warfarin and Colonic-Diseases

Topics: Aspirin; Blood Transfusion; Clopidogrel; Colonic Diseases; Colonoscopy; Combined Modality Therapy; Drug Therapy, Combination; Endoscopy, Digestive System; Equipment Design; Fibrinolytic Agents; Gastrointestinal Hemorrhage; Hemostatic Techniques; Humans; Ileocecal Valve; Male; Middle Aged; Reoperation; Thrombosis; Warfarin

Patients on chronic oral anticoagulation can be challenging to manage in the perioperative period.. Review of patients on warfarin undergoing elective abdominal colon and rectal operations at a single institution from 2000 to 2006.. One forty-six patients underwent 165 abdominal procedures. Mean (±SEM) age was 67 ± 1 years; 59% of patients were men. Median estimated blood loss was 200 ml, and 19% received intraoperative blood products while 19% of patients received a postoperative transfusion. Sixteen patients (10%) experienced bleeding complications (three requiring reoperation). No risk factors for bleeding were identified by multivariate analysis (MVA). Five patients (3%) suffered a postoperative thromboembolic event. Preoperative anticoagulation for cerebrovascular disease was a risk factor for thromboembolism (p = 0.03). Overall operative morbidity was 30% with no identifiable risk factor in MVA. Mortality was nil.. Postoperative bleeding and thromboembolism in patients on chronic anticoagulation are not insignificant (10% and 3%, respectively). Patients on warfarin for cerebrovascular disease are at increased risk for thromboembolic events postoperatively and should be placed on appropriate prophylaxis and monitored.

Topics: Administration, Oral; Aged; Anticoagulants; Blood Loss, Surgical; Blood Transfusion; Colonic Diseases; Female; Heparin, Low-Molecular-Weight; Humans; Male; Multivariate Analysis; Postoperative Complications; Postoperative Hemorrhage; Rectal Diseases; Thromboembolism; Warfarin

The authors point to the risk of hypocoagulation by patients with colorectal carcinoma, who use warfarin.. 185 patients with colorectal cancer were examined for plattellets, prothrombin time and D-dimer.. Only 64 patients (35%) had haemocoagulation in the standard, 114 patients (61%) were hypercoagulable and only 7 patients (3.7%) were hypocoagulable. The authors present an interesting case report of a patient who used warfarin. This patient has ileos state by sigmoideal cancer, and in parallel a progressive intramural haematoma in the hepatic flexure of the colon.. Hypocoagulation state with an intramural haematoma of colon may be very dangerous complication for patients with colorectal cancer and ileos state. Very careful choice of surgical strategy is necessary.

Topics: Aged; Blood Coagulation Disorders; Colonic Diseases; Hematoma; Humans; Male; Sigmoid Neoplasms; Warfarin

A 73-year-old woman presented with a history of persistent atrial fibrillation, which had lasted more than five years. She also had a remote history of transient ischemic attack and had received warfarin therapy. The international normalized ratio had been carefully maintained at slightly subtherapeutic levels because of recurrent gastrointestinal bleeding, which was severe enough to require frequent blood transfusions. With colonoscopy, the source of bleeding was localized to multiple arterial-venous malformations. The patient underwent catheter ablation of the atrioventricular junction and received a single chamber pacemaker. Two years later, she received a dual chamber pacemaker followed by cardioversion to restore a sinus rhythm. Following brief cardioversion, her symptoms of atrial fibrillation returned after two days.. Transesophageal echocardiography, pacemaker interrogation.. Persistent atrial fibrillation, gastrointestinal bleeding requiring transfusion.. Percutaneous left atrial appendage occlusion, antiplatelet therapy.

Topics: Aged; Anticoagulants; Arteries; Arteriovenous Fistula; Atrial Appendage; Atrial Fibrillation; Catheter Ablation; Colon; Colonic Diseases; Electric Countershock; Female; Gastrointestinal Hemorrhage; Humans; International Normalized Ratio; Pacemaker, Artificial; Recurrence; Reoperation; Veins; Warfarin

Topics: Acute Disease; Aged; Anticoagulants; Colonic Diseases; Female; Hematoma; Humans; Intestinal Obstruction; Tomography, X-Ray Computed; Warfarin

Colonic angiodysplasia is one of the most frequent causes of recurrent lower gastrointestinal tract bleeding, mainly in the elderly. In 50% of patients multiple angiodysplastic lesions were reported when they were the cause of rectal bleeding. Bleeding from angiodysplasia is more severe and less responsive to treatment in those with coagulation disorders. A 74-year-old woman with an artificial mitral valve who was treated with coumadine is reported. A few years after operation she began to develop severe recurrent rectal bleeding because of multiple angiodysplastic lesions along the right colon, proven by colonoscopy. She was frequently hospitalized for blood transfusions; endoscopic treatment was not feasible and the surgical risk of colectomy was very high. Treatment with estrogen and progesterone significantly decreased recurrent episodes of bleeding.

Topics: Aged; Angiodysplasia; Anticoagulants; Blood Transfusion; Colonic Diseases; Ethinyl Estradiol; Female; Gastrointestinal Hemorrhage; Heart Valve Prosthesis; Humans; Norgestrel; Warfarin

Topics: Agranulocytosis; Anus Diseases; Anus Neoplasms; Blood Coagulation Disorders; Blood Platelet Disorders; Blood Platelets; Blood Transfusion; Colitis, Ulcerative; Colonic Diseases; Colonic Neoplasms; Factor V Deficiency; Factor VII Deficiency; Gastrointestinal Hemorrhage; Hemophilia A; Humans; Hypoprothrombinemias; Liver Diseases; Lymphoma; Rectal Diseases; Warfarin