warfarin and Appendicitis

Intravenous thrombolysis is not suitable for patients undergoing oral anticoagulants therapy, with INR > 1.7 or PT > 15 s. We described a case of intravenous thrombolysis in a patient with INR 1.9.. A 66-year-old female patient was diagnosed with acute appendicitis complicated with atrial fibrillation. Seven days after admission, the patient suffered mixed aphasia with right limb asthenia. The NIHSS score was 11 points. and early infarction and hemorrhagic manifestations were not found in the emergency head CT. Thirty minutes after the onset of symptoms, NIHSS of patient increased from 11 to 14, but the INR was 1.92.. Acute ischemic stroke.. The IT therapy was recommended and all the therapy related risks were explained to the patient's parents. Briefly, the patient was given rTPA 38.5 mg. In addition to intravenous thrombolysis, VitK1 40 mg was simultaneously administered.. The patient's symptoms of drowsiness were improved. After 24 hours, all symptoms were stabilized with NIHSS of 2 points, there was a slight language obstruction, and no hemorrhagic transformation in head CT. Three months later, the review showed MRS score of 0, and the patient could take care of herself in daily life.. The clinical guidelines are still the main reference for guiding clinical practice, and the main thrombolytic standards and contraindications for treatment still need to be conformed. On this basis, for individualized patients, clinicians must accurately judge the cause of acute stroke, to make optimal choice, reduce disability and mortality, and improve quality of life of patients.

Topics: Aged; Appendicitis; Female; Fibrinolytic Agents; Humans; International Normalized Ratio; Patient Safety; Postoperative Complications; Stroke; Thrombolytic Therapy; Treatment Outcome; Warfarin

This case report describes a young man who presented with 9-day history of sudden-onset epigastric and right-sided lower abdominal pain. He was tachycardiac with temperature of 102°F. Tenderness was present in the peri-umbilical area and right iliac fossa. Investigations revealed a raised total leucocyte count (predominantly neutrophilic). Triphasic CTscan abdomen found thrombosis of right portal vein and its hepatic tributaries alongwith superior mesenteric vein (SMV) and its tributaries. Co-existent fluid in right hemipelvis abutting the cecum and appendiceal tip was suggestive of acute appendicitis. He was resuscitated with fluids and analgesics and started on intravenous metronidazole and ceftriaxone. Anticoagulation with subcutaneous heparin was commenced and eventually switched over to warfarin. Appendicectomy was not performed as the patient responded to conservative treatment. Appendicitis is associated with multiple complications but secondary venous thrombosis has rarely been reported with it.

Topics: Acute Disease; Adult; Anti-Infective Agents; Anticoagulants; Appendicitis; Humans; Male; Mesenteric Veins; Metronidazole; Portal Vein; Tomography, X-Ray Computed; Treatment Outcome; Venous Thrombosis; Warfarin

Topics: Abdominal Pain; Anti-Bacterial Agents; Anticoagulants; Appendectomy; Appendicitis; Drainage; Escherichia coli Infections; Female; Heparin; Humans; Mesenteric Vascular Occlusion; Mesenteric Veins; Middle Aged; Radiography; Sclerosis; Venous Thrombosis; Warfarin

A 61-year-old man receiving anticoagulant therapy after the aortic valve replacement underwent emergency surgery for acute appendicitis. Although the patient was intubated with difficulty, no immediate complications were evident after extubation. On the evening of the first postoperative day he complained of a sore throat, difficulty in swallowing and dysphonia. The swelling of the tongue with right-side predominance and the swelling of the right neck were observed. The right-sided sublingual hematoma was confirmed by CT. The symptoms improved with steroid administration. The possibility of airway obstruction due to hematoma of the tongue should be considered in patients on anticoagulant therapy.

Topics: Acute Disease; Airway Obstruction; Anticoagulants; Appendicitis; Dexamethasone; Emergencies; Hematoma; Humans; Infusions, Intravenous; Laryngoscopy; Male; Middle Aged; Mouth Floor; Treatment Outcome; Warfarin

Mesenteric vein thrombosis (MVT) is rare. Its diagnosis is usually difficult and delayed. Herein, we report 2 patients who developed MVT as a complication of an appendicular mass. One of them had appendectomy and developed fever 10 days postoperatively. The other was treated conservatively. An abdominal computerized tomography (CT) scan with intravenous contrast was helpful in diagnosing the superior MVT in both patients, which were not suspected. Intravenous contrast should be used when performing CT of an appendicular mass. Special interest should be directed at studying the superior mesenteric vein. Early diagnosis of our patients helped to start early medical treatment with anticoagulation.

Topics: Abdominal Pain; Adult; Anticoagulants; Appendectomy; Appendicitis; Enoxaparin; Humans; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Radiography, Abdominal; Treatment Outcome; Venous Thrombosis; Warfarin

Topics: Adult; Anticoagulants; Appendectomy; Appendicitis; Follow-Up Studies; Humans; Portal Vein; Venous Thrombosis; Warfarin