warfarin and Hematemesis

Upper gastrointestinal (GI) bleeding is a common reason for hospital admission in older adult patients and carries a high morbidity and mortality if not properly managed. Risk factors include advanced age, Helicobacter pylori infection, medication use, smoking, and history of liver disease. Patients with known or suspected liver disease and suspected variceal bleeding should also receive antibiotics and somatostatin analogues. Risk stratification scores should be used to determine patients at highest risk for further decompensation. Upper endoscopy is both a diagnostic and therapeutic tool used in the management of upper GI bleeding. Endoscopy should be performed within 24 hours of presentation after appropriate resuscitation. Management of anticoagulation in upper GI bleeding largely depends on the indication for anticoagulation, the risk of continued bleeding with continuing the medication, and the risk of thrombosis with discontinuing the medication. A multidisciplinary approach to the decision of anticoagulation continuation is preferred when possible.

Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Hematemesis; Humans; Melena; Peptic Ulcer; Peptic Ulcer Hemorrhage; Warfarin

Intramural esophageal hematoma is part of a spectrum of esophageal injuries. Vomiting and straining, endoscopic procedures and bleeding disorders are the most common predisposing factors. However, it can also be an unusual complication of anticoagulation and/or thrombolysis therapy. The most common symptoms are retrosternal chest pain, dysphagia and hematemesis. Computed tomography is the modality of choice and treatment is medically conservative with the cessation of Warfarin and thrombolysis use. When anticoagulation and/or thrombolysis therapy is necessary, periodic reassessment for symptoms of intramural esophageal hematoma may be helpful for early identification and management. We described one case of intramural esophageal hematoma possibly resulting from anticoagulation and/or thrombolysis therapy in the setting of pulmonary embolism.

Topics: Aged; Anticoagulants; Chest Pain; Deglutition Disorders; Diagnosis, Differential; Esophageal Diseases; Fatal Outcome; Hematemesis; Hematoma; Humans; Male; Pulmonary Embolism; Thrombolytic Therapy; Tomography, X-Ray Computed; Warfarin

Warfarin is an anticoagulant agent known to have a common complication, bleeding. Intramural intestinal haematoma is an uncommon incidence of warfarin-induced haemorrhage. Abdominal pain is its most frequent symptom and presentation with upper-gastrointestinal haemorrhage is rarely seen. Here, we present a 67-year-old male who was admitted to the hospital with active upper-gastrointestinal haemorrhage. In this case, the cause of bleeding has been attributed to duodenal intramural haematoma due to warfarin overuse.

Topics: Aged; Anticoagulants; Duodenal Diseases; Hematemesis; Hematoma; Humans; Jejunal Diseases; Male; Warfarin

The authors aimed to investigate the incidence and outcomes of acute upper gastrointestinal bleeding (AUGIB) and to examine the role of drugs potentially associated with AUGIB.. The study was prospective, population-based and consisted of all patients who underwent upper gastrointestinal endoscopy (UGE), during the year of 2010 at the National University Hospital of Iceland. Drug intake of NSAIDs, low-dose aspirin (LDA), warfarin, SSRIs and bisphosphonates prior to GIB was prospectively registered and also checked in a Pharmaceutical Database covering all prescriptions in Iceland. An age- and gender-matched control group consisted of patients who underwent UGE during the study period and were without GIB.. A total of 1731 patients underwent 2058 UGEs. Overall, 156 patients had AUGIB. The crude incidence for AUGIB was 87/100,000 inhabitants per year. The most common etiologies were duodenal (21%) and gastric ulcers (15%). Use of LDA (40% vs. 30%), NSAIDs (20% vs. 8%), warfarin (15% vs. 7%), combination of NSAIDs + LDA (8% vs. 1%) and SSRIs + LDA (8% vs. 3%) were significantly more common among bleeders than non-bleeders. Three patients (1.9%) had emergency surgery and two patients died of AUGIB. Independent predictors of clinically significant bleeding were gastric ulcer (OR 6.6, p = 0.012) and NSAIDs (OR 6.6, p = 0.004).. LDA, NSAIDs and warfarin play an important role in AUGIB etiology and particularly combinations of drugs. Gastric ulcer and NSAIDs were independent predictors of severe bleeding. Mortality and the need for surgery during hospitalization was low in this population-based setting.

