warfarin and Arterial-Occlusive-Diseases

Antiphospholipid syndrome is a diagnosis with the clinical manifestations of thromboses in the presence of an antiphospholipid antibody. A 25-year-old man with a history of deep venous thrombosis, pulmonary emboli, and myocardial infarction, and receiving long-term anticoagulation with warfarin, all due to primary antiphospholipid syndrome, presented with blue toe syndrome from a primary superficial femoral artery thrombus. He was anticoagulated with fondaparinux in addition to dipyridamole and aspirin perioperatively. The area of thrombus was resected and reconstructed using a cephalic vein interposition graft. This report reviews antiphospholipid syndrome and identifies potential questions and problems relating to a rare clinical presentation.

Topics: Adult; Antiphospholipid Syndrome; Arterial Occlusive Diseases; Blue Toe Syndrome; Femoral Artery; Follow-Up Studies; Humans; Male; Plastic Surgery Procedures; Radiography; Risk Assessment; Severity of Illness Index; Thrombectomy; Thrombosis; Treatment Outcome; Warfarin

Patients with peripheral artery disease suffer from a high incidence of ischemic vascular complications in coronary, cerebral, and peripheral vascular beds. Reduction of atherothrombotic complications with aspirin or clopidogrel has proven to be successful. The role of oral anticoagulants in patients with symptomatic peripheral artery is limited. Randomized controlled trials comparing the effects of aspirin with oral anticoagulants are scarce. Oral anticoagulants (International Normalized Ratio = 2.5 to 4.5) are more effective than aspirin in preventing infrainguinal bypass occlusion only when venous graft material is used and the bypass is considered to be at high risk for occlusion. Whether the use of oral anticoagulants reduces all-cause morbidity and mortality is not unequivocally clear. The risk of ischemic events is reduced at the expense of an increased number of bleeding complications, which is one of the main reasons that therapy has not been widely adopted.

Topics: Administration, Oral; Anticoagulants; Arterial Occlusive Diseases; Cardiovascular Diseases; Humans; Peripheral Vascular Diseases; Vascular Surgical Procedures; Warfarin

Topics: Angioplasty, Balloon, Coronary; Arterial Occlusive Diseases; Aspirin; Clopidogrel; Endarterectomy, Carotid; Fibrinolytic Agents; Graft Occlusion, Vascular; Humans; Leg; Peripheral Vascular Diseases; Platelet Aggregation Inhibitors; Thromboembolism; Ticlopidine; Warfarin

Topics: Arterial Occlusive Diseases; Aspirin; Carotid Artery Diseases; Cerebrovascular Disorders; Dipyridamole; Endarterectomy; Female; Heparin; Humans; Ischemic Attack, Transient; Male; Risk; Warfarin

Using two antithrombotic treatment (clopidogrel vs. clopidogrel combined warfarin) strategies after femoral-popliteal artery angioplasty prospectively, to evaluate which strategy is more effective for the restenosis prevention.. Totally 50 patients referred for endovascular treatment (including the percutaneous transluminal angioplasty (PTA) and stent implantation) of the superficial femoral artery and popliteal artery from January 2008 to May 2009 were randomly divided into clopidogrel group (group A, 25 cases, 30 limbs) and clopidogrel plus warfarin group (group B, 25 cases, 33 limbs) before operation. Clinical outcomes and restenosis rate of the target lesions were evaluated at 3, 6 and 12 months after operation.. Totally 88 patients were screened for participation in the study, 56 patients were included after the follow-up of 12 months. At 3 months, the rates of restenosis were 16.7% in group A and 18.2% in group B (χ² = 0.025, P = 0.874). At 6 months, the accumulated restenosis rates were 36.7% in group A and 36.4% in group B (χ² = 0.001, P = 0.98). At 12 months, the accumulated restenosis rates were 53.3% in group A and 42.4% in group B (χ² = 0.75, P = 0.387). Analysis for the critical limb ischemia sub-group showed that follow-up of 12 months, the accumulated restenosis rate was 8/10 in group A and 6/12 in group B (χ² = 1.023, P = 0.312).. The clopidogrel alone treatment for PTA or PTA plus stent implantation of femoral popliteal artery has no statistically significant difference in comparison with the clopidogrel combined warfarin treatment in terms of the cumulative vascular restenosis rate at 3, 6, 12 months postoperatively.

Topics: Adult; Aged; Aged, 80 and over; Angioplasty, Balloon; Arterial Occlusive Diseases; Clopidogrel; Female; Femoral Artery; Humans; Male; Middle Aged; Popliteal Artery; Postoperative Complications; Prospective Studies; Ticlopidine; Warfarin

Poor patency of synthetic grafts for infragenicular revascularization has led to use of distal vein patches or cuffs. The aim of this study was to compare the distally widened Distaflo PTFE graft, which mimics a vein cuff, with a PTFE graft with distal vein modification. In this prospective, randomized, multicenter trial we compared use of a precuffed PTFE graft wit that of PTFE grafts with distal vein modification for infragenicular revascularization in patients with critical limb ischemia without saphenous vein. Study end points were primary and secondary patency and limb salvage rates at 2 years. From January 28,1999 to November 1, 2000, 104 patients were enrolled in 10 North American centers. Thirteen were excluded for protocol violation. Ninety-one bypasses were performed in 89 patients with a mean age of 73 years (range 47-90). By randomization, 47 bypasses were done with the precuffed graft and 44 with PTFE graft with vein cuff. Both groups were comparable for comorbidities and operative variables, except for a higher incidence of acute ischemia in the precuffed group (19% vs. 4.5%, p = 0.03). Bypass was a redo procedure in 53% and was performed at the infrapopliteal vessels in 79%. Operative mortality was 2.2% (2/91). Mean follow-up was 14 months (range 1-30). At 1 and 2 years, primary patency was 52% and 49% for the precuffed group and 62% and 44% for the vein cuffed group, respectively (p = 0.53). At 1 year and 2 years, the limb salvage rate was 72% and 65% for the precuffed group and 75% and 62% in the vein cuffed group (p = 0.88). Although numbers are small and follow-up short, this midterm analysis shows similar results for the Distaflo precuffed grafts and PTFE grafts with vein cuff. A precuffed graft is a reasonable alternative conduit for infragenicular reconstruction in the absence of saphenous vein and provides favorable limb salvage.

Topics: Aged; Aged, 80 and over; Anastomosis, Surgical; Anticoagulants; Arterial Occlusive Diseases; Aspirin; Blood Vessel Prosthesis; Female; Follow-Up Studies; Graft Occlusion, Vascular; Humans; Iliac Artery; Ischemia; Limb Salvage; Lower Extremity; Male; Middle Aged; Platelet Aggregation Inhibitors; Polytetrafluoroethylene; Popliteal Artery; Prospective Studies; Prosthesis Design; Reoperation; Tibial Arteries; Time Factors; Treatment Outcome; Vascular Patency; Warfarin

When warfarin is interrupted for surgery, low-molecular-weight heparin is often used as bridging therapy. However, this practice has never been evaluated in a large prospective study. This study was designed to assess the efficacy and safety of bridging therapy with low-molecular-weight heparin initiated out of hospital.. This was a prospective, multicenter, single-arm cohort study of patients at high risk of arterial embolism (prosthetic valves and atrial fibrillation with a major risk factor). Warfarin was held for 5 days preoperatively. Low-molecular-weight heparin was given 3 days preoperatively and at least 4 days postoperatively. Patients were followed up for 3 months for thromboembolism and bleeding. Eleven Canadian tertiary care academic centers participated; 224 patients were enrolled. Eight patients (3.6%; 95% CI, 1.8 to 6.9) had an episode of thromboembolism, of which 2 (0.9%; 95% CI, 0.2 to 3.2) were judged to be due to cardioembolism. Of these 8 episodes of thromboembolism, 6 occurred in patients who had warfarin deferred or withdrawn because of bleeding. There were 15 episodes of major bleeding (6.7%; 95% CI, 4.1 to 10.8): 8 occurred intraoperatively or early postoperatively before low-molecular-weight heparin was restarted, 5 occurred in the first postoperative week after low-molecular-weight heparin was restarted, and 2 occurred well after low-molecular-weight heparin was stopped. There were no deaths.. Bridging therapy with subcutaneous low-molecular-weight heparin is feasible; however, the optimal approach for the management of patients who require temporary interruption of warfarin to have invasive procedures is uncertain.

