warfarin and Ecchymosis

Two patients developed catastrophic multicentric skin necrosis while receiving warfarin to treat venous thromboembolism complicated by immune-mediated heparin-induced thrombocytopenia (HIT). Patient 1 developed skin necrosis involving the breasts, thighs, and face, as well as venous limb gangrene and bilateral hemorrhagic necrosis of the adrenal glands, resulting in death. The second patient developed bilateral mammary necrosis necessitating mastectomies, as well as skin necrosis involving the thigh. Neither patient had an identifiable hypercoagulable syndrome, other than HIT. HIT may represent a risk factor for the development of multicentric warfarin-induced skin necrosis (WISN).

Topics: Adrenal Gland Diseases; Aged; Amputation, Surgical; Anticoagulants; Antigens, Human Platelet; Autoantibodies; Autoimmune Diseases; Databases, Factual; Disseminated Intravascular Coagulation; Ecchymosis; Fatal Outcome; Female; Gangrene; Hemorrhage; Heparin; Humans; Mastectomy; Middle Aged; Multiple Organ Failure; Necrosis; Postoperative Complications; Pulmonary Embolism; Skin; Skin Diseases; Thigh; Thrombin; Thrombocytopenia; Thrombophilia; Thrombophlebitis; Vena Cava Filters; Warfarin

Oral anticoagulants are extensively used in everyday medical practice, especially for the prophylaxis of deep vein thrombosis and pulmonary thromboembolism. Bleeding is the major risk of such therapy. Although infrequent, however, non-haemorrhagic complications may also play a considerable role. The purpose of this paper is briefly to review the most important non-haemorrhagic adverse reactions and their clinical signs. Moreover, the pathogenetic hypotheses, the relationships with protein C and S levels, and the possibility of prevention and treatment are also discussed.

Topics: Administration, Oral; Anticoagulants; Drug Eruptions; Ecchymosis; Humans; Necrosis; Peripheral Vascular Diseases; Skin; Warfarin

Skin and soft tissue necrosis is a rare complication of anticoagulation therapy. Two patients who exhibited the spectrum of this disorder are described. The clinical features, etiology, pathophysiology, and treatment of coumarin skin necrosis are outlined, and the English-language literature is reviewed.

Topics: Adult; Aged; Coumarins; Ecchymosis; Female; Hemorrhage; Humans; Male; Middle Aged; Necrosis; Purpura; Thrombophlebitis; Warfarin

Topics: Animals; Blood Coagulation Disorders; Blood Coagulation Factors; Clofibrate; Ecchymosis; Humans; Male; Middle Aged; Prothrombin Time; Vitamin E; Vitamin K; Warfarin

Subcutaneous (SC) low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) are safe and efficacious for bridging anticoagulation after warfarin interruption. Although LMWH and UFH are self-administered by >90% of patients, factors that may be important to patients such as differences in pain and ecchymosis have not been explored.. We randomized 24 patients to receive SC LMWH or SC UFH twice-daily during the perioperative period. Injection associated pain was recorded using a visual analogue scale and area of ecchymosis was measured by digital photography of the injection site on the day of the procedure.. The area of ecchymosis was 2-fold higher with UFH than LMWH (19.4 cm(2) vs. 8.98 cm(2); P = 0.33) and pain was similar with both treatments (115 mm vs. 171 mm; P = 0.25), though neither finding attained statistical significance.. This exploratory study was underpowered to detect differences between the groups. Further studies are needed to reliably compare pain and ecchymosis in LMWH vs. UFH.

Topics: Anticoagulants; Ecchymosis; Heparin; Heparin, Low-Molecular-Weight; Humans; Pain; Preoperative Care; Warfarin

Spontaneous hemorrhage is a known risk for patients on anticoagulation therapy. Most previous spontaneous airway hemorrhage cases reported involve warfarin, and of the few that involved a direct oral anticoagulant, none involved the epiglottis. The following case describes a spontaneous epiglottic hematoma in a patient one week after starting a direct oral anticoagulant. An 85-year-old man presented to the emergency department with acute onset of neck swelling, odynophagia and sublingual ecchymosis. Evaluation in the emergency department included advanced imaging of the neck and consultation with otolaryngology. Flexible fiberoptic laryngoscopy showed a markedly enlarged and ecchymotic epiglottis. The patient received medical management including rivaroxaban reversal, steroids, and broad-spectrum antibiotics, but no airway management was deemed necessary. After close monitoring, the patient was discharged on hospital day two. Further research and risk profiling could benefit patients and emergency clinicians when considering spontaneous hemorrhage in the airway in patients taking a direct oral anticoagulant.

