warfarin and Fever

Numerous factors affect the response to vitamin K antagonists (VKA) including age, dietary vitamin K, other drugs, pharmacogenetics, and disease states. In antithrombotic guidelines, fever is mentioned as a factor that may increase response to VKA. The purpose of this article is to review the available evidence regarding the effect of fever on response to VKA, and to discuss possible mechanisms of this effect. We performed a search of the English literature from 1943 to June 2014, using the key words fever AND warfarin, acenocoumarol, phenprocoumon, coumarin anticoagulants and VKA; fever AND vitamin K dependent clotting factors II, VII, IX, and X. One animal investigation and 6 studies in humans suggest fever increases response to VKA, but one study did not find a significant effect. The magnitude of this effect is variable. Possible mechanisms for the increased effect of VKA associated with fever are increased catabolism of vitamin K dependent clotting factors, decreased vitamin K intake, and inhibition of VKA metabolism. More rigorous studies are needed to confirm that fever increases response to warfarin and other VKA.

Topics: Acenocoumarol; Animals; Anticoagulants; Clinical Trials as Topic; Coumarins; Fever; Hemorrhage; Humans; International Normalized Ratio; Phenprocoumon; Rats; Risk Factors; Treatment Outcome; Vitamin K; Warfarin

Warfarin is associated with numerous drug and food interactions, and much attention has been appropriately focused on this subject. Because several disease states may also affect response to oral anticoagulants, we present a summary of the literature.. We searched MEDLINE for original articles on the effect of disease states on response to warfarin.. Liver disease and thyroid dysfunction are well-documented as affecting warfarin response. Further study is needed to establish whether febrile illness, congestive heart failure, and other disease states enhance the effect of warfarin in some patients.. Careful monitoring of anticoagulant therapy in patients with diseases that have the potential to affect warfarin response could increase safety and efficacy of this important agent.

Topics: Administration, Oral; Anticoagulants; Disease; Drug Interactions; Drug Monitoring; Fever; Food-Drug Interactions; Heart Failure; Humans; Liver Diseases; Safety; Thyroid Diseases; Warfarin

Kawasaki disease (KD) is the leading cause of acquired heart disease due to its complicated coronary artery lesions. Up to now, few studies were focused on the status of persistent coronary artery aneurysms (CAA) in KD patients. The present study was designed to identify the coronary artery outcomes and seek the risk factors associated with the regression of CAA in KD patients. One hundred and twenty KD patients with CAA hospitalized in Children's Hospital of Soochow University from Jan 2008 to Dec 2013 were prospectively studied by a 3-year follow-up. Data regarding demographic, clinical, laboratory, and echocardiographic characteristics were documented and further analyzed. It was estimated that 39.2% of the patients had complete regression of CAA within 4 weeks, 59.2% within 8 weeks, and 70.0% within 16 weeks. No fatal cardiac events occurred. We found patients who aged ≤ 1 year, received initial intravenous immunoglobulin (IVIG) treatment after the 10th day of illness, and IVIG non-responders were associated with the regression of persistent CAA. The relative risks were 1.55, 1.87, and 1.88, respectively. Age, initial IVIG treatment, and IVIG response were risk factors of persistent CAA, and more attention should be paid on these patients.

Topics: Adolescent; Anticoagulants; Antipyretics; Aspirin; Child; Child, Preschool; China; Coronary Aneurysm; Female; Fever; Follow-Up Studies; Humans; Immunoglobulins, Intravenous; Infant; Male; Mucocutaneous Lymph Node Syndrome; Prospective Studies; Remission Induction; Risk Factors; Time Factors; Warfarin

Topics: Abdominal Pain; Abscess; Adalimumab; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Anticoagulants; Behcet Syndrome; Budd-Chiari Syndrome; Female; Fever; Humans; Liver Abscess; Splenic Diseases; Suction; Tomography, X-Ray Computed; Treatment Outcome; Warfarin; Young Adult

A 47-year-old woman with a medical history of Raynaud's phenomenon presented with fever, cough and shortness of breath. She was found to have left lower lobe consolidation and pleural effusion and was treated as a case of pneumonia. During the hospital course, her respiratory status worsened, and she was intubated on the third hospital day. To investigate the high A-a gradient, a Computerized Tomographic Pulmonary Embolism (CTPE) study was done which identified a large left lower pulmonary artery embolism. She was also found to have a new murmur, and an echocardiogram demonstrated a large lesion on tricuspid valve. However, multiple sets of her blood cultures came back consistently negative. Alternative diagnoses for culture-negative endocarditis were considered, and a full set of rheumatological workup was done. Laboratory tests were suggestive of antiphospholipid syndrome, hence the diagnosis of tricuspid valve Libman-Sacks endocarditis was made.