Topics: Anticoagulants; Arterial Occlusive Diseases; Aspirin; Atrial Fibrillation; Blood Loss, Surgical; Cohort Studies; Dalteparin; Elective Surgical Procedures; Feasibility Studies; Heart Valve Prosthesis Implantation; Humans; International Normalized Ratio; Intraoperative Complications; Postoperative Complications; Postoperative Hemorrhage; Premedication; Preoperative Care; Prospective Studies; Risk; Thromboembolism; Treatment Outcome; Vitamin K; Warfarin

Patients with peripheral arterial disease (PAD) have high rates of cardiovascular morbidity and mortality, including that caused by associated coronary heart disease and cerebrovascular disease. Previous studies have shown that coagulation parameters are altered in PAD and that altered coagulation may play a critical role in the susceptibility to cardiovascular complications in PAD. It is therefore important to assess the effect of secondary prevention measures on coagulation in patients with PAD. The Arterial Disease Multiple Intervention Trial (ADMIT), a multicenter, randomized, placebo-controlled trial, was conducted to determine the feasibility of a combined lipid-modifying, antioxidant, and antithrombotic treatment regimen in patients with PAD. The objective of this study was to assess the effect of the ADMIT interventions on coagulation.. ADMIT participants were randomly assigned to low-dose warfarin, niacin, and antioxidant vitamin cocktail or corresponding placebos in a 2 x 2 x 2 factorial design. Specialized coagulation studies were performed in a subset of 80 ADMIT participants at baseline and after 12 months of treatment.. Low-dose warfarin (1 to 4 mg/d) resulted in a significant decrease in factor VIIc (P <.001) and in plasma F1.2 (P =.001). Unexpectedly, niacin treatment also resulted in significant decrease in both fibrinogen (48 mg/dL; P <.001) and F1.2 (P =.04). von Willebrand factor increased after antioxidant vitamin treatment (P =.04).. A regimen of low-dose warfarin effectively modifies coagulation in patients with PAD. Niacin also favorably modifies fibrinogen and plasma F1.2. Niacin, in addition to its lipid effects, modifies abnormal coagulation factors that accompany PAD.

Topics: Aged; Anticoagulants; Antioxidants; Arterial Occlusive Diseases; Ascorbic Acid; beta Carotene; Blood Coagulation; Disease Progression; Drug Therapy, Combination; Feasibility Studies; Female; Fibrinogen; Humans; Male; Niacin; Vitamin E; von Willebrand Factor; Warfarin

This study demonstrates that niacin supplementation decreases plasma fibrinogen and low-density lipoprotein cholesterol in subjects with peripheral vascular disease randomized to receive niacin, warfarin, antioxidants, or placebo. Changes in fibrinogen levels are highly correlated with changes in low-density lipoprotein cholesterol (r = 0.61; p < 0.009) in subjects taking niacin.

Topics: Adult; Antioxidants; Arterial Occlusive Diseases; Cholesterol, HDL; Cholesterol, LDL; Dose-Response Relationship, Drug; Female; Fibrinogen; Hemodynamics; Humans; Hypolipidemic Agents; Ischemia; Leg; Male; Middle Aged; Niacin; Warfarin

Cilostazol (6-[4-(1-cyclohexyl-1H-tetrazol-5-yl)butoxy]-3,4- dihydro-2(1H)-quinolinone) is a new antiplatelet agent with a vasodilating action. The purpose of this study was comparison of cilostazol with warfarin as antithrombotic therapy after femoro-popliteal bypass surgery using an expanded polytetrafluorethylene (ePTFE) graft.. This report is a retrospective study and the patients were followed up for five years.. Outpatients of university hospital.. Sixteen arteriosclerosis obliterans patients, who were diagnosed as having only superficial femoral artery stenosis or occlusion, underwent femoro-popliteal (above the knee) bypass using an ePTFE graft 6 mm in diameter. Cilostazol (150-200 mg/day) was administered to 6 cases (9 bypasses), and warfarin (prothrombin time was controlled to 15-25%.) was administered to 10 cases (14 bypasses).. No clinically characteristic differences were found between the two groups. The cumulative 1-, 3-, and 5-year primary and secondary graft patency rates were 69% and 80%, 69% and 80%, and, 69% and 80% in the cilostazol group, vs 61% and 91%, 51% and 91%, and, 51% and 91% in the warfarin group, respectively. These differences were not significant (p < 0.05). No hemorrhage complications were observed in the cilostazol group. The management of cilostazol administration was safe and simple.. Although the number of cases was small in this study, cilostazol was considered to be as effective as warfarin and suitable for the postoperative antithrombotic therapy after the ePTFE bypass surgery.

Topics: Aged; Anticoagulants; Arterial Occlusive Diseases; Arteriosclerosis Obliterans; Blood Vessel Prosthesis Implantation; Femoral Artery; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors; Polyethylenes; Popliteal Artery; Postoperative Care; Retrospective Studies; Tetrazoles; Warfarin

Therapeutic oral anticoagulation on hospital admission reduces morbidity and mortality after acute ischaemic stroke in patients with atrial fibrillation (AF). The underlying mechanism is not fully understood. In order to assess the impact of INR-level on admission on stroke volume, lesion pattern and the frequency of intracranial arterial occlusion, we analysed serial MRI measurements in AF patients suffering acute ischaemic stroke.. This subgroup analysis of the prospective '1000Plus' study included patients with acute ischaemic stroke and known AF or a first episode of AF in hospital. All patients underwent serial brain magnetic resonance imaging. Stroke patients were categorized as follows: Group1, phenprocoumon intake, international normalized ratio (INR) ≥1.7 on admission, no thrombolysis; Group2, INR < 1.7 on admission, thrombolysis; and Group3, INR < 1.7, no thrombolysis. In 98 AF patients {77 ± 9 years, 60% male; median National Institute of Health Stroke Scale [NIHSS] score on admission 5 (interquartile range [IQR] 2-8)} with known AF before admission, territorial infarction was less often found in Group 1 (n = 20) compared with Group 2 + 3 (20% vs. 47%, P = 0.022). Arterial occlusion rate on admission differed among groups (30%, 75%, and 35%, respectively, P = 0.004) but not between Group 1 vs. Group 2 + 3 (30% vs. 45%, P = 0.31). Median FLAIR volume on Days 5-7 was lower in Group1 compared with Group 2 (n = 20) [3.2 cm3 (IQR 1.1-11.3) vs. 18.6 cm3 (IQR 8.2-49.4); P = 0.009] but not compared with Group 2 + 3 [7.8 cm3 (IQR 1.6-25.9); P = 0.23]. An INR ≥ 1.7 on admission was not associated with smaller stroke volume in multivariable regression analysis. Adding 57 patients with a first AF episode during the in-hospital stay, similar results were observed in 155 AF patients.. In this AF cohort, an INR ≥ 1.7 at stroke onset affects lesion pattern but does not affect significantly lower stroke volume and the frequency of arterial occlusion on admission.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Arterial Occlusive Diseases; Atrial Fibrillation; Brain Ischemia; Cerebral Arteries; Female; Germany; Humans; International Normalized Ratio; Length of Stay; Magnetic Resonance Imaging; Male; Prospective Studies; Severity of Illness Index; Stroke; Warfarin

A 67-year-old woman developed weakness of the entire left side of the body and disturbance of consciousness, and was admitted to our hospital. She had atrial fibrillation (AF) on arrival at the hospital. Diffusion weighted magnetic resonance imaging showed high intensity area in the right basal ganglia, and magnetic resonance angiography showed occlusion of the right internal carotid artery (ICA). Thrombolytic therapy with intravenous tissue plasminogen activator (IV tPA) was administered 225 minutes after onset, and endovascular procedure also performed. After endovascular therapy, the patient had successful recanalization of the right ICA. Transesophageal echocardiography (TEE) showed a mass in the left atrium. Cardiac surgery for the excision of a left atrial mass and the maze procedure for atrial fibrillation were performed on the 29th hospital day. The mass was pathologically confirmed as thrombus. Follow up TEE after cardiac surgery revealed recurrence of thrombus at the both origin of pulmonary vein in the left atrium. Finally, the thrombus was disappeared at 6-month after onset with taking warfarin. She had no stroke events during the clinical course.

