warfarin and Edema

Here we describe an 8-year old male child with homozygous sickle cell disease who presented with left parietal skull bone infarction and, during his stay in hospital, developed a right femoral deep vein thrombosis (DVT), both uncommon complications of the disease. He initially presented with severe headache and generalised tenderness of the calvarium, which did not respond to simple analgesics. Scalp swelling in and around the left frontal (including left orbit) and parietal regions developed 24 h after presentation. The differential diagnosis included incipient stroke, acute sickle bone crisis and osteomyelitis, with a possible complication of epidural haematoma, or orbital compression syndrome. An initial exchange blood transfusion did not lead to appreciable reduction in opiate requirements. Significant symptomatic relief was attained only after a second exchange transfusion. The DVT developed at the site of catheterisation (right femoral vein), and this was treated with maximal doses of enoxaparin followed by warfarin. The child is now well and off anti-coagulants. In this article we present a review of the literature and discuss possible mechanisms of these complications in our patient.

Topics: Anemia, Sickle Cell; Anticoagulants; Catheterization; Child; Diagnosis, Differential; Edema; Enoxaparin; Exchange Transfusion, Whole Blood; Femoral Vein; Headache; Humans; Infarction; Male; Osteomyelitis; Parietal Bone; Stroke; Thrombophilia; Thrombophlebitis; Warfarin

This reports an arm edema that was initially treated as cellulitis and later diagnosed to be subclavian thrombosis due to pacemaker wire irritation. We present an 87-year-old Caucasian man with 5 weeks duration of left arm swelling and pain that was treated with two courses of antibiotics. An axillary venous Doppler study was interpreted as normal with no evidence of venous thrombosis. However, a venogram showed evidence of thrombosis involving the left innominate, subclavian, and axillary veins with multiple collateral veins diverting the blood to the contralateral side and into the superior vena cava. Intravenous anticoagulation was initiated and subsequently the patient was maintained on warfarin (Coumadin). The thrombosis subsequently improved and the original pacemaker was maintained. Arm edema are commonly mistaken for cellulitis, causing a delay in a more definite diagnosis of subclavian thrombosis. In a setting of a patient with pacemaker, subclavian thrombosis should be considered even with a normal screening venous ultrasound test. The incidence, manifestation, venous Doppler, and venogram findings are reviewed and discussed. Upper arm edema and superior vena cava syndrome are the most common presentation of this subclavian thrombosis associated with pacemakers. Venous ultrasound tests may be normal and a venogram is usually required to establish a diagnosis.

Topics: Aged; Aged, 80 and over; Anticoagulants; Arm; Axillary Vein; Brachiocephalic Veins; Cellulitis; Collateral Circulation; Diagnosis, Differential; Edema; Humans; Incidence; Injections, Intravenous; Male; Pacemaker, Artificial; Pain; Radiography; Subclavian Vein; Superior Vena Cava Syndrome; Thrombosis; Ultrasonography, Doppler; Vena Cava, Superior; Warfarin

Topics: Adult; Anticoagulants; Edema; Female; Humans; Low Back Pain; May-Thurner Syndrome; Venous Thrombosis; Warfarin

Lutembacher syndrome is characterized by a congenital ostium secundum atrial septal defect and an acquired mitral valve stenosis. We present a similar case in a 31-year old male who came in with orthopnoea, central cyanosis and pedal oedema. Examination revealed cardiac murmurs in tricuspid and apical regions. Chest x-ray showed signs of pulmonary congestion and ventricular enlargement. Electrocardiogaphy (ECG) revealed right axis deviation and right bundle branch block along with atrial fibrillation and Transthoracic Echocardiography (TTE) showed abnormal valves (mitral stenosis with calcification and tricuspid regurgitation) and dilated cardiac chambers. The patient was consequently treated with beta-blockers and diuretics and scheduled for valvular and septal repair via open heart surgery. The purpose of this case report is to assist cardiologists in diagnosing this syndrome accurately on the basis of symptoms and investigations.

Topics: Adrenergic beta-Antagonists; Adult; Amiloride; Anticoagulants; Atrial Fibrillation; Bundle-Branch Block; Calcinosis; Cardiac Surgical Procedures; Cardiomegaly; Cyanosis; Diuretics; Echocardiography; Edema; Electrocardiography; Foot; Furosemide; Heart Septal Defects, Atrial; Humans; Lutembacher Syndrome; Male; Mitral Valve Annuloplasty; Mitral Valve Stenosis; Tricuspid Valve Insufficiency; Warfarin

Topics: Anticoagulants; Brachiocephalic Veins; Cardiomyopathies; Defibrillators, Implantable; Edema; Face; Heparin; Humans; Jugular Veins; Male; Middle Aged; Treatment Outcome; Ultrasonography, Doppler, Color; Venous Thrombosis; Warfarin

