warfarin and Hematoma

The characteristics and natural history of acute non-vitamin K antagonists oral anticoagulants (NOAC)-associated intracerebral haemorrhage (ICH) are largely unknown. We performed a comprehensive systematic review and meta-analysis to compare baseline ICH volume, haematoma expansion and clinical outcomes between NOAC-ICH versus vitamin K antagonists-ICH (VKA-ICH).. We searched PubMed and conference abstracts for observational studies comparing baseline characteristics and outcomes in patients with NOAC-ICH versus VKA-ICH using an appropriate keyword/MeSH term search strategy. Data were extracted following PRISMA and MOOSE guidelines. The main outcome measures were mortality and unfavourable functional outcome (modified Rankin Score: 4-6) at discharge and at 3 months, as well as ICH volumes and haematoma expansion rates in the two groups. Random-effects models with DerSimonian-Laird weights were used for pooled estimates calculation.. Twelve studies including 393 NOAC-ICH and 3482 VKA-ICH were pooled in meta-analysis. There was no difference in mean ICH-volume between the two groups (standard mean difference: -0.24; 95% CI -0.52 to 0.04, p=0.093). The rates of haematoma expansion were comparable in NOAC-ICH versus VKA-ICH (OR: 0.76; 95% CI 0.49 to 1.19, p=0.236). We did not find any difference between patients with NOAC-ICH versus VKA-ICH in all-cause mortality at discharge (OR: 0.66; 95% CI 0.42 to 1.05, p=0.077) and unfavourable functional outcome at discharge (OR: 0.77; 95% CI 0.41 to 1.44, p=0.413). The 3-month outcome was also comparable between the two ICH groups. Moderate-to-substantial statistical heterogeneity was noted.. Our results confirm that ICH volume, haematoma expansion, mortality and functional outcome appear to be similar for NOAC-ICH versus VKA-ICH. Large prospective cohorts and updated meta-analyses are needed to provide more precise estimates.

Topics: Anticoagulants; Antithrombins; Cerebral Hemorrhage; Dabigatran; Factor Xa Inhibitors; Hematoma; Humans; Mortality; Odds Ratio; Phenprocoumon; Pyrazoles; Pyridines; Pyridones; Rivaroxaban; Severity of Illness Index; Thiazoles; Vitamin K; Warfarin

To compare the safetyand efficacy of warfarin treatment continuation and heparin-bridging therapy during cardiac rhythm device (CRD) implantation in patients chronically treated with anticoagulants.We performed a search and analysis of peer-reviewed studies Four randomized controlled trials (RCTs)were included in our analysis with 941 patients. The bleeding risk in patients continuing warfarin perioperatively was lower than those interrupting warfarin and using a heparin-bridge (RD -0.08, 95% CI -0.17 to 0.02, p< 0.05). There was no significant difference in ischaemic risk between two methods (RD 0, 95% CI -0.01 to 0.02, p=1.00). Hence, in patients undergoing