warfarin and Back-Pain

Topics: Abdominal Pain; Aged; Anticoagulants; Atrial Fibrillation; Back Pain; Diagnosis, Differential; Embolization, Therapeutic; Emergency Service, Hospital; Female; Flank Pain; Humans; Infarction; Kidney; Risk Factors; Tachycardia; Thrombosis; Tomography, X-Ray Computed; Warfarin

Warfarin is widely used. Spontaneous bleeding is one of the complications of warfarin treatment. A 70-year-old man was admitted to the emergency room with right back pain. There was no history of trauma. He was using warfarin following a bypass graft. The patient's vital signs were stable. On physical examination, swelling at the level of the right scapula was detected. Laboratory findings showed that the international normalised ratio (INR) was ↑↑ (a very high reading) (1.47 1 month previously). There was no melena on rectal examination. A chest CT was performed to differentiate the swelling of the right scapula. Warfarin was stopped and vitamin K was administered. Fresh frozen plasma was initiated and the patient was hospitalised to the cardiovascular surgical service. The fact that use of warfarin in the elderly may increase the risk of spontaneous bleeding should be especially kept in mind.

Topics: Aged; Anticoagulants; Back Pain; Hematoma; Humans; Male; Scapula; Tomography, X-Ray Computed; Warfarin

Topics: Aged; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Atrial Fibrillation; Back Pain; Drug Interactions; Humans; Ibuprofen; International Normalized Ratio; Male; Tramadol; Warfarin

We are presenting a case of non-traumatic spontaneous spinal subdural hematoma in a patient on warfarin and fluoxetine. This diagnosis should be considered early in patients who are on warfarin or fluoxetine or both presenting with acute neurological abnormalities of the limbs, and early decompression could result in good neurological outcome.

Topics: Aged; Antifibrinolytic Agents; Back Pain; Blood Coagulation Factors; Combined Modality Therapy; Decompression, Surgical; Dexamethasone; Early Diagnosis; Early Medical Intervention; Fluoxetine; Glucocorticoids; Hematoma, Subdural, Spinal; Humans; Laminectomy; Magnetic Resonance Imaging; Male; Paraplegia; Spinal Cord Compression; Treatment Outcome; Urinary Retention; Vitamin K; Warfarin

Ms TS is a 66-year-old woman who receives warfarin for prevention of systemic embolization in the setting of hypertension, diabetes, and atrial fibrillation. She had a transient ischemic attack about 4 years ago when she was receiving aspirin. Her INR control was excellent; however, over the past few months it has become erratic, and her average dose required to maintain an INR of 2.0 to 3.0 appears to have decreased. She has had back pain over this same period and has been taking acetaminophen at doses at large as 650 mg four times daily, with her dose varying based on her symptoms. You recall a potential interaction and wonder if (1) her acetaminophen use is contributing to her loss of INR control, and (2) does this interaction place her at increased risk of warfarin-related complications?

Topics: Acetaminophen; Aged; Analgesics, Non-Narcotic; Anticoagulants; Atrial Fibrillation; Back Pain; Biotransformation; Diabetes Complications; Drug Interactions; Drug Monitoring; Embolism; Female; Humans; Hypertension; International Normalized Ratio; Vitamin K; Warfarin

Tramadol is a commonly used synthetic opioid with the advantage of lowering the potential for dependence. Two reports of a tramadol-warfarin drug interaction have been published, and the current product insert states that increased international normalized ratios (INRs) with concomitant tramadol-warfarin use have been reported. We report a tramadol-warfarin drug interaction that caused a supratherapeutic INR in a 65-year-old man in previously stable condition who was being treated at our anticoagulation clinic. Within 6 days of starting tramadol 50 mg twice/day, the patient's INR rose from 2.5 to 6.14. He elected to continue therapy with the tramadol. A 30% dosage reduction from warfarin 60 to 42 mg/week was eventually needed. To our knowledge, this is the first case report of the successful continuation of tramadol after a tramadol-warfarin drug interaction. Based on our experience, we suggest an empiric dosage reduction of 25-30% in warfarin followed by repeat measurement of the INR within 1 week in patients who are starting tramadol therapy. As an alternative, maintaining the current dose of warfarin, followed by a repeat INR determination in 3 days, may be appropriate.

