogrel.

Topics: Aged; Anticoagulants; Aortic Aneurysm, Thoracic; Aspirin; Blood Vessel Prosthesis; Clopidogrel; Drug Therapy, Combination; Echocardiography, Transesophageal; Follow-Up Studies; Heart Diseases; Heparin, Low-Molecular-Weight; Humans; Risk Assessment; Severity of Illness Index; Thrombocytopenia; Thrombosis; Ticlopidine; Treatment Outcome; Warfarin

We describe a case of thoracic aortic aneurysm complicated by chronic disseminated intravascular coagulation (DIC). Initially the DIC was controlled successfully by administration of gabexate mesilate and dalteparin. However, because these drugs were given intravenously, the patient could not be discharged. Subsequently, the DIC was treated successfully by changing to orally administered camostat mesilate, warfarin and aspirin, which allowed the patient to leave hospital.

Topics: Administration, Oral; Aged; Anticoagulants; Aortic Aneurysm, Thoracic; Aspirin; Chronic Disease; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Esters; Gabexate; Guanidines; Humans; Male; Warfarin