Topics: Anticoagulants; Antiphospholipid Syndrome; Cough; Echocardiography; Endocarditis, Non-Infective; Female; Fever; Humans; Middle Aged; Pulmonary Embolism; Treatment Outcome; Tricuspid Valve; Warfarin

An increasingly reported entity, Lemierre's syndrome classically presents with a recent oropharyngeal infection, internal jugular vein thrombosis and the presence of anaerobic organisms such as Fusobacterium necrophorum. The authors report a normally fit and well 17-year-old boy who presented with severe sepsis following a 5-day history of a sore throat, myalgia and neck stiffness requiring intensive care admission. Blood cultures grew F. necrophorum and radiological investigations demonstrated left internal jugular vein, cavernous sinus and sigmoid sinus thrombus, left vertebral artery dissection and thrombus within the left internal carotid artery. Imaging also revealed two areas of acute ischaemia in the brain, consistent with septic emboli, skull base (clival) osteomyelitis and an extensive epidural abscess. The patient improved on meropenem and metronidazole and was warfarinised for his cavernous sinus thrombosis. He has an on-going left-sided hypoglossal (XIIth) nerve palsy.

Topics: Adolescent; Anti-Infective Agents; Anticoagulants; Cranial Fossa, Posterior; Fever; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Hypoglossal Nerve Diseases; Jugular Veins; Lemierre Syndrome; Male; Meropenem; Metronidazole; Osteomyelitis; Pharyngitis; Sepsis; Thienamycins; Treatment Outcome; Warfarin

Topics: Aged; Antibodies, Anticardiolipin; Anticoagulants; Antiphospholipid Syndrome; Diagnostic Errors; Fever; Heparin, Low-Molecular-Weight; Humans; Male; Pneumonia; Pulmonary Artery; Thrombophilia; Thrombosis; Tomography, X-Ray Computed; Warfarin

Topics: Abdominal Pain; Anticoagulants; Antiphospholipid Syndrome; Fatal Outcome; Female; Fever; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Mesenteric Arteries; Mesenteric Veins; Postprandial Period; Vasculitis; Warfarin; Young Adult

Topics: Adult; Anticoagulants; Antiphospholipid Syndrome; Behcet Syndrome; Diagnosis, Differential; Fever; Humans; Male; Myxoma; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

Cerebral venous thrombosis (CVT) is an uncommon but serious type of stroke. Thrombosis may involve the cortical or deep veins or the venous sinuses. The presenting clinical features are non-specific. We report a 48-year-old man with CVT who presented with fever, bitemporal throbbing headache, and generalised convulsion. Computed tomography (CT) of the brain revealed acute haemorrhages over right anterior frontal and posterior temporal regions with surrounding oedema and right anterior temporal subcortical oedema. The initial diagnosis was herpes simplex encephalitis. Absence of venous flow over the right transverse and sigmoid sinuses during the venous phase of digital subtraction angiography (DSA) revealed CVT. He was anti-coagulated for 6 months. An underlying cause of CVT was not detected. A high index of suspicion is required when risk factors of CVT are present. CT brain may be normal or showing non-specific findings. Magnetic resonance imaging plus venography, CT venography, or DSA is diagnostic.

Topics: Angiography, Digital Subtraction; Anticoagulants; Brain; Diagnosis, Differential; Encephalitis, Herpes Simplex; Fever; Frontal Lobe; Heparin, Low-Molecular-Weight; Humans; Intracranial Hemorrhages; Intracranial Thrombosis; Male; Middle Aged; Seizures; Temporal Lobe; Tomography, X-Ray Computed; Venous Thrombosis; Warfarin

Topics: Angiography; Aspirin; Coronary Aneurysm; Electrocardiography; Fever; Heart Murmurs; Humans; Immunoglobulins, Intravenous; Infant; Male; Mucocutaneous Lymph Node Syndrome; Pericardial Effusion; Tachycardia, Sinus; Warfarin

We report an unselected series of eight patients younger than 6 months of age with Kawasaki disease evaluated between January 1982 and May 1984. The incidence of coronary artery aneurysms (six patients) and the mortality (two patients) were unusually high in this small series. Because of the confusing clinical presentation in three patients, diagnosis was delayed until pathologic or echocardiographic evidence of coronary vasculitis or aneurysm was discovered. The currently accepted clinical criteria for Kawasaki disease may not always identify patients with the pathologic findings of the syndrome who are younger than 6 months of age. The diagnosis of Kawasaki disease and echocardiographic evaluation of the coronary arteries should be considered in young infants with prolonged fever of unknown origin.

Topics: Aspirin; Coronary Aneurysm; Dipyridamole; Drug Therapy, Combination; Echocardiography; Electrocardiography; Female; Fever; Humans; Infant; Male; Mucocutaneous Lymph Node Syndrome; Myocardium; Risk; Warfarin

Topics: Animals; Blood Coagulation; Endotoxins; Female; Fever; Lipopolysaccharides; Male; Mononuclear Phagocyte System; Rabbits; Salmonella typhi; Warfarin

Topics: Agglutination Tests; Analysis of Variance; Animals; Antibody Formation; Antigens; Blood Coagulation; Complement System Proteins; Endotoxins; Fever; Hemagglutination Tests; Hemolysis; Immunoglobulin M; Mercaptoethanol; Precipitin Tests; Rabbits; Salmonella typhi; Ultracentrifugation; Warfarin

Topics: Anti-Bacterial Agents; Anticoagulants; Drug Therapy; Female; Fever; Genital Diseases, Female; Heparin; Humans; Hysterectomy; Pelvis; Postoperative Complications; Puerperal Disorders; Thrombophlebitis; Warfarin