warfarin and Central-Nervous-System-Diseases

The association of antibodies with an apparent specificity for anionic phospholipids with thrombosis, fetal loss, thrombocytopenia, and certain other clinical manifestations is now well-recognized as the antiphospholipid syndrome (APS). Recent advances in our understanding of the antibodies and antigens involved include discovery of the crystal structure of beta2-glycoprotein I, (beta2GPI), genetic studies of beta2GPI polymorphisms, and the development of anti-beta2GPI and antiprothrombin immunoassays as clinical laboratory tests. The identification of antigen-specific T cells in APS patients has stimulated interest in the role of the cellular immune response in the syndrome. Clinical research in APS will also benefit from the development of preliminary classification criteria.

Topics: Annexin A5; Antibodies, Antiphospholipid; Anticoagulants; Antiphospholipid Syndrome; Autoantibodies; beta 2-Glycoprotein I; Central Nervous System Diseases; Glycoproteins; Humans; Immunity, Cellular; Prothrombin; Thrombosis; Warfarin

Thirteen of 394 (3.3%) regularly dialyzed patients of the Regional Kidney Disease Program developed subdural hematoma. The following factors contributed to formation of subdural hematoma: head trauma, ultrafiltration to control excessive accumulation of fluid and hypertension, anticoagulants, and frequent vascular access infection and clotting. Neurologic symptoms and signs, which may be similar to dialysis disequilibrium, aid only in signifying the presence, not the ultimate localization, of subdural hematoma. Our experience underscores the frequency of bilateral disease, irrespective of neurologic findings. Skull films, lumbar puncture, and electroencephalography were of little diagnostic help. Although valuable and safe, brain scanning was not as useful as desired due to occurrences of false-negative studies and failure to identify bilaterality of lesions. Cerebral angiography was always diagnostic. Surgical intervention yielded disappointing results, and only 2 patients (15%) survived. A review of 9 other patient reports is included.

Topics: Adult; Aged; Central Nervous System Diseases; Cerebral Angiography; Female; Hematoma, Subdural; Humans; Male; Middle Aged; Peritoneal Dialysis; Renal Dialysis; Ultrafiltration; Warfarin; Wounds and Injuries

Since its introduction in the United States in 1974, ibuprofen (Motrin, Upjohn) has been shown to be safe and effective for the treatment of pain, dysmenorrhea, inflammation, and fever. A careful review of pre-registration and postmarketing data from both patients and normal subjects clearly indicates ibuprofen's remarkable safety profile compared with that of aspirin and other commonly prescribed nonsteroidal anti-inflammatory agents. Continued safety can be anticipated on the basis of the past 15 years of review experience.

Topics: Anti-Inflammatory Agents; Aspirin; Blood Cell Count; Blood Coagulation Tests; Blood Proteins; Central Nervous System Diseases; Chemical and Drug Induced Liver Injury; Clinical Trials as Topic; Dose-Response Relationship, Drug; Drug Eruptions; Drug Interactions; Drug Tolerance; Gastrointestinal Diseases; Humans; Ibuprofen; Kidney Diseases; Liver Function Tests; Warfarin

Recombinant Factor VIIa decreases hematoma growth after spontaneous intracerebral hemorrhage (ICH) and rapidly decreases international normalized ratios in patients on warfarin but is also associated with an increased risk for thromboembolic complications. In this study, we assessed the risk of thromboembolic events in patients receiving recombinant Factor VIIa after ICH associated with warfarin treatment.. We reviewed the medical charts, laboratory data, and radiological findings of consecutive patients with anticoagulation-related hemorrhages of the central nervous system who received recombinant Factor VIIa at Mayo Clinic Rochester and Mayo Clinic Florida between 2002 and 2009. The primary end point was the frequency of new thromboembolic events, including myocardial infarction, deep vein thrombosis, ischemic stroke, and pulmonary embolism.. We identified 101 patients; 54% had ICH and 30% subdural hematomas. The most common indications for anticoagulation were atrial fibrillation, deep vein thrombosis, and prosthetic valve. Thirteen patients (12.8%) had new thromboembolic events (10 deep vein thromboses and 3 ischemic strokes) within 90 days after recombinant Factor VIIa administration. Eight of these adverse events occurred within 2 weeks of treatment. In patients with ICH, the rate of thromboembolic complications was 5% and all events were venous.. The risk of thromboembolic events in patients who received recombinant Factor VIIa for anticoagulation-associated ICH was not higher than that seen in patients treated for spontaneous ICH in the Factor Seven for Acute Hemorrhagic Stroke (FAST) trial. Spontaneous deep vein thrombosis was the most common complication in our series.

Topics: Adult; Aged; Aged, 80 and over; Central Nervous System Diseases; Cerebral Hemorrhage; Factor VIIa; Female; Hematoma, Epidural, Spinal; Humans; Male; Middle Aged; Recombinant Proteins; Warfarin

Topics: Acetates; Amines; Anticoagulants; Anticonvulsants; Brain; Carbamazepine; Central Nervous System Diseases; Clotrimazole; Cyclohexanecarboxylic Acids; Cyclophosphamide; Drug Hypersensitivity; Drug Therapy, Combination; Gabapentin; gamma-Aminobutyric Acid; Humans; Immunosuppressive Agents; Liver; Magnetic Resonance Imaging; Male; Middle Aged; Vasculitis; Vasculitis, Leukocytoclastic, Cutaneous; Warfarin

Topics: Angina Pectoris; Aorta; Cardiac Surgical Procedures; Central Nervous System Diseases; Coronary Disease; Coronary Vessels; Electrocardiography; Extracorporeal Circulation; Heart Ventricles; Humans; Hypoxia; Intubation, Intratracheal; Methods; Postoperative Complications; Recurrence; Ventricular Fibrillation; Warfarin