warfarin and Dizziness

Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder, and increases in prevalence with increasing age and the number of cardiovascular comorbidities. AF is characterized by a rapid and irregular heartbeat that can be asymptomatic or lead to symptoms such as palpitations, dyspnoea and dizziness. The condition can also be associated with serious complications, including an increased risk of stroke. Important recent developments in the clinical epidemiology and management of AF have informed our approach to this arrhythmia. This Primer provides a comprehensive overview of AF, including its epidemiology, mechanisms and pathophysiology, diagnosis, screening, prevention and management. Management strategies, including stroke prevention, rate control and rhythm control, are considered. We also address quality of life issues and provide an outlook on future developments and ongoing clinical trials in managing this common arrhythmia.

Topics: Ablation Techniques; Anticoagulants; Aspirin; Atrial Fibrillation; Dizziness; Dyspnea; Electric Countershock; Flecainide; Heart Failure; Heart Rate; Humans; Hypertension; Myocardial Ischemia; Platelet Aggregation Inhibitors; Prevalence; Propafenone; Quality of Life; Risk Factors; Sodium Channel Blockers; Stroke; Thromboembolism; Warfarin

The antiphospholipid syndrome is the association between the presence of antiphospholipid antibodies, thrombosis and/or pregnancy morbidity and mortality. This report presents two cases of antiphospholipid antibodies and sensorineural hearing loss and discusses the probable causative link. We recommend that patients presenting with sudden sensorineural hearing loss are investigated for evidence of antiphospholipid antibodies. Life long anticoagulation is necessary to prevent life threatening thrombotic or thromboembolic events.

Topics: Anticoagulants; Antiphospholipid Syndrome; Dizziness; Hearing Loss, Sensorineural; Hearing Loss, Sudden; Hearing Loss, Unilateral; Humans; Lupus Coagulation Inhibitor; Male; Middle Aged; Thrombophilia; Thrombosis; Vertigo; Warfarin

Warfarin is one of the most frequently used anticoagulant agents in the clinic. The most important adverse effect of warfarin is hemorrhage of vital organs, such as lung and brain. Diffuse Alveolar Hemorrhage (DAH) is a rare clinical condition which occurs due to variety of medical disorders. Although it's rarely reported, DAH can be a result of coagulopathy prompted by warfarin therapy. In this study we present a case of DAH, caused by warfarin toxicity which referred to the hospital with non-specific respiratory symptoms.. A 41-year-old female patient referred to the hospital complaining of shortness of breath, cough and dizziness. She had been taking warfarin due to mitral valve replacement for the past 10 years. Her recent symptoms began shortly after taking amoxicillin, a few days before admission. Early clinical examination and paraclinical studies reveal DAH as the cause of respiratory symptoms. The patient was then intubated and received fresh frozen plasma, packed cells and oral vitamin K. Laboratory findings apart from increased INR, PT, ESR and CRP were all within normal range. After the initiation of treatment patient's INR decreased and her clinical condition improved. Follow-up CT-Scan and bronchoscopy also confirmed resolving DAH.. The usage of warfarin in anticoagulation should be closely monitored due to its narrow therapeutic window and other factors, including its interaction with other medications such as antibiotics. Warfarin toxicity can lead to DAH, a life-threatening condition which can be presented with non-specific symptoms and deteriorate patient's clinical condition in a short time. Therefore, it is of utmost importance to watch closely for primary symptoms of such rare incident in patients under warfarin therapy and initiate treatment as soon as possible, to prevent mortality.

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Anticoagulants; Bronchoscopy; Cough; Dizziness; Female; Hemorrhage; Humans; Lung Diseases; Pulmonary Alveoli; Respiratory Insufficiency; Tomography, Spiral Computed; Warfarin

Vitamin K antagonist (VKA) reversal in patients with acute major bleeding and coagulopathy is an example of an urgent intervention in the emergency department. Intravenous (IV) prothrombin complex concentrate (PCC) may reverse VKA-induced coagulopathy in <30 min. In patients lacking IV access, effective PCC administration becomes problematic. No previous case reports have documented PCC infusion via intraosseous (IO) or alternative routes in this setting.. A 74-year-old man presented to the emergency department (ED) after a head injury, with sudden onset of left-sided facial droop, weakness, hypertension, and dizziness. Initial vital signs include blood pressure of 221/102 mm Hg, a heart rate of 75 beats/min, and oxygen saturation of 96% on room air. Warfarin 3 mg once daily was among his medications. His international normalized ratio (INR) was 3.9 with a computed tomography scan showing intraparenchymal hemorrhage in the right temporal lobe. Multiple attempts for IV access at various sites were unsuccessful. Therefore, IO access was established. Because of his prolonged prothrombin time, elevated INR, and intraparenchymal hemorrhage, the decision was made to use 4-factor PCC to reverse the supratherapeutic INR. The INR normalized as an emergent right parietal hematoma evacuation was performed. After an inpatient course, the patient was eventually discharged. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: VKAs, like warfarin, are commonly prescribed medications. When life-threatening hemorrhage is present, rapid reversal of a VKA-induced coagulopathy may be a life-saving therapy. In the event that IV access has not been established, we have demonstrated that IO access is a viable alternative route for PCC administration.

Topics: Aged; Anticoagulants; Blood Coagulation Factors; Dizziness; Hemorrhage; Humans; Hypertension; Infusions, Intraosseous; Male; Muscle Weakness; Time Factors; Warfarin

Topics: Aged; Angiodysplasia; Anticoagulants; Blood Urea Nitrogen; Capsule Endoscopy; Cecal Diseases; Cecum; Diagnosis, Differential; Dizziness; Esophagitis; Gastrointestinal Hemorrhage; Heart-Assist Devices; Humans; Male; Myocardial Ischemia; Warfarin

Topics: Anticoagulants; Antiparkinson Agents; Biotransformation; Dizziness; Drug Interactions; Drug Substitution; Drug Therapy, Combination; Factor Xa Inhibitors; Humans; Indans; Male; Middle Aged; Parkinson Disease; Rivaroxaban; Trihexyphenidyl; Venous Thrombosis; Warfarin

Topics: Adenosine Diphosphate; Adult; Anticoagulants; Blood Platelet Disorders; Diagnosis, Differential; Dizziness; Epinephrine; Female; Humans; Platelet Aggregation; Syndrome; Thromboembolism; Vertigo; Vomiting; 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