Topics: Adolescent; Angioplasty; Anticoagulants; Balloon Valvuloplasty; Diagnosis, Differential; Edema; Enoxaparin; Female; Hemiplegia; Humans; Leg; May-Thurner Syndrome; Stents; Thrombectomy; Tissue Plasminogen Activator; Ultrasonography; Ultrasonography, Doppler; Venous Thrombosis; Warfarin

Topics: Anticoagulants; Edema; Exanthema; Face; Female; Humans; International Normalized Ratio; Warfarin

Topics: Adult; Anticoagulants; Chronic Disease; Dyspnea; Edema; Endarterectomy; Female; Heparin; Humans; Hypertension, Pulmonary; Lower Extremity; Pulmonary Embolism; Recurrence; Respiratory Insufficiency; Thromboembolism; Warfarin

A 74-year-old female patient with bladder cancer presented with edema in the right lower limb in a follow-up at the outpatient department.She was diagnosed with deep vein thrombosis in the right lower limb, and warfarin treatment was started.Subsequent gemcitabine and cisplatin combination(GC)therapy for prevention of bladder cancer recurrence prolonged the PT-INR to an immeasurable level on day 6 of therapy.Thus, warfarin was immediately discontinued and a single dose of menatetrenone was administered.Subsequently, the PT-INR recovered to 1.36 one day after discontinuation of warfarin.In the second course of GC therapy, warfarin was discontinued before administration of the anticancer drugs, and there was no change in the PT-INR.The abnormally high PT-INR observed in the early stage after GC therapy in this case shows that it is important to monitor blood coagulation from immediately after administration of GC therapy in a patient under treatment with warfarin.

Topics: Aged; Anticoagulants; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Deoxycytidine; Edema; Female; Gemcitabine; Humans; International Normalized Ratio; Leg; Prothrombin; Thrombophlebitis; Urinary Bladder Neoplasms; Warfarin

We report a case of an incidental finding of congenital absence of the intrahepatic segment of the inferior vena cava (IVC) complicated by extensive bilateral deep venous thrombosis (DVT) with significant oedema following a long-distance road trip. Initially the patient failed treatment with standard anticoagulation therapy with enoxaparin and warfarin. However, he has responded to the new oral antifactor-Xa anticoagulant (rivaroxaban). Within a few days, rivaroxaban improved the oedema and DVT. The significant features of this case are the unusual presentation, the poor response to initial standard anticoagulation therapy and the beneficial outcomes when managed with the novel new anticoagulant. The patient has continued the new treatment regularly for the last 12 months with good toleration and without side effects. This report presents the findings, management and outcomes in a case of extensive bilateral DVT in a previously healthy young man who was found to have a congenital short IVC.

Topics: Adult; Anticoagulants; Edema; Enoxaparin; Humans; Iliac Vein; Incidental Findings; Male; Morpholines; Rivaroxaban; Thiophenes; Tomography, X-Ray Computed; Travel; Vena Cava, Inferior; Venous Thrombosis; Warfarin; Young Adult

Topics: Aged; Alcohol Withdrawal Delirium; Anticoagulants; Aortic Aneurysm; Aortic Dissection; Aortic Valve Insufficiency; Atrial Fibrillation; Delayed Diagnosis; Diagnostic Errors; Dyspnea; Edema; Epilepsy, Tonic-Clonic; Fatal Outcome; Heart Failure; Heart Valve Prosthesis; Humans; Hypertension; Male; Postoperative Complications; Psychomotor Agitation; Tomography, X-Ray Computed; Warfarin

Topics: Anticoagulants; Blepharoptosis; Carotid Artery, Internal, Dissection; Cluster Headache; Diagnosis, Differential; Edema; Essential Tremor; Humans; Magnetic Resonance Angiography; Male; Middle Aged; Vasodilator Agents; Verapamil; Vertigo; Warfarin

Topics: Aged; Anticoagulants; Arm; Chest Pain; Dyspnea; Edema; Enoxaparin; Exercise; Factor V; Humans; Male; Methylenetetrahydrofolate Reductase (NADPH2); Mutation; Ultrasonography, Doppler; Venous Thrombosis; Warfarin

Topics: Adult; Anticoagulants; Cumulative Trauma Disorders; Edema; Exercise; Heparin, Low-Molecular-Weight; Humans; Male; Pain; Phlebography; Subclavian Vein; Upper Extremity; Venous Thrombosis; Warfarin

Topics: Aged; Aged, 80 and over; Angina Pectoris; Anticoagulants; Diagnosis, Differential; Dyspnea; Echocardiography; Edema; Female; Humans; Pulmonary Embolism; Venous Thrombosis; Warfarin