Topics: Aged; Anticoagulants; Arterial Occlusive Diseases; Atrial Fibrillation; Cardiac Surgical Procedures; Carotid Artery Diseases; Carotid Artery, Internal; Diffusion Magnetic Resonance Imaging; Echocardiography, Transesophageal; Endovascular Procedures; Female; Heart Atria; Heart Diseases; Humans; Intracranial Embolism; Magnetic Resonance Angiography; Recurrence; Thrombosis; Treatment Outcome; Warfarin

The effect of warfarin on the risk of cardiovascular (CV) disease is unknown among chronic hemodialysis patients with atrial fibrillation (HD-AF).. Population-based propensity score and prescription time-distribution matched cohort study including 6719 HD-AF patients with CHA. Warfarin treatment in HD-AF patients with AF preceding HD was associated with higher risks of developing congestive heart failure [hazard ratio (HR)=1.82, 95% confidence interval (CI)=1.29-2.58, p<0.01], peripheral artery occlusive disease (HR=3.42, 95% CI=1.86-6.31, p<0.01), and aortic valve stenosis (HR=3.20, 95% CI=1.02-9.98, p<0.05). Warfarin users were not associated with risks of ischemic or hemorrhagic stroke and all-cause mortality as compared to nonusers.. Warfarin may be associated with vascular calcification, increasing the risks of congestive heart failure and peripheral artery occlusive disease among HD-AF patients.

Topics: Adult; Aged; Anticoagulants; Arterial Occlusive Diseases; Atrial Fibrillation; Brain Ischemia; Female; Heart Failure; Humans; Male; Middle Aged; Renal Dialysis; Stroke; Vascular Calcification; Warfarin

Chronic myeloproliferative disorders share a stem cell-derived clonal myeloproliferation. This group of disorders include essential thrombocythemia (ET), polycythemia vera (PV), chronic myeloid leukemia, and primary myelofibrosis (PMF), with the respective features of thrombocytosis, erythrocytosis, and bone marrow fibrosis. These disorders can be associated with genetic mutations affecting protein tyrosine kinases, resulting in different configurations of abnormal signal transduction. The Janus tyrosine kinase 2 mutation can be used as a key diagnostic tool for diagnosing MPDs, specifically, ET, PV, and PMF. Patients with ET and PV are at an increased risk for thromboembolic and hemorrhagic events. We present a unique case of ET causing extensive arterial thromboembolism, despite being on adequate antithrombotic agents including warfarin and aspirin.

Topics: Anticoagulants; Arterial Occlusive Diseases; Blood Coagulation; Blood Coagulation Tests; Computed Tomography Angiography; Drug Substitution; Enoxaparin; Humans; Hydroxyurea; Male; Middle Aged; Thrombocythemia, Essential; Thromboembolism; Treatment Failure; Treatment Outcome; Warfarin

A 69-year-old man visited a clinic for left leg weakness. With suspicions of lung cancer and a metastatic brain tumor, he was referred to our hospital and was diagnosed with large cell neuroendocrine carcinoma, cT1bN0M1b (BRA), stage IV. After stereotactic radiosurgery for his brain metastasis, he was treated with chemotherapy containing cisplatin and irinotecan. A week after initiating chemotherapy, he suddenly developed severe right leg pain and adynamia. A computed tomography angiogram revealed occlusion of the right common femoral artery, and percutaneous thrombectomy was performed. The symptoms resolved completely, and he was discharged without any sequelae or recurrence. Acute arterial occlusion of the limbs during chemotherapy is uncommon and requires prompt diagnosis and treatment; hence, caution should be paid when it is clinically suspected.

Topics: Aged; Anticoagulants; Arterial Occlusive Diseases; Heparin; Humans; Lower Extremity; Lung Neoplasms; Male; Thrombectomy; Warfarin

The safety and effectiveness of non-vitamin K antagonist (VKA) oral anticoagulants, dabigatran or rivaroxaban, were compared with VKA in anticoagulant-naive patients with nonvalvular atrial fibrillation during the early phase of anticoagulant therapy.. With the use of the French medico-administrative databases (SNIIRAM and PMSI), this nationwide cohort study included patients with nonvalvular atrial fibrillation who initiated dabigatran or rivaroxaban between July and November 2012 or VKA between July and November 2011. Patients presenting a contraindication to oral anticoagulants were excluded. Dabigatran and rivaroxaban new users were matched to VKA new users by the use of 1:2 matching on the propensity score. Patients were followed for up to 90 days until outcome, death, loss to follow-up, or December 31 of the inclusion year. Hazard ratios of hospitalizations for bleeding and arterial thromboembolic events were estimated in an intent-to-treat analysis using Cox regression models. The population was composed of 19 713 VKA, 8443 dabigatran, and 4651 rivaroxaban new users. All dabigatran- and rivaroxaban-treated patients were matched to 16 014 and 9301 VKA-treated patients, respectively. Among dabigatran-, rivaroxaban-, and their VKA-matched-treated patients, 55 and 122 and 31 and 68 bleeding events and 33 and 58 and 12 and 28 arterial thromboembolic events were observed during follow-up, respectively. After matching, no statistically significant difference in bleeding (hazard ratio, 0.88; 95% confidence interval, 0.64-1.21) or thromboembolic (hazard ratio, 1.10; 95% confidence interval, 0.72-1.69) risk was observed between dabigatran and VKA new users. Bleeding (hazard ratio, 0.98; 95% confidence interval, 0.64-1.51) and ischemic (hazard ratio, 0.93; 95% confidence interval, 0.47-1.85) risks were comparable between rivaroxaban and VKA new users.. In this propensity-matched cohort study, our findings suggest that physicians should exercise caution when initiating either non-VKA oral anticoagulants or VKA in patients with nonvalvular atrial fibrillation.

Topics: Adolescent; Adult; Aged; Anticoagulants; Antithrombins; Arterial Occlusive Diseases; Atrial Fibrillation; Dabigatran; Databases, Factual; Factor Xa Inhibitors; Follow-Up Studies; Hemorrhage; Hospitalization; Humans; Middle Aged; Risk; Rivaroxaban; Thromboembolism; Thrombophilia; Vitamin K; Warfarin; Young Adult

Hypothenar hammer syndrome (HHS) is a rare condition of distal ulnar artery injury and thrombosis secondary to repetitive blunt trauma to the hypothenar area. We present a case of HHS for which point-of-care ultrasound (POCUS) was used as the initial means of imaging, prompting management and disposition without further imaging studies ordered in the emergency department (ED). This case demonstrates the utility of POCUS to aid the Emergency Physician in the diagnosis and management of patients with extremity vascular issues in the ED, and details a rarely seen clinical entity in the ED.