Topics: Aged, 80 and over; Anticoagulants; Ecchymosis; Epiglottis; Hematoma; Humans; Male; Rivaroxaban; Warfarin

Topics: Airway Obstruction; Anticoagulants; Ecchymosis; Epiglottis; Female; Hematoma; Humans; Medical Illustration; Middle Aged; Pharynx; Respiratory System; Tongue; Vocal Cords; Warfarin

Topics: Accidental Falls; Aged; Anticoagulants; Buttocks; Ecchymosis; Female; Hematoma; Humans; Tomography, X-Ray Computed; Warfarin

A 67-year-old man was found dead, at his home. On external examination, we found a voluminous purplish black ecchymosis of the anterior neck area. On internal examination, we found a voluminous epiglottis hematoma completely obstructing the upper airway. It was associated with other sites of intra-abdominal hemorrhage. Toxicological studies revealed the presence of warfarin at a concentration of 8.4 mg/L in peripheral blood, which supposes an INR well above 4.5. To conclude, we supposed death was due to asphyxia secondary to a spontaneous epiglottic hematoma caused by a high blood concentration of warfarin. Hemorrhage in the epiglottis is very rare. To our knowledge, our patient is the only case of "sudden death" reported with spontaneous epiglottic hematoma due to high blood concentration of warfarin. In forensic practice, an anterior neck ecchymosis, without trauma, may suggest hemorrhage into soft airway tissues. Pathology findings make it possible to exclude exogenous trauma.

Topics: Aged; Airway Obstruction; Anticoagulants; Asphyxia; Death, Sudden; Ecchymosis; Hematoma; Humans; Laryngeal Diseases; Male; Warfarin

Topics: Amyloidosis; Anticoagulants; Ecchymosis; Hemorrhage; Humans; Male; Middle Aged; Pulmonary Embolism; Retroperitoneal Space; Tomography, X-Ray Computed; Warfarin

Topics: Amyloidosis; Anticoagulants; Diagnosis, Differential; Ecchymosis; Exsanguination; Hemorrhage; Humans; Male; Middle Aged; Retroperitoneal Space; Warfarin

To explore the influence of the single use of perinatal warfarin anticoagulation therapy on pregnancy outcome after the mechanical heart-valve replacement surgery in pregnant women.. Fifty-eight cases of pregnant women after heart-valve replacement surgery (2005.1-2009.12) received low-dose warfarin anticoagulation therapy. The perinatal outcomes included: (1) maternal complications: thrombosis, hemorrhage, heart failure, etc., and (2) adverse perinatal outcomes: miscarriage, stillbirth, neonatal death, fetal malformation, preterm delivery, such as warfarin syndrome.. In 58 patients, valve thrombosis was found in one case of pregnancy, general hemorrhage was found in 16 cases, spontaneous abortion was found in two cases, malformation was found in two cases. There were no stillbirth and neonatal death. Three cases were premature delivery. Thirty-two of 56 cases were late pregnancy vaginal delivery. Twenty-four cases were cesarean section produced, in which heart failure happened in 1 case and late postpartum hemorrhage happened in one case.. The low-dose and low-intensity warfarin anticoagulation therapy during pregnancy is good for patients with good compliance and low rate of fetal malformations and can effectively prevent maternal complications.

Topics: Abortion, Spontaneous; Adult; Anticoagulants; Aortic Valve; Cardiac Valve Annuloplasty; Cesarean Section; Congenital Abnormalities; Delivery, Obstetric; Ecchymosis; Epistaxis; Female; Gingival Hemorrhage; Heart Valve Prosthesis; Humans; Mitral Valve; Pregnancy; Premature Birth; Thrombosis; Warfarin; Young Adult

Topics: Aged, 80 and over; Anti-Bacterial Agents; Anticoagulants; Diagnosis, Differential; Drug Monitoring; Ecchymosis; Female; Humans; Hyperpigmentation; Minocycline; Warfarin

To highlight the importance of recognizing the increased anticoagulant effect of warfarin associated with use of doxycycline.. Case report.. Clinical review describing initial presentation, course, and outcome of one patient who received oral doxycycline for corneal melt while on warfarin in a multi-specialty clinic.. Concomitant use of doxycycline and warfarin resulted in prominent ecchymosis of the upper extremities associated with a marked elevation in the international normalized ratio (INR = 6.5). Discontinuation of doxycycline resulted in reduction of INR to therapeutic levels (INR = 2.3).. Doxycycline can enhance the anticoagulant effect of warfarin. This is likely due to competitive interaction for albumin binding and possibly inhibition of the cytochrome P-450 system. An increase in plasma levels of free warfarin may result in severe bleeding. It is important to recognize this potential interaction and obtain a complete medication profile prior to initiating doxycycline.

Topics: Administration, Oral; Aged, 80 and over; Anti-Bacterial Agents; Anticoagulants; Corneal Ulcer; Doxycycline; Drug Interactions; Drug Therapy, Combination; Ecchymosis; Humans; International Normalized Ratio; Male; Warfarin

Topics: Aged; Anemia; Anticoagulants; Antifungal Agents; Atrial Fibrillation; Drug Interactions; Ecchymosis; Female; Hemorrhage; Humans; Hypothyroidism; Melena; Miconazole; Stomatitis; Thyroxine; Warfarin

A 53-year-old woman being treated for a vaginal yeast infection experienced ecchymosis. Laboratory evaluation revealed a prolonged prothrombin time. It is possible that the bleeding was due to an interaction between warfarin and miconazole. Health care professionals should be aware of the potential for drug interactions with vaginally administered miconazole, especially in women receiving anticoagulation therapy.