The synthesis of several coumarin Mannich bases is described. The structures of the synthesized compounds were confirmed by spectral and elemental analysis. Their lipophilicity was determined experimentally by RPTLC method. All compounds were evaluated for their antiinflammatory and antioxidant activity and for their ability to inhibit in vitro lipoxygenase. The derivatives were found to present antioxidant and antiinflammatory activities. The tested derivatives inhibited carraggeenin-induced hind paw edema. They also significantly suppressed the arthritis induced by Freund's adjuvant. Compound 10, the most active in vivo, was found to possess protective properties against adjuvant-induced arthritis in rats. The biological in vitro activities were concentration dependent. Hydrophilicity, the presence of a free 7-OH, and steric requirements for the substituent at position 8 are the most important factors in terms of SAR. An attempt was made to correlate several physicochemical properties of the molecules with their in vivo/in vitro activity.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Experimental; Carrageenan; Coumarins; Cyclooxygenase Inhibitors; Edema; Female; Free Radical Scavengers; Immunologic Factors; Lipoxygenase Inhibitors; Male; Mannich Bases; Rats; Rats, Inbred F344; Structure-Activity Relationship; Superoxides

The synthesis of several novel coumarin derivatives with a 7-azomethine linkage was carried out starting from 7-formyl-coumarin. The compounds were tested in vivo for their anti-inflammatory activity and in vitro for their antioxidant ability. Compounds 3a and 3e possess significant protection against carrageenin induced rat paw edema.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Antioxidants; Azo Compounds; Carrageenan; Coumarins; Edema; Hindlimb; Inflammation; Molecular Structure; Rats; Structure-Activity Relationship

Behçet's disease frequently involves the venous system, usually affecting small vessels, but sometimes large vessels such as the vena cava. Antiphospholipid antibody syndrome is associated with an increased incidence of arterial and venous thrombosis. A 29-year-old male with Behçet's disease developed bilateral leg edema secondary to thrombotic occlusion of the inferior vena cava. Laboratory tests revealed positive antiphospholipid antibodies and lupus anticoagulant. Treatment with steroid and warfarin subsequent to intravenous administration of uro-kinase resulted in improvement of symptoms. The association of antiphospholipid antibody syndrome and Behçet's disease may have caused the total thrombotic occlusion of the vena cava in this case.

Topics: Adult; Antiphospholipid Syndrome; Behcet Syndrome; Edema; Humans; Male; Prednisolone; Vena Cava, Inferior; Venous Thrombosis; Warfarin

The effect of anticoagulation upon renal edema and plasma protein accumulation in acute ischemic renal damage was studied. Rats were subjected to unilateral renal artery occlusion for 60 min and 15 min of reflow. The kidney weight and the content of 125-I-fibrinogen and 131-I-albumin, injected 24 h priorly, were measured and the renal morphology studied. Groups of rats were pretreated with a heparin analogue with low anticoagulant effect, standard heparin, warfarin or saline. A marked increase in fibrinogen and albumin content and of the weight of the damaged kidney was noted. Heparin and warfarin both significantly attenuated these changes, whereas the heparin analogue did not. Microscopically, fibrin-positive material was seen in the peritubular capillaries, vasa recta and in the tubules of rats pretreated with saline or the heparin analogue, but not in rats pretreated with heparin or warfarin. The results support the hypothesis that fibrin deposition in the kidney is of importance for the development of renal edema in this model of ischemic renal damage.

Topics: Animals; Blood Pressure; Edema; Female; Fibrinogen; Heparin; Ischemia; Kidney; Kidney Diseases; Rats; Rats, Inbred Strains; Renal Artery; Renal Circulation; Serum Albumin; Warfarin

Topics: Adolescent; Adult; Age Factors; Aged; Drug Interactions; Drug Therapy, Combination; Drug-Related Side Effects and Adverse Reactions; Edema; Ethnicity; Female; Glyburide; Glycyrrhiza; Hematologic Diseases; Hospitalization; Humans; Male; Middle Aged; New Zealand; Outpatient Clinics, Hospital; Phenobarbital; Plants, Medicinal; Purpura, Thrombocytopenic; Quinidine; Sex Factors; Succinates; Triterpenes; Warfarin

Topics: Adult; Aged; Anticoagulants; Blood Coagulation; Blood Coagulation Tests; Edema; Female; Heparin; Humans; Leg; Male; Middle Aged; Postoperative Complications; Thrombophlebitis; Warfarin

Topics: Adrenal Glands; Animals; Anti-Inflammatory Agents; Anticoagulants; Aspirin; Carrageenan; Coumarins; Dicumarol; Edema; ortho-Aminobenzoates; Phenindione; Phenylbutazone; Radiation Injuries, Experimental; Rats; Warfarin