Topics: Adult; Anticoagulants; Arterial Occlusive Diseases; Aspirin; Emergency Medical Services; Humans; Male; Point-of-Care Testing; Thrombosis; Tomography, X-Ray Computed; Ulnar Artery; Ultrasonography; Warfarin

To evaluate the prevalence of dual platelet inhibition in cases of severe retrobulbar hemorrhage following retrobulbar and peribulbar anesthesia.. Department of Ophthalmology, Ludwig-Maximilans Universität, München, Germany.. Retrospective study.. Two groups of patients were screened retrospectively over a 5-year period for the inclusion criterion of severe retrobulbar hematoma after retrobulbar or parabulbar injection. The first group consisted of emergency cases referred to the clinic. A second group of patients had received retrobulbar block at the hospital. All cases were collected and screened for the presence of antiplatelet therapy.. Among roughly 160 000 patient records screened, 3 patients with grade IV retrobulbar hematoma were identified. Two of these patients were taking dual antiplatelet medications and 2 were on anticoagulation therapy during the time of retrobulbar or peribulbar anesthesia. None of the cases showed single medication platelet inhibition. The visual acuity of all patients stayed low at the 6-month follow-up (1.2 logMAR in 1 patient and no light perception in 2 patients).. Retrobulbar hematoma is a rare but severe complication of retrobulbar anesthesia. With the high prevalence of dual platelet inhibition found in these cases, a prospective controlled trial seems unethical. In these high-risk patients, surgery should be performed under topical anesthesia if possible or general anesthesia if necessary.. No author has a financial or proprietary interest in any material or method mentioned.

Topics: Aged; Anesthesia, Local; Anticoagulants; Arterial Occlusive Diseases; Aspirin; Cardiac Surgical Procedures; Cardiovascular Diseases; Clopidogrel; Drug Combinations; Female; Humans; Lens Implantation, Intraocular; Male; Phacoemulsification; Platelet Aggregation Inhibitors; Retrobulbar Hemorrhage; Retrospective Studies; Risk Factors; Ticlopidine; Warfarin

In this study we report our experience with the diagnosis and surgical treatment of popliteal entrapment syndrome (PAES) over a 10-year period.. Between 2002 and 2011, PAES was diagnosed in 27 limbs of 24 patients (19 males and 5 females), based on clinical symptoms and imaging examinations. The mean age of the patients was 30.4 years (range 8-69 years). All patients underwent surgical decompression of the entrapment mechanism and selective vascular reconstruction. Oral aspirin and warfarin therapy was administered after discharge.. All patients underwent successful surgical treatment. No perioperative complications occurred. Clinical symptoms either disappeared or exhibited obvious improvement in all patients after surgery. No patient presented with recurrent symptoms after discharge. Doppler ultrasound during follow-up revealed the patency of the popliteal artery and saphenous vein grafts.. PAES is an unusual but major cause of peripheral arterial insufficiency, particularly in patients lacking risk factors for atherosclerosis. A combination of imaging examinations is required for an early and accurate diagnosis. Surgical decompression and selective vascular reconstruction is recommended for both anatomic and symptomatic functional entrapment.

Topics: Administration, Oral; Adolescent; Adult; Aged; Anticoagulants; Arterial Occlusive Diseases; Aspirin; Child; Constriction, Pathologic; Decompression, Surgical; Diagnostic Imaging; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Plastic Surgery Procedures; Platelet Aggregation Inhibitors; Popliteal Artery; Predictive Value of Tests; Syndrome; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Doppler; Vascular Patency; Vascular Surgical Procedures; Warfarin; Young Adult

The efficacy of warfarin-induced anticoagulation in reducing radial artery occlusion (RAO) after transradial access is not known. The present case-control study compared the incidence of early (24 hours) and late (30 days) RAO in patients undergoing transradial diagnostic coronary angiography during therapeutic warfarin anticoagulation (group 1) with that of a matched (3:1) cohort of patients not receiving warfarin and receiving intraprocedural heparin (group 2). All patients underwent transradial diagnostic coronary angiography using a 5F hydrophilic introducer sheath. The patients in group 2 received an intravenous heparin bolus (50 IU/kg) immediately after sheath insertion. After sheath removal, hemostasis was obtained using the TR-band (Terumo Interventional Systems, Terumo Medical, Tokyo, Japan) and a plethysmography-guided patent hemostasis technique. We included 86 patients receiving warfarin with an international normalized ratio of 2 to 4 in group 1 and 250 matched patients in group 2. No significant differences were present in the demographic and procedural variables between the 2 groups. Early RAO occurred in 18.6% of the patients in group 1 compared with 9.6% of patients in group 2 (p = 0.024). The incidence of late RAO remained significantly higher in group 1 compared with group 2 (13.9% vs 5.2%, p = 0.01). All patients with RAO remained asymptomatic. In conclusion, patients receiving chronic oral anticoagulation with warfarin and undergoing transradial coronary angiography without parenteral anticoagulation had a higher incidence of early and late RAO compared with patients receiving standard intravenous heparin therapy.

Topics: Aged; Anticoagulants; Arterial Occlusive Diseases; Cardiac Catheterization; Coronary Angiography; Coronary Disease; Female; Follow-Up Studies; Humans; Incidence; Male; Pennsylvania; Prognosis; Radial Artery; Retrospective Studies; Risk Factors; Warfarin

The development of aortic thrombosis without the presence of atheroscrelosis, dissection, or aneurysms is rare. A cancer-related hypercoagulable state is a well-known risk factor for venous thrombosis, however, atrial thrombosis has rarely been reported in cancer patients. Cisplatin-based chemotherapy is known to cause various side-effects. Detecting aortic thrombosis is important because it is a fatal condition. We herein present the first reported case of endo-aortic thrombosis occurring during cisplatin-based chemotherapy for gastric cancer.

Topics: Acute Disease; Anticoagulants; Antineoplastic Combined Chemotherapy Protocols; Aortic Diseases; Aortography; Arterial Occlusive Diseases; Carcinoma, Signet Ring Cell; Cisplatin; Dexamethasone; Drug Combinations; Heparin; Humans; Oxonic Acid; Stomach Neoplasms; Tegafur; Thrombosis; Tomography, X-Ray Computed; Warfarin

Topics: Anticoagulants; Arterial Occlusive Diseases; Humans; Male; Middle Aged; Thrombectomy; Thrombosis; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

This article presents a case of a 17-year-old girl with primary antiphospholipid syndrome developing subacute signs of hand and leg ischaemia caused by radiologically verified radial and popliteal artery occlusion. She is successfully treated with a thrombolytic agent (alteplase) and recovers completely. Her laboratory results came positive for all three subtypes of antiphospholipid antibodies. This kind of antiphospholipid syndrome presentation is a very rare entity in itself. Shortly afterwards her mother is diagnosed with primary antiphospholipid syndrome as well. A familial form of antiphospholipid syndrome is suspected. Combination of a familial antiphospholipid syndrome presenting as bivessel arterial thrombosis is a unique case, to the best of our knowledge, never described in the literature before.

Topics: Administration, Oral; Adolescent; Angiography, Digital Subtraction; Antibodies, Antiphospholipid; Anticoagulants; Antiphospholipid Syndrome; Arterial Occlusive Diseases; Biomarkers; Constriction, Pathologic; Female; Fibrinolytic Agents; Genetic Predisposition to Disease; Heredity; Humans; Ischemia; Pedigree; Popliteal Artery; Radial Artery; Thrombolytic Therapy; Tissue Plasminogen Activator; Treatment Outcome; Warfarin

Topics: Aged; Anticoagulants; Arterial Occlusive Diseases; Humans; Leg Ulcer; Male; Thrombosis; Venous Insufficiency; Vitamin K; Warfarin

A pro-thrombotic condition was described in 1983 which was characterised by the presence of circulating antiphospholipid antibodies, as well as peripheral thrombosis (e.g. DVT), a tendency to internal organ involvement, repeated miscarriage, and, occasionally, thrombocytopenia (aPL) (Hughes, Br Med J 287:1088-1089, 1983). Previously, there had been a number of observations, mainly in patients with lupus having "false positive" tests for syphilis, miscarriage and circulating lupus anticoagulants. The description in 1983 had three notable features (a) a detailed comprehensive clinical picture of the syndrome; (b) this description differed from other coagulopathies in showing a propensity for arterial thrombosis (e.g. stroke and heart attack); and (c) this was a syndrome quite independent from lupus. There are indications that the primary antiphospholipid syndrome will turn out to be more common than lupus, though this could still be a reflection of referral practice.