Topics: Administration, Intravaginal; Anticoagulants; Antifungal Agents; Drug Synergism; Ecchymosis; Female; Humans; Miconazole; Middle Aged; Partial Thromboplastin Time; Suppositories; Vaginitis; Warfarin

A large subcutaneous hematoma extending from the left axillary region to the left flank developed in a 70-year-old man receiving anticoagulant therapy. The cause was repeated microtrauma caused by the axillary pad on a walker. Physicians and physiotherapists should be aware that rehabilitation devices causing pressure on the skin increase hemorrhagic risk in patients taking anticoagulants. Accordingly, these patients should systematically be checked for hemorrhagic complications, and the use of such devices should be limited.

Topics: Aged; Anticoagulants; Ecchymosis; Equipment Design; Hematoma; Hemorrhage; Humans; Male; Pressure; Risk Factors; Skin; Skin Diseases; Walkers; Warfarin

Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Celecoxib; Drug Monitoring; Ecchymosis; Humans; Male; Nursing Assessment; Pyrazoles; Sulfonamides; Warfarin

Topics: Abdominal Muscles; Activated Protein C Resistance; Anticoagulants; Dyspnea; Ecchymosis; Factor V; Hemothorax; Humans; Male; Middle Aged; Point Mutation; Venous Thrombosis; Warfarin

Topics: Adult; Diagnosis, Differential; Ecchymosis; Emergency Medical Services; Epistaxis; Factitious Disorders; Female; Hematemesis; Humans; Rodenticides; Sex Offenses; Suicide, Attempted; Warfarin

Topics: Abdominal Pain; Anticoagulants; Ecchymosis; Heart Valve Prosthesis; Hematoma; Hemorrhage; Humans; Male; Middle Aged; Retroperitoneal Space; Tomography, X-Ray Computed; Warfarin

Topics: Aged; Aspirin; Ecchymosis; Female; Hematoma; Humans; Medication Errors; Patient Education as Topic; Self Administration; Warfarin

Topics: Drug Interactions; Ecchymosis; Female; Fluoxetine; Humans; Warfarin

A 61-year-old woman receiving warfarin for postoperative atrial fibrillation and carbamazepine for a peripheral neuropathy had extreme elevation of prothrombin time associated with clinically significant hemorrhage when the carbamazepine therapy was discontinued. The mechanism of this significant drug interaction involves the withdrawal of carbamazepine-induced enhancement of hepatic warfarin breakdown with resultant delay of warfarin excretion and excessive hypoprothrombinemia. The clinically significant hemorrhage associated with warfarin-carbamazepine interaction is an indication for caution when these two agents are prescribed concomitantly.

Topics: Carbamazepine; Drug Interactions; Ecchymosis; Female; Humans; Middle Aged; Prothrombin Time; Substance Withdrawal Syndrome; Warfarin

To evaluate complications resulting from increased bleeding, 2,178 cataract surgery patients, 28 of whom were on anticoagulants, were studied prospectively. The anticoagulated patients showed no increase in sight-threatening complications when compared to the nonanticoagulated cataract patients.

Topics: Aged; Anticoagulants; Cataract Extraction; Conjunctival Diseases; Ecchymosis; Eyelid Diseases; Hemorrhage; Heparin; Humans; Hyphema; Middle Aged; Prospective Studies; Visual Acuity; Warfarin

A 64-year-old man on chronic anticoagulant therapy underwent electromyography (EMG) and six days later noted a 13 X 8cm ecchymotic region on the right flank and a smaller area of ecchymosis along the lower spine. He was found to have significant subcutaneous bleeding (hematocrit decreased from 43% to 29%), which required a two-unit blood transfusion. In light of the location of the hematoma and the temporal relationship to the EMG, it is proposed that this unusual case represents a significant complication of a usually benign procedure. Clinicians need to be aware of the possibility of such a complication in the anticoagulated patient and of the need for a risk-benefit decision prior to EMG.

Topics: Ecchymosis; Electromyography; Heart Aneurysm; Hematoma; Humans; Male; Middle Aged; Thrombosis; Time Factors; Warfarin

Topics: Analgesics; Angina Pectoris; Anticoagulants; Drug Synergism; Ecchymosis; Female; Humans; Middle Aged; Oxyphenbutazone; Pain; Warfarin

Topics: Acenocoumarol; Anticoagulants; Coumarins; Dicumarol; Drug Therapy; Ecchymosis; Ethyl Biscoumacetate; Gangrene; Necrosis; Phenindione; Pulmonary Embolism; Purpura; Skin Diseases; Thrombophlebitis; Toxicology; Warfarin

Topics: Blood Coagulation Disorders; Blood Coagulation Tests; Diagnosis, Differential; Ecchymosis; Female; Humans; Menorrhagia; Minnesota; Thromboplastin; Toxicology; Warfarin