warfarin and Contusions

Topics: Anticoagulants; Atrial Fibrillation; Contusions; Hematoma; Humans; Platelet Aggregation Inhibitors; Warfarin

This lesson of the month highlights that certain radiology terminology may be used to report bleeding on head computerised tomography (CT) reports. On-call junior doctors should not be expected to interpret CT head images, so often their decisions will be based on the written report. The wording used can change the clinical decision and therefore the treatment given by a junior doctor. Clinical teams and junior doctors should be educated on terminology in relation to bleeding on CT head reports.

Topics: Accidental Falls; Aged; Anticoagulants; Atrial Fibrillation; Brain; Contusions; Diagnosis, Differential; Fatal Outcome; Female; Humans; Intracranial Hemorrhage, Traumatic; Tomography, X-Ray Computed; Warfarin

Topics: Collagenases; Contusions; Drug Interactions; Dupuytren Contracture; Hemorrhage; Humans; Injections, Intralesional; International Normalized Ratio; Risk Assessment; Warfarin

Topics: Anticoagulants; Antihypertensive Agents; Contusions; Female; Humans; Hypertension; Medication Errors; Perindopril; Warfarin

A woman in her late 70s presented to the acute general surgical take with a 3-day history of worsening right leg pain and swelling. She had undergone right revision total hip arthroplasty 20 months previously and reported chronic postoperative right thigh pain attributed to a femoral deep venous thrombosis for which she had been warfarinised. On examination, Grey Turner's sign (bruising of the flanks indicating retroperitoneal haemorrhage) was present, as well as a large tender mass in the right iliac fossa and pitting oedema throughout the right lower limb. Urgent CT scan with intravenous contrast revealed a right retroperitoneal haematoma secondary to a right acetabular screw protruding into the right external iliac vein. The patient was successfully managed with warfarin reversal and surgical removal of the relevant acetabular screw. At 2-month follow-up, the patient's symptoms continue to resolve.

Topics: Aged; Anticoagulants; Arthroplasty, Replacement, Hip; Bone Screws; Contusions; Female; Hemorrhage; Humans; Iliac Vein; Radiography; Retroperitoneal Space; Venous Thrombosis; Warfarin

Topics: Adult; Anticoagulants; Antihypertensive Agents; Contusions; Female; Humans; Hypertension; Medication Errors; Perindopril; Warfarin

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Blood Coagulation Disorders; Contusions; Epistaxis; Female; Hematemesis; Humans; Male; Middle Aged; Vitamin K; Vitamins; Warfarin

Topics: Anticoagulants; Contusions; Female; Humans; Middle Aged; Warfarin

We report the case of a 71-year-old man on warfarin for chronic atrial fibrillation presenting with a massive spontaneous soft tissue bleed. Despite reversing the effects of warfarin with large doses of intravenous vitamin K and fresh frozen plasma, bleeding continued, and his prothrombin time and activated partial thromboplastin time remained prolonged. The prothrombin time and activated partial thromboplastin time failed to correct with 50% normal plasma. Further investigations confirmed a lupus inhibitor with low levels of factors II, V, VII and XI. Factor II, V and XI levels normalized, however, when the patient's plasma was diluted 1:16 in buffer, suggesting the lupus inhibitor may have been interfering with these factor assays causing artefactual low results. Factor VII levels remained consistently low at all dilutions. The patient subsequently died following a massive left haemothorax despite surgical intervention and treatment with activated recombinant factor VII concentrate. We presumed the primary problem was bleeding from a local vascular lesion but the patient was never well enough to undergo confirmatory angiography. This case highlights the fact that patients with lupus inhibitors can develop severe haemorrhagic complications, and illustrates the complexities involved in both the investigation and treatment of abnormal bleeding in these patients.

Topics: Aged; Anticoagulants; Atrial Fibrillation; Contusions; Factor VII Deficiency; Fatal Outcome; Hemorrhage; Hemothorax; Humans; Lupus Coagulation Inhibitor; Male; Partial Thromboplastin Time; Prothrombin Time; Warfarin

The potentiation of the anticoagulant effects of warfarin by miconazole, when used in oral gel form, is described in three patients. The associated morbidity is examined, emphasising the importance of considering this potentially serious interaction when prescribing antifungal agents to patients on oral anticoagulants.

Topics: Administration, Oral; Aged; Anticoagulants; Antifungal Agents; Blood Coagulation; Candidiasis, Oral; Contusions; Drug Interactions; Female; Gels; Humans; Male; Melena; Miconazole; Middle Aged; Mouth Diseases; Purpura; Stomatitis, Denture; Warfarin

Topics: Administration, Oral; Administration, Topical; Aged; Anticoagulants; Antifungal Agents; Candidiasis, Oral; Contusions; Drug Interactions; Female; Hemorrhage; Humans; Miconazole; Middle Aged; Warfarin

A previously fit 22 year old man was struck in the chest by a concrete block dropped through the windscreen of his car while he was driving on the motorway. He suffered extensive chest wall trauma and lung contusion, which subsequently precipitated acute respiratory distress. On admission ECG showed right bundle branch block and left axis deviation. Three days later QRS duration was normal but there was anterior ST segment elevation and subsequent T wave change. There was a large rise in creatine kinase, and echocardiography revealed septal and apical hyokinesis as well as a mobile mass attached to the left side of the interventricular septum, which had the echogenic texture of myocardium. The patient had fixed perfusion defects in the areas of hypokinesis on thallium scanning but the coronary arteries were unobstructed at angiography. He was treated with warfarin in the short term and an angiotensin converting enzyme inhibitor in the longer term and has made an asymptomatic recovery. Outpatient echocardiography two months after the injury demonstrated some recovery in overall left ventricular systolic function and no evidence of the intracardiac mass. This case illustrates some of the typical features of non-fatal cardiac contusion associated with non-penetrating cardiac trauma, and was complicated by partial thickness avulsion of a strip of the myocardium in the interventricular septum.

Topics: Accidents, Traffic; Adult; Angiotensin-Converting Enzyme Inhibitors; Contusions; Echocardiography; Electrocardiography; Heart Injuries; Humans; Lung Injury; Male; Multiple Trauma; Respiration, Artificial; Warfarin; Wounds, Nonpenetrating

Soft tissue bleeding can be manifested clinically by swelling, skin discoloration, pain and tenderness. Early recognition can be difficult in the spinal cord-injured population in whom sensation is impaired. We are presenting a case of occult bleeding into the gluteal region during anticoagulation therapy in a paraplegic patient that presented as migrating pain and tenderness in the hip and pelvic area.

Topics: Adolescent; Buttocks; Contusions; Hematoma; Humans; Male; Spinal Cord Injuries; Thrombosis; Tomography, X-Ray Computed; Warfarin

Topics: Aged; Candidiasis, Vulvovaginal; Contusions; Drug Synergism; Female; Humans; Ketoconazole; Pulmonary Embolism; Warfarin

Topics: Adolescent; Adult; Contusions; Dipyridamole; Drug Interactions; Epistaxis; Female; Glomerulonephritis; Hematuria; Humans; Male; Middle Aged; Phenindione; Prothrombin Time; Warfarin