Topics: Abortion, Spontaneous; Antibodies, Antiphospholipid; Antiphospholipid Syndrome; Arterial Occlusive Diseases; Aspirin; Brain Diseases; Cardiovascular Diseases; Constriction, Pathologic; Female; Heparin, Low-Molecular-Weight; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Infarction; Pregnancy; Thrombosis; Warfarin

Many investigators including TransAtlantic Inter-Society Consensus (TASC) recommend against primary endovascular treatment for severe (TASC C and D) superficial femoral artery (SFA) disease. Vein bypass is preferable but may not be appropriate due to comorbidities or lack of suitable vein. This study reviews our results with Viabahn stent graft-assisted subintimal recanalization (VASIR) for TASC C and D SFA atherosclerosis.. In all, 13 males and 14 females, mean age 72 ± 11 years underwent 28 VASIR for severe (TASC C 8 of 28, TASC D 20 of 28, and 5 of 28 no continuous infrapopliteal runoff artery) SFA disease. Indications were claudication (14 of 28 limbs), ischemic rest pain (6 of 28), and tissue loss (8 of 28). Viabahn stent graft-assisted subintimal recanalization was chosen instead of bypass due to comorbidities or lack of vein. Patients received aspirin and, if not already taking warfarin, they also received clopidogrel. Patients were examined with Ankle-brachial Index (ABI) and duplex scan at 1 month, then every 3 months after VASIR.. Viabahn stent graft-assisted subintimal recanalization was technically successful in all. Ankle-brachial Index averaged 0.47 ± 0.17 preprocedure, 0.89 ± 0.20 postprocedure, and increased by 0.15 or more in every case. Median follow-up is 20 months. There were 3 perioperative (<30 days) and 7 later failures including revision prior to any thrombosis. One patient required amputation. Four have died, 2 with patent grafts, none from causes related to VASIR, all more than 30 days post-VASIR. Estimated 1-year primary and secondary patency were 70% ± 11% and 73% ± 10%. Failure was not significantly associated with indications, comorbidities, or runoff status. There was a clear distinction between patients with early failure and the rest of the patients. None of the 8 patients with failure in the first 8 months after surgery has a patent graft. However, of 17 grafts primarily patent at 8 months, only 2 have failed (1 thrombosed and 1 required preemptive balloon angioplasty). There was a strong trend toward better patency with 6 and 7 mm diameter compared to 5 mm diameter stent grafts. Furthermore, although warfarin was not prescribed as part of the protocol, no patient taking warfarin before and who resumed warfarin after VASIR (n=4) suffered failure.. Despite significant early failures, we found VASIR to be durable in those who did not have early failure. Viabahn stent graft-assisted subintimal recanalization is an acceptable alternative to vein bypass in selected patients with severe SFA disease. Smaller arterial or stent graft diameter may be associated with poorer results. Warfarin may be valuable to reduce the risk of failure after VASIR.

Topics: Aged; Aged, 80 and over; Amputation, Surgical; Ankle Brachial Index; Anticoagulants; Arterial Occlusive Diseases; Aspirin; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Chi-Square Distribution; Clopidogrel; Endovascular Procedures; Female; Femoral Artery; Humans; Illinois; Male; Middle Aged; Platelet Aggregation Inhibitors; Prosthesis Design; Reoperation; Severity of Illness Index; Stents; Ticlopidine; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex; Vascular Patency; Warfarin

Ascending aorta and aortic arch thrombosis is rare in a young man with no risk factor. Here, we report the case of a young male patient with factor V Leiden mutation who developed ascending aorta and aortic arch thrombosis and subsequent emboli.

Topics: Adult; Anticoagulants; Aortic Diseases; Arterial Occlusive Diseases; Blood Coagulation; Blood Coagulation Disorders, Inherited; Echocardiography, Transesophageal; Embolism; Factor V; Humans; Lower Extremity; Male; Mutation; Thrombosis; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures; Warfarin

Selective right pulmonary arteriography and 3-dimensional computed tomography revealed multiple severe stenoses of the peripheral pulmonary artery associated with poststenotic aneurysms in a 65-year-old woman. She was referred to the hospital for evaluation of dry cough, gradually increasing dyspnea and multiple nodular shadows on a chest radiograph. Echocardiography and cardiac catheterization showed severe pulmonary hypertension, though other structural heart diseases or well-characterized congenital syndromes were ruled out. She was diagnosed as isolated peripheral pulmonary artery branch stenosis. Recent advances in CT technology enable a less-invasive assessment of pulmonary artery, and can be useful in the management of pulmonary arterial hypertension.

Topics: Aged; Aneurysm; Arterial Occlusive Diseases; Cardiac Catheterization; Constriction, Pathologic; Cough; Dyspnea; Epoprostenol; Female; Humans; Hypertension, Pulmonary; Imaging, Three-Dimensional; Oxygen Inhalation Therapy; Piperazines; Pulmonary Artery; Purines; Sildenafil Citrate; Sulfones; Tomography, X-Ray Computed; Ultrasonography; Vasodilator Agents; Warfarin

Locked-in syndrome is characterized by upper motor neuron quadriplegia, paralysis of lower cranial nerves, bilateral horizontal gaze palsy and anarthria, with preserved consciousness. It is due to a ventral pontine lesion following a basilar artery occlusion. We report the first Indian case report of locked-in syndrome, a 10-year old girl in whom the syndome was preceded by a 'herald hemiparesis'. Although the exact etiology for the basilar artery occlusion could not be determined, treatment with low molecular weight heparin and warfarin was followed by partial recovery.

Topics: Arterial Occlusive Diseases; Basilar Artery; Child; Female; Follow-Up Studies; Heparin, Low-Molecular-Weight; Humans; India; Magnetic Resonance Angiography; Neuropsychological Tests; Quadriplegia; Rare Diseases; Recovery of Function; Severity of Illness Index; Stroke; Treatment Outcome; Warfarin

Topics: Arterial Occlusive Diseases; Humans; Skin Diseases; Thrombocytopenia; Warfarin

Warfarin-induced skin necrosis is an unusual complication of anticoagulation therapy associated with high morbidity. A patient is presented who had protein C deficiency and in whom this complication developed twice within a short time as a result of delayed diagnosis. Early recognition of this syndrome has important implications in the treatment of such patients and may reduce the severity of complications.

Topics: Adult; Arterial Occlusive Diseases; Humans; Male; Necrosis; Protein C Deficiency; Skin Diseases; Thrombosis; Warfarin

Popliteal vascular entrapment syndrome can result in calf claudication, aneurysm formation, distal arterial emboli, or popliteal vessel thrombosis. The most commonly reported causes of this syndrome have been anomalies of the medial head of the gastrocnemius muscle as it relates to the course of the popliteal artery. We report two cases of rare anomalous slips of the lateral head of the gastrocnemius muscle causing popliteal vascular entrapment syndrome.

Topics: Angiography, Digital Subtraction; Anticoagulants; Arterial Occlusive Diseases; Constriction, Pathologic; Female; Fibrinolytic Agents; Humans; Leg; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Middle Aged; Muscle, Skeletal; Popliteal Artery; Popliteal Vein; Rare Diseases; Syndrome; Tissue Plasminogen Activator; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color; Venous Thrombosis; Warfarin

Thalidomide has been associated with venous thrombotic events, as reported in the post-marketing surveillance reports by Celgene Corporation; as well as case reports in the literature. Seven arterial thrombotic events have been reported in patients receiving thalidomide with 3 cases occurring in patients with other predisposing conditions. We report 4 additional cases of arterial thromboses in 1 lymphoma and 3 myeloma patients treated with thalidomide. The mechanism for these events is unclear; however, it is significant that 2 patients were receiving concomitant anticoagulation with aspirin and warfarin.

Topics: Aged; Arterial Occlusive Diseases; Aspirin; Drug Therapy, Combination; Female; Humans; Intracranial Thrombosis; Lymphoma; Male; Middle Aged; Multiple Myeloma; Thalidomide; Thrombosis; Warfarin

Topics: Adult; Anticoagulants; Antiphospholipid Syndrome; Arterial Occlusive Diseases; Female; Humans; Male; Ophthalmic Artery; Stroke; Warfarin

Topics: Aged; Aged, 80 and over; Anticoagulants; Arterial Occlusive Diseases; Carotid Artery Diseases; Coronary Angiography; Coronary Artery Bypass; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Female; Fibrinolytic Agents; Heart Septal Defects, Atrial; Heparin; Humans; Hypertension; Intraoperative Complications; Intraoperative Period; Popliteal Vein; Subclavian Artery; Thrombolytic Therapy; Tissue Plasminogen Activator; Warfarin

Warfarin-induced skin necrosis is a rare complication associated with the use of oral anticoagulants. Most patients develop this at the initiation of therapy, often while still receiving intravenous unfractionated heparin (UFH). Recently, low-molecular-weight heparins (LMWHs) have gained wider use, providing an option for outpatient treatment of deep-vein thrombosis. The treatment protocols are similar to UFH, including the early initiation of oral anticoagulation with warfarin. A Medline search failed to reveal any cases of warfarin-induced skin necrosis while using a LMWH. We present a patient with protein S deficiency who developed warfarin skin necrosis despite appropriate anticoagulation with enoxaparin, and review the chemical and clinical difference between UFH and LMWH.

Topics: Anticoagulants; Arterial Occlusive Diseases; Enoxaparin; Female; Fibrinolytic Agents; Heparin, Low-Molecular-Weight; Humans; Middle Aged; Necrosis; Popliteal Artery; Postoperative Complications; Protein S Deficiency; Skin Diseases; Subclavian Vein; Tibial Arteries; Treatment Failure; Vascular Surgical Procedures; Venous Thrombosis; Warfarin

Antiphospholipid syndrome (APS) has been well defined in adults; however, primary nontraumatic arterial thrombosis owing to this entity is unusual in the pediatric population. The authors report a case of APS with lower extremity arterial thrombosis who had discolored feet since delivery.

Topics: Antibodies, Anticardiolipin; Anticoagulants; Antiphospholipid Syndrome; Arterial Occlusive Diseases; Aspirin; Child, Preschool; Collateral Circulation; Heparin, Low-Molecular-Weight; Humans; Immunoglobulin G; Immunosuppressive Agents; Intermittent Claudication; Leg Ulcer; Male; Prednisolone; Skin Diseases, Vascular; Thrombophilia; Warfarin

Topics: Abdominal Abscess; Anticoagulants; Aortic Diseases; Arterial Occlusive Diseases; Arteriosclerosis; Calcinosis; Conversion Disorder; Diagnostic Errors; Female; Humans; Hypesthesia; Ischemia; Leg; Middle Aged; Muscle Denervation; Paraplegia; Peripheral Nerves; Thrombosis; Tibial Arteries; Tomography, X-Ray Computed; Warfarin

Topics: Adenocarcinoma; Adult; Anticoagulants; Arterial Occlusive Diseases; Autoimmune Diseases; Drug Resistance; Female; Heparin; Heparin, Low-Molecular-Weight; Hepatitis C, Chronic; Hirudins; Humans; Inflammatory Bowel Diseases; Male; Middle Aged; Neoplasms, Unknown Primary; Platelet Aggregation Inhibitors; Portal Vein; Pulmonary Embolism; Recombinant Proteins; Recurrence; Thrombocytopenia; Vena Cava, Inferior; Venous Thrombosis; Warfarin

To investigate the value of subintimal angioplasty (SA) and selective stent placement in the treatment of long (> or =15 cm) superficial femoral artery (SFA) occlusions.. During a period of 4.5 years, 67 long SFA occlusions in 61 patients (52 male, 9 female) were intended to be treated with SA, either retrogradely (n = 55) or antegradely (n = 12). Postprocedural medical treatment included aspirin + ticlopidine/clopidogrel (AT/C) combination. In 25 patients warfarin was also given for 3-6 months. Patients were followed up for 1-30 months (mean 12.5 +/- 9.0 months). Hemodynamic patencies were determined with the Kaplan-Meier method, risk factors affecting patency were evaluated with the Cox model, and the patencies of the subgroups were compared with log-rank test.. Subintimal recanalization was technically successful in 59 of 67 occlusions. Technical success was 83% in the first 30 procedures, 92% in the last 37, and 100% in the last 29. Forty-six occlusions were treated with SA alone and 13 with SA and stent placement. On an intention-to-treat basis, primary patency at 6 and 12 months was 49% and 22%, respectively, and assisted primary patency at 6 and 12 months was 69% and 57%, respectively. Patency rates were not significantly different in patients with claudication versus critical limb ischemia, or in those treated with SA alone versus SA and stent placement. With the multivariate Cox model, medical treatment with AT/C combination was identified as the only significant risk factor for both primary patency and assisted primary patency. With the Kaplan-Meier analysis, primary and assisted primary patencies were significantly higher in the warfarin group than the AT/C group (P =.0002 and.0001, respectively).. SA is a simple and safe method with a high technical success rate in the endovascular treatment of long SFA occlusions. Long-term patency rates, however, seem unsatisfactory, despite early reports. Subintimal stent placement provides cumulative patency at least as good as SA alone. Warfarin may significantly improve both primary patency and assisted primary patency after subintimal recanalization, but even with this treatment patency rates are still lower than those reported for bypass surgery. Therefore, in long SFA occlusions, SA is not recommended for claudicants but may be valuable in patients with critical limb ischemia.

Topics: Angioplasty; Arterial Occlusive Diseases; Aspirin; Clopidogrel; Female; Femoral Artery; Fibrinolytic Agents; Follow-Up Studies; Humans; Male; Middle Aged; Multivariate Analysis; Platelet Aggregation Inhibitors; Postoperative Care; Proportional Hazards Models; Stents; Ticlopidine; Time Factors; Treatment Outcome; Vascular Patency; Warfarin

Arthroscopic posterior cruciate ligament reconstruction may carry certain risks of complications, including injury to the neurovascular structures in the popliteal region. Acute occlusion of the popliteal artery, a limb-threatening complication, was reported after total knee arthroplasty. We report a case of acute popliteal artery occlusion after arthroscopic posterior cruciate ligament reconstruction. The possible causes included underlying artherosclerosis, the use of pneumatic tourniquet, surgical manipulation, and arterial spasm. Early diagnosis and prompt surgical treatment are the keys to success in the treatment of this limb-threatening complication. Spontaneous resolution of the thrombus such as is reported in this case is exceptional.

Topics: Anticoagulants; Arterial Occlusive Diseases; Arthroscopy; Heparin; Humans; Ischemia; Joint Instability; Leg; Male; Middle Aged; Popliteal Artery; Posterior Cruciate Ligament; Postoperative Complications; Remission, Spontaneous; Thrombosis; Tourniquets; Warfarin

Medically refractory positional cerebral ischemia and concomitant orthostatic hypotension associated with chronic common carotid artery (CCA) occlusion are rare. The authors detail their experience with three cases treated exclusively by an extracranial bypass in which the thyrocervical trunk was used as the donor vessel. Postoperatively grafts were patent and symptoms resolved in all three patients, although orthostatic hypotension remained. Postural cerebral ischemia due to CCA occlusion can be treated by extracranial bypass surgery. The thyrocervical trunk is a suitable donor for reconstruction of the external carotid artery in these cases.

Topics: Aged; Anticoagulants; Arterial Occlusive Diseases; Carotid Artery Diseases; Carotid Artery, Common; Carotid Artery, External; Cerebral Angiography; Cerebral Revascularization; Dizziness; Ephedrine; Fludrocortisone; Humans; Hypotension, Orthostatic; Ischemic Attack, Transient; Middle Aged; Paresis; Posture; Tomography, Emission-Computed, Single-Photon; Vision Disorders; Warfarin

Topics: Acute Disease; Adult; Aged; Amputation, Surgical; Anticoagulants; Aortic Diseases; Arterial Occlusive Diseases; Aspirin; Clopidogrel; Diagnosis, Differential; Echocardiography, Transesophageal; Female; Follow-Up Studies; Humans; Ischemia; Leg; Male; Middle Aged; Spain; Thrombectomy; Thrombosis; Ticlopidine; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

A 66-year-old woman admitted with dyspnea on exertion had atrial fibrillation and left ventricular dysfunction. Echocardiography revealed an atrial septal defect (ASD) and a soft, easily deformable thrombus in the dilated left atrium. The atrial mass suddenly disappeared on the 10th day after admission, and contrast-enhanced chest computed tomography and pulmonary blood flow scintigraphy showed that the thrombus had detached from the left atrium, floated into the right atrium through the ASD and caused pulmonary embolism. This is the first documented case of a left atrial thrombus causing pulmonary embolism by passing through an ASD. When an ASD is present, it is important to consider not only paradoxical thromboembolism (from the right to the left atrium), but also pulmonary embolism caused by thromboembolism from the left to the right atrium.

Topics: Aged; Anticoagulants; Arterial Occlusive Diseases; Atrial Fibrillation; Echocardiography, Transesophageal; Female; Heart Atria; Humans; Pulmonary Embolism; Treatment Outcome; Ventricular Dysfunction, Left; Warfarin

We report an unusual case of renovascular hypertension in a 16-year-old boy with primary antiphospholipid syndrome (PAPS), admitted to our clinic for severe drug-resistant hypertension and hypokalemia. Hormonal investigation revealed secondary aldosteronism and positive captopril test for renovascular disease. Aortography confirmed the occlusion of the left renal artery. After nephrectomy, normalization of blood pressure and secondary aldosteronism occurred. Presently the patient remains in good health, receiving warfarin anticoagulant therapy. PAPS is defined by the presence of antiphospholipid antibodies and recurrent thrombosis. Arterial thrombosis (29%) appears to be less prevalent than venous thrombosis. Thrombotic microangiopathy of the kidney is frequently observed but renal artery occlusion, as seen in our patient, is unusual.

Topics: Adolescent; Anticoagulants; Antiphospholipid Syndrome; Arterial Occlusive Diseases; Humans; Hypertension, Renovascular; Male; Nephrectomy; Renal Artery; Thrombosis; Warfarin

There is evidence from knock-out mice that the extrahepatic vitamin K-dependent protein, matrix gla protein, is necessary to prevent arterial calcification. The aim of this study was to determine if a warfarin treatment regimen in rats, designed to cause extra-hepatic vitamin K deficiency, would also cause arterial calcification. Sprague-Dawley rats were treated from birth for 5-12 weeks with daily doses of warfarin and concurrent vitamin K1. This treatment causes an extrahepatic vitamin K deficiency without affecting the vitamin K-dependent blood clotting factors. At the end of treatment the rats were killed and the vascular system was examined for evidence of calcification. All treated animals showed extensive arterial calcification. The cerebral arteries and the veins and capillaries did not appear to be affected. It is likely that humans on long-term warfarin treatment have extrahepatic vitamin K deficiency and hence they are potentially at increased risk of developing arterial calcification.

Topics: Animals; Arterial Occlusive Diseases; Calcinosis; Rats; Rats, Sprague-Dawley; Vitamin K Deficiency; Warfarin

We evaluated several molecular markers of hemostasis in 92 patients with hypercoagulable states treated with anticoagulant therapy. In all patients, the average values of the international normalized ratio (INR) were 1.70 +/- 0.50; this increase in INR was not, however, significant in patients under thrombotest (TT) monitoring. There were no thrombotic or severe bleeding complications in these patients during a period of 27 months. Plasma levels of thrombin-antithrombin complex (TAT), plasmin-plasmin inhibitor complex (PPIC), D-dimer, and soluble fibrin monomer (sFM) were slightly increased, suggesting that anticoagulant therapy was not completely effective in our Japanese patients based on the values of the TT. The INR was negatively correlated with TT, protein C, and protein S and particularly with TT between 10 and 80%. The range of TT was not correlated with the plasma level of TAT, PPIC, D-dimer, or sFM, but the range of INR was correlated with the plasma level of TAT, D-dimer, and sFM. The percentage of TAT, D-dimer, and sFM within normal range was significantly lower in patients with high INR. These findings show that INR is better than TT for the monitoring of warfarin therapy and that the therapeutic values of INR during the anticoagulant therapy should be > 1.7 in Japanese patients.

Topics: Adult; Aged; alpha-2-Antiplasmin; Anticoagulants; Antifibrinolytic Agents; Antithrombin III; Arterial Occlusive Diseases; Biomarkers; Female; Fibrin Fibrinogen Degradation Products; Fibrinolysin; Heart Valve Prosthesis; Hemostasis; Humans; International Normalized Ratio; Male; Middle Aged; Peptide Hydrolases; Protein C; Protein S; Pulmonary Embolism; Thrombin Time; Thromboembolism; Venous Thrombosis; Warfarin

Warfarin limits the synthesis of y-glutamyl carboxylated forms of coagulation factors, factor II, factor VII, factor IX, and factor X, protein C, and protein S and as a result impairs the function of these proteins. In contrast, direct inhibitors of thrombin only affect one enzyme in the coagulation cascade. The aim of this study was to investigate the antithrombotic effect and the slope of the dose-response curves of the multifactorial coagulation inhibitor warfarin in comparison with the single factor low-molecular-weight thrombin inhibitors melagatran and inogatran. An arterial thrombosis model in rats was used, and vessel damage was induced by topical application of ferric chloride to the carotid artery. The slopes of the dose-response curves were 3.6, 1.8, 1.1, and 1.2, for warfarin, heparin, inogatran, and melagatran, respectively. For warfarin the antithrombotic effect increased from 23% to 81% when the dose was doubled. In contrast, 10-fold increases in the doses of inogatran and melagatran were necessary to obtain a similar increase in antithrombotic effect. The doses needed to obtain 80% antithrombotic effect for heparin, warfarin, and melagatran were investigated in a tail transection bleeding model. For heparin, this dose significantly prolonged the bleeding time and the blood loss; for warfarin, only the total bleeding time was increased while for melagatran there was no increase in bleeding. We conclude that, thrombin inhibitors affecting only one enzyme in the coagulation cascade seem preferable to inhibitors affecting multiple enzymes, such as warfarin, due to shallower dose-response curves and a wider therapeutic interval.

Topics: Animals; Anticoagulants; Arterial Occlusive Diseases; Bleeding Time; Blood Coagulation Tests; Disease Models, Animal; Dose-Response Relationship, Drug; Humans; Male; Rats; Rats, Sprague-Dawley; Thrombin; Thrombosis; Warfarin

Two patients experienced upper extremity thromboembolism after axillary-axillary bypass grafting (AxAG) for symptomatic subclavian artery stenosis. The first patient, a 67-year-old male, presented with left upper extremity thromboembolism 3 years after AxAG with 8 mm externally support PTFE. An arteriogram revealed a patent AxAG, thrombus in the proximal left subclavian arterial stump just distal to its occlusion, and multiple digital artery emboli. The patient was treated with warfarin for 8 months, with resolution of symptoms. The second patient, a 57-year-old male, occluded his AxAG (8 mm knitted Dacron) with minimal return of symptoms. Non-operative treatment was elected and 4 years later the patient presented with right upper extremity (donor side) thromboembolism. Arteriography revealed occlusion of the AxAG, radial artery, and digital arteries of the index, long and ring fingers. Thrombolytic therapy of the right arm was undertaken with minimal improvement. Subsequent detachment of the AxAG and placement of an interposition reversed saphenous vein graft was performed. Both patients continue to be asymptomatic during follow-up of 4.7 and 2.0 years, respectively.