Topics: Aged; Analgesics, Opioid; Anticoagulants; Back Pain; Drug Interactions; Humans; International Normalized Ratio; Male; Pulmonary Embolism; Tramadol; Venous Thrombosis; Warfarin

Topics: Abdominal Pain; Administration, Oral; Adult; Age Factors; Back Pain; Drug Therapy, Combination; Heparin; Humans; Infusions, Intravenous; Male; Mesenteric Veins; Venous Thrombosis; Warfarin

Portal vein thrombosis (PVT) is a complication of hepatic disease and a potentially lethal complication of splenectomy. The reported incidence of this complication is low (approximately 1%). However, its true incidence may have been underestimated due to difficulty in making the diagnosis. Herein we report the case of a 19 year-old woman who presented with a 2-year history of idiopathic thrombocytopenic purpura (ITP). Because she had become refractory to medical therapy, she underwent laparoscopic splenectomy. She was discharged on postoperative day 2 after an uncomplicated procedure. She did well, complaining only of mild backache, until postoperative day 21, when she presented with nausea, vomiting, and leukocytosis. CT showed PVT and superior mesenteric vein thrombosis. Despite heparin and fluid administration, her condition worsened. At laparotomy, she had diffuse small bowel edema and congestion. At a second-look procedure 24 h later, nearly all her jejunum and ileum were necrotic. After three procedures, she was left with 45 cm of proximal and 10 cm of distal small bowel. Bowel continuity was restored 8 weeks later. She continued on warfarin anticoagulation therapy for 1 year. Postsplenectomy PVT is most often seen following splenectomy for myeloproliferative disorders and almost never after trauma. The large splenic vein stump and the hypercoagulable state in patients with splenomegaly are thought to be contributory. The presentation of PVT is vague, without defining signs or symptoms. Color-flow Doppler and contrast-enhanced CT scans are the best methods for the nonoperative diagnosis of PVT. Aggressive thrombolysis offers the best hope for clot lysis and maintenance of bowel viability. Even vague symptoms must be considered seriously following splenectomy.

Topics: Adult; Anastomosis, Surgical; Anticoagulants; Back Pain; Combined Modality Therapy; Crystalloid Solutions; Diagnostic Errors; Female; Fluid Therapy; Heparin; Humans; Ileum; Immunosuppressive Agents; Ischemia; Isotonic Solutions; Jejunum; Laparoscopy; Mesenteric Veins; Muscular Diseases; Necrosis; Parenteral Nutrition; Plasma Substitutes; Plasmapheresis; Platelet Transfusion; Portal Vein; Postoperative Complications; Purpura, Thrombocytopenic, Idiopathic; Splenectomy; Splenomegaly; Venous Thrombosis; Warfarin

We describe the case of a woman with congenital rubella who presented with backache. Plain abdominal X-ray revealed calcification of a superior mesenteric artery aneurysm. Intra-arterial digital subtraction angiography demonstrated multiple aneurysms of the arteries to the upper and lower limbs and the viscera. We have not found another report in the literature of the association of congenital rubella with multiple aneurysms.

Topics: Adult; Anticoagulants; Aortic Aneurysm, Abdominal; Back Pain; Female; Humans; Radiography; Rubella Syndrome, Congenital; Treatment Outcome; Warfarin

Topics: Anticoagulants; Back Pain; Cranial Nerve Diseases; Female; Heart Valve Prosthesis; Hematoma, Subdural; Heparin; Humans; Magnetic Resonance Imaging; Middle Aged; Risk; Spinal Cord Compression; Spinal Puncture; Thromboembolism; Urinary Catheterization; Urinary Retention; Warfarin

Spinal subdural hematoma (SSH) is an uncommon entity. There is a higher incidence among patients with a bleeding diathesis and among those with a bleeding diathesis having a lumbar puncture. The case reported here is of a 65-year-old woman on oral anticoagulants presenting with atypical symptoms who developed SSH over a six-hour period. Emergency investigation and treatment are required because recovery is inversely related to the length of time of spinal cord compression. A review of the literature revealed 37 previously reported cases of nonmajor traumatic SSH.

Topics: Back Pain; Female; Hematoma, Subdural; Humans; Middle Aged; Spinal Cord Compression; Time Factors; Warfarin

Topics: Adult; Back Pain; Diagnostic Errors; Drug Hypersensitivity; Female; Hematuria; Humans; Munchausen Syndrome; Warfarin