Topics: Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Female; Gastrointestinal Hemorrhage; Hematemesis; Humans; Iceland; Incidence; Male; Melena; Middle Aged; Prospective Studies; Risk Factors; Severity of Illness Index; Upper Gastrointestinal Tract; 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

Venous complications in patients with acute pancreatitis typically occur as a form of splenic, portal, or superior mesenteric vein thrombosis and have been detected more frequently in recent reports. Although a well-organized protocol for the treatment of venous thrombosis has not been established, anticoagulation therapy is commonly recommended. A 73-year-old man was diagnosed with acute progressive portal vein thrombosis associated with acute pancreatitis. After one month of anticoagulation therapy, the patient developed severe hematemesis. With endoscopy and an abdominal computed tomography scan, hemorrhages in the pancreatic pseudocyst, which was ruptured into the duodenal bulb, were confirmed. After conservative treatment, the patient was stabilized. While the rupture of a pseudocyst into the surrounding viscera is a well-known phenomenon, spontaneous rupture into the duodenum is rare. Moreover, no reports of upper gastrointestinal bleeding caused by pseudocyst rupture in patients under anticoagulation therapy for venous thrombosis associated with acute pancreatitis have been published. Herein, we report a unique case of massive upper gastrointestinal bleeding due to pancreatic pseudocyst rupture into the duodenum, which developed during anticoagulation therapy for portal vein thrombosis associated with acute pancreatitis.

Topics: Acute Disease; Aged; Anticoagulants; Duodenal Diseases; Gastrointestinal Hemorrhage; Hematemesis; Humans; Intestinal Fistula; Male; Pancreatic Pseudocyst; Pancreatitis, Alcoholic; Portal Vein; Risk Factors; Rupture, Spontaneous; Tomography, X-Ray Computed; Treatment Outcome; Venous Thrombosis; Warfarin

Little is known about the site and nature of bleeding lesions related to low-dose aspirin and other antithrombotic agents.. To describe the mucosal abnormalities in patients presenting with upper gastrointestinal bleeding while being treated with these drugs.. The endoscopic findings and clinical details were analysed in all patients presenting with haematemesis and/or melaena at a single centre during three calendar years. Associations between endoscopic findings and risk factors, including the intake of non-steroidal anti-inflammatory drugs, low-dose aspirin (75 mg daily) and other antithrombotic drugs including warfarin, clopidogrel, and dipyridamole, were assessed by logistic regression analysis.. In 674 upper gastrointestinal bleeders, we found that the odds ratio for the presence of erosive oesophagitis in aspirin users was 2 (95% CI, 1-3; P = 0.03) and 3 (2-5; P = 0.0003) in patients taking other antithrombotic agents. In 41 patients with oesophagitis and taking these drugs, 36 (88%) had cardiovascular disease and only 4 (10%) had peptic symptoms.. Erosive oesophagitis is common in patients with upper gastrointestinal bleeding taking low-dose aspirin or antithrombotic agents, and could potentially be confused with the coexisting heart disease.

Topics: Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Aspirin; Clopidogrel; Dipyridamole; Drug Administration Schedule; Drug Therapy, Combination; Duodenal Ulcer; Endoscopy, Gastrointestinal; Esophagitis; Female; Fibrinolytic Agents; Gastrointestinal Hemorrhage; Hematemesis; Humans; Intestinal Mucosa; Male; Middle Aged; Platelet Aggregation Inhibitors; Stomach Ulcer; Ticlopidine; Warfarin

Topics: Aged; Combined Modality Therapy; Critical Illness; Female; Follow-Up Studies; Hematemesis; Humans; Intensive Care Units; Postoperative Care; Pulmonary Embolism; Radiography; Respiration, Artificial; Risk Assessment; Thrombectomy; Warfarin

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

Topics: Adult; Danazol; Drug Interactions; Endometriosis; Female; Heart Valve Diseases; Hematemesis; Humans; Pregnadienes; Prothrombin Time; Warfarin

A young woman presented with a 2 year history of a severe bleeding disorder and marked deficiencies in all four vitamin-K-dependent factors. Metabolic studies with tracer doses of tritium-labelled vitamin K1 suggested that the patient might be taking an oral anticoagulant; and subsequently her plasma was found to contain a substance identical to phenindione in its spectrophotometric and chromatographic properties. The half-disappearance times of factors II, IX, X were measured after the administration of a concentrate of these factors and were found to conform with published figures. The concentrate controlled the patient's excessive bruising and prolonged skin and gingival bleeding. It would therefore seem that factor VII may not be essential in reversal of the bleeding disorder induced by anticoagulant overdose.

Topics: Adult; Anemia; Blood Coagulation Disorders; Blood Coagulation Factors; Blood Coagulation Tests; Chromatography, Gas; Chromatography, Thin Layer; Diabetes Complications; Female; Glucosephosphate Dehydrogenase; Hematemesis; Hematuria; Humans; Menorrhagia; Phenindione; Self Medication; Spectrum Analysis; Substance-Related Disorders; Vitamin K; Warfarin

Topics: Aged; Clofibrate; Hematemesis; Hematuria; Hemorrhage; Humans; Male; Prothrombin Time; Warfarin

Topics: Abdomen, Acute; Barium Sulfate; Blood Pressure; Blood Transfusion; Cerebrovascular Disorders; Duodenum; Female; Hematemesis; Hematuria; Hemoperitoneum; Humans; Intestinal Obstruction; Jejunum; Laparotomy; Male; Melena; Middle Aged; Myocardial Infarction; Prothrombin Time; Radiography; Vitamin K 1; Warfarin