Topics: Aged; Anticoagulants; Arm; Arterial Occlusive Diseases; Axillary Artery; Blood Vessel Prosthesis; Constriction, Pathologic; Embolism; Fingers; Follow-Up Studies; Graft Occlusion, Vascular; Humans; Male; Middle Aged; Polytetrafluoroethylene; Postoperative Complications; Radial Artery; Saphenous Vein; Subclavian Artery; Thromboembolism; Thrombolytic Therapy; Thrombosis; Warfarin

Topics: Aged; Aged, 80 and over; Arterial Occlusive Diseases; Drug Interactions; Female; Humans; Hypoprothrombinemias; Lovastatin; Warfarin

To identify risk factors for lower limb loss after arterial embolectomy a cohort of 1189 patients was studied. Detailed data were obtained for 165 patients who underwent a major amputation within 30 days of embolectomy and for 165 matched controls. The amputation risk was increased in patients with two or more myocardial infarctions (odds ratio (OR) 3.1, 95 per cent confidence interval (CI) 0.8-11.2), chronic ischaemia (OR 2.1, CI 0.9-4.9), long duration of symptoms (OR 4.3, CI 1.9-9.6, for greater than or equal to 25 h versus less than or equal to 6 h) or postoperative heart failure (OR 3.4, CI 1.8-6.5). Reduced risks were found in association with acute myocardial infarction (OR 0.3, CI 0.1-0.9) and postoperative anticoagulation treatment with warfarin (OR 0.3, CI 0.1-0.9). The independent prognostic value of chronic ischaemia and symptom duration, and the beneficial effect of postoperative anticoagulation gained additional support in multivariate analysis. We conclude that the risk of early amputation after arterial embolectomy or thrombectomy can be predicted by several clinical characteristics.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Amputation, Surgical; Arterial Occlusive Diseases; Case-Control Studies; Cohort Studies; Female; Heart Arrest; Humans; Ischemia; Leg; Male; Middle Aged; Myocardial Infarction; Postoperative Complications; Risk Factors; Warfarin

Topics: Adult; Arterial Occlusive Diseases; Autoantibodies; Blood Coagulation Factors; Humans; Lupus Coagulation Inhibitor; Male; Retinal Artery; Retinal Diseases; Vision Disorders; Warfarin

We report the clinical features and prognosis in nine patients with angiographically documented basilar artery stenosis of the middle and distal segments. Six patients had transient ischemic attacks (TIAs), and in two this was their only clinical manifestation. The TIAs in four patients included two or more of the following symptoms: dizziness, diplopia, perioral numbness, dysphagia, weakness, or loss of consciousness. Two other patients had isolated symptoms of transient dizziness and unilateral weakness. Seven patients had posterior circulation strokes, preceded by TIAs in four. Basilar artery occlusive disease can affect any segment of the artery. The short-term prognosis of middle and distal basilar artery stenosis was good especially when patients were treated with warfarin or platelet antiaggregants.

Topics: Aged; Arterial Occlusive Diseases; Basilar Artery; Cerebral Angiography; Follow-Up Studies; Humans; Ischemic Attack, Transient; Male; Middle Aged; Tomography, X-Ray Computed; Warfarin

Topics: Arterial Occlusive Diseases; Aspirin; Blood Platelets; Dipyridamole; Endarterectomy; Female; Femoral Artery; Humans; Male; Middle Aged; Popliteal Artery; Recurrence; Warfarin

This report describes successful management of recent peripheral arterial occlusions by intra-arterial low dosage thrombolytic drug infusions and percutaneous balloon angioplasty. An intra-arterial infusion of either streptokinase or urokinase at 1/20 of the usual systemic dose was delivered through an angiographic catheter into the region of the thrombus. Clot lysis was achieved for arterial occlusions of the iliac artery, an old aortofemoral graft limb and femoropopliteal arteries. Arterial clots of several weeks duration were lysed. Recurrent thrombosis can be prevented by anticoagulation, balloon angioplasty or surgical repair of causative arterial lesions. Thrombolytic therapy for arterial occlusions is not a replacement for surgical management but an important adjunct to the over-all treatment. Low dosage regional thrombolytic therapy deserves wider application in the management of selected arterial occlusions.

Topics: Aged; Angioplasty, Balloon; Aorta; Arterial Occlusive Diseases; Blood Pressure Determination; Blood Vessel Prosthesis; Female; Femoral Artery; Fibrinolytic Agents; Foot; Humans; Infusions, Intra-Arterial; Leg; Male; Middle Aged; Popliteal Artery; Postoperative Complications; Radiography; Streptokinase; Thrombosis; Urokinase-Type Plasminogen Activator; Warfarin

Warfarin anticoagulation data from forty-seven patients studied retrospectively was used to develop an algorithm for predicting daily maintenance dose of warfarin. A plot of prothrombin time versus cumulative warfarin loading dose was made for each of the forty-seven patients and the aera under the curve (AREA) measured from the baseline prothrombin time to a prothrombin time of 20 seconds. A linear correlation between the established daily maintenance dose of warfarin and AREA was derived regression analysis: Daily maintenance dose (mg/day) = 0.0465 x (AREA) + 1.5. The correlation was then used to predict daily maintenance dose in twenty-four patients studied prospectively. The mean prothrombin time for a seven day stabilization period after loading for all patients in the prospective study was 21.5 +/- 2.2 seconds and the seven day mean prothrombin time for each patient fell between 19 and 24 seconds. The results of the prospective study indicate that this technic is useful in the early, accurate prediction of a daily maintenance dose of warfarin.

Topics: Adult; Aged; Arterial Occlusive Diseases; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Prospective Studies; Prothrombin Time; Retrospective Studies; Thromboembolism; Warfarin

Topics: Administration, Oral; Arterial Occlusive Diseases; Cerebral Arteries; Female; Heparin; Humans; Hyperthyroidism; Hypoprothrombinemias; Injections, Intravenous; Middle Aged; Propylthiouracil; Prothrombin Time; Sodium; Thyroid Crisis; Warfarin

This is a report of 3 cases of ocular damage which occurred during t he use of oral contraceptives. A 21-year-old woman experienced sudden loss of vision in her right eye after 4 months of combination type oral contraceptive therapy. Ocular tension was normal; the fundus showed occlusion of the central retinal artery. The other eye was normal. Anticoagulant medications were given iv and orally. The next day vision was improved and some restoration of circulation to the retina was noted. After 18 months vision and visual fields were normal in both eyes. In another case a 42-year-old patient experienced sudden loss of vision in her left eye. She had been taking contraceptive pills for 14 months. The right eye was normal. The fundus of the left eye showed evidence of acute occlusion of the central artery of the retina with only the temporal side of the field of vision retained. The oral contraceptive was discontinued and anticoagulation medication given. No improvement occurred. After 6 months total occlusion of the lower temporal artery remained. The third case, 1 21-year-old woman, complained of progressive blurring vision in the right eye for 2 weeks. She had taken oral contraceptives following a normal delivery 7 months previously but had stopped medication 1 month before admission. The affected eye showed a central scotoma and a markedly restricted visual field. Anticoaguland drugs and vitamin-B were given. After 7 days vision was markedly improved and the central scotoma had decreased in size. After another week vision and visual fields were normal. In this case an optic neuritis due to occlusion of a branch of the retinal artery was thought to have been present. Immediate therapy for such cases is important. Since estrogens have been implicated in the etiology of thromboembolic disease, smaller doses of this steroid (50 instead of 80 mcg) are recommended.

Topics: Adult; Amino Alcohols; Arterial Occlusive Diseases; Contraceptives, Oral; Contraceptives, Oral, Synthetic; Drug Combinations; Ethinyl Estradiol; Ethynodiol Diacetate; Female; Humans; Mestranol; Nicotinic Acids; Norethindrone; Retinal Artery; Theophylline; Vision Disorders; Warfarin

Topics: Adult; Angiography; Arterial Occlusive Diseases; Carotid Artery Diseases; Carotid Artery Injuries; Carotid Artery, Internal; Electroencephalography; Hematoma; Humans; Male; Mental Disorders; Physical Therapy Modalities; Rupture; Ultrasonography; Vasa Vasorum; Warfarin