warfarin and Hematologic-Diseases

Topics: Abnormalities, Drug-Induced; Anti-Infective Agents; Anticoagulants; Biomedical Research; Cytochrome P-450 Enzyme System; Drug Eruptions; Drug Interactions; Female; Folic Acid Deficiency; Hematologic Diseases; Hemolysis; Humans; Hyperkalemia; Hypoglycemia; Hypoglycemic Agents; Immunocompromised Host; Infant, Newborn; Infant, Small for Gestational Age; Kidney; Nervous System Diseases; Pregnancy; Trimethoprim, Sulfamethoxazole Drug Combination; Warfarin

Topics: Anemia, Iron-Deficiency; Copper; Folic Acid Deficiency; Hematologic Diseases; Humans; Nutrition Assessment; Nutritional Physiological Phenomena; Vitamin B 12 Deficiency; Vitamin K Deficiency; Warfarin

Topics: Anesthesia, Dental; Anticoagulants; Conscious Sedation; Hematologic Diseases; Humans; International Normalized Ratio; Medical History Taking; Patient Care Planning; Warfarin

Lupus anticoagulant (LA) is an antibody that interferes with phospholipid-dependent coagulation tests. We investigated the usefulness of the ratio of factor V activity determined by the Simplastin auto test (PT assay) to factor V activity determined by the Platelin Excel LS test (APTT assay) for detection of LA in plasma samples obtained from 276 patients with haematological and non-haematological disorders and 73 healthy subjects. This ratio was significantly higher in the 15 LA-positive (4.82 +/- 3.34) than in samples from healthy subjects (1.09 +/- 0.10) and was > 1.4 in 10 of the remaining 261 patient samples. The ratio was particularly low in the 54 samples from warfarin-treated patients. These findings suggest that determination of this ratio may be useful as a routine laboratory test for detection of LA. This test requires no specific antigens and can be applied in patients receiving anticoagulants such as warfarin and heparin.

Topics: Adult; Biomarkers; Factor V; False Positive Reactions; Female; Hematologic Diseases; Humans; Lupus Coagulation Inhibitor; Male; Neoplasms; Partial Thromboplastin Time; Prothrombin Time; Warfarin

Splenic, portal, or mesenteric venous thrombosis after splenectomy for hematologic disease has not been reported in the pediatric literature. It is a rare complication associated with significant morbidity and mortality in adult reports. Between 1981 and 1991, 3 patients (13-year-old boy with hereditary elliptocytosis [HE], 13-year-old boy with thalassemia intermedia [TI], and 18-year-old girl with idiopathic thrombocytopenic purpura [ITP]) presented with abdominal pain, nausea, with or without fever, at 4, 11, and 13 days postsplenectomy, respectively. Abdominal Doppler ultrasound (US) and/or computed tomography (CT) showed: (1) an intraluminal filling defect with partial obstruction to flow in the right branch of the portal vein with the remaining vessels patent (HE); (2) splenic vein thrombosis with complete occlusion of the main portal vein and proximal superior mesenteric vein (TI); and (3) complete thrombosis of the splenic vein, proximal superior mesenteric vein and portal vein (including central radicles), with retrogastric collateralization (ITP). Subsequent imaging showed either complete resolution of vascular obstruction on no treatment (patient 1), or portal venous cavernomatous transformation with hepatofugal flow after 6 months of systemic anticoagulation (patients 2 and 3), and all 3 patients are currently asymptomatic. Postoperative sonographic evaluation of a consecutive series of pediatric splenectomies for hematologic disease (n = 16), was performed at a median of 51 days (range, 3 to 124). This demonstrated one case of asymptomatic left portal venous thrombosis with subsequent recanalization in the absence of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Child; Female; Hematologic Diseases; Heparin; Humans; Male; Portal Vein; Postoperative Complications; Splenectomy; Thrombosis; Ultrasonics; Ultrasonography; Warfarin

We examined hematological complications in 415 patients having valve replacement with the St. Jude mechanical prosthesis (212, aortic valve replacement [AVR]; 159, mitral valve replacement [MVR]; and 44, AVR + MVR). There were 164 men and 251 women with a mean age of 59 years (range, 20 to 88 years). Preoperatively 386 patients were in New York Heart Association functional classes III and IV. There were 154 associated procedures (37%), the most common being myocardial revascularization. Overall hospital mortality was 7.5% (31/415), 7% after AVR, 8% after MVR, and 7% after AVR + MVR. All operative survivors were anticoagulated with Coumadin (crystalline warfarin sodium) to maintain the prothrombin time at 1.5 times control. During a mean follow-up of 21 months (range, 6 to 60 months), there were 29 late deaths (7.6%) and 5 patients (1.3%) lost to follow-up. No patient experienced structural valve degeneration. At 48 months, actuarial freedom from thromboembolism was 87% +/- 3% after AVR and 91% +/- 9% after MVR; from anticoagulation-related hemorrhage, 97% +/- 3% after AVR and 91% +/- 3% after MVR; and from hemolysis, 100% after AVR and 98% +/- 2% after MVR. Freedom from all valve-related morbidity at 4 years was 82% +/- 5% after AVR and 75% +/- 10% after MVR. Actuarial survival at 48 months was 80% +/- 4% after AVR and 65% +/- 7% after MVR.

Topics: Adult; Aged; Aged, 80 and over; Aortic Valve; Drug Administration Schedule; Female; Follow-Up Studies; Heart Diseases; Heart Valve Prosthesis; Hematologic Diseases; Hemolysis; Hemorrhage; Humans; Male; Middle Aged; Mitral Valve; Thromboembolism; Warfarin

Topics: Adenosine Diphosphate; Blood Coagulation Tests; Collagen; Hematologic Diseases; Humans; Nephelometry and Turbidimetry; Platelet Aggregation; Warfarin

Specific radioimmunoassays, sensitive to plasma levels of less than 1% of normal, were developed for protein C and Factor X. In 31 normal subjects, mean plasma antigen levels were as follows: protein C, 3.23 +/- 0.79 microgram/mL (2 SD); Factor X, 7.74 +/- 1.81 microgram/mL. In patient son chronic warfarin therapy, protein C and factor X were depressed equivalently: protein C, 42% +/- 20% (of a pooled plasma reference); Factor X, 44% +/- 24%. Protein C antigen fell much more rapidly than Factor X antigen when warfarin therapy was begun, creating an initial period of potential hypercoagulability. In patients with severe liver disease, mean protein C antigen (25% +/- 17%) was lower than Factor X antigen (51% +/- 29%). Protein C antigen levels did not appear to be a sensitive indicator of compensated intravascular coagulation or systemic fibrinolysis induced by infusion of streptokinase. Clinical implications of these findings are discussed.

Topics: Blood Coagulation Factors; Cross Reactions; Disseminated Intravascular Coagulation; Factor X; Female; Glycoproteins; Hematologic Diseases; Hemostasis; Humans; Kinetics; Liver Diseases; Lupus Erythematosus, Systemic; Pregnancy; Protein C; Radioimmunoassay; Streptokinase; Warfarin

Topics: Animals; Dog Diseases; Dogs; Female; Hematologic Diseases; Vitamin K; Warfarin

Topics: Aerospace Medicine; Cerebrovascular Disorders; Hematologic Diseases; Humans; Licensure; Pulmonary Embolism; Pulmonary Heart Disease; Thrombosis; 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: Arteriosclerosis; Cardiovascular Diseases; Carotid Artery Diseases; Cerebral Angiography; Cerebrovascular Disorders; Dextrans; Hematologic Diseases; Heparin; Humans; Infarction; Injections, Intravenous; Ischemic Attack, Transient; Papaverine; Subclavian Steal Syndrome; Vertebral Artery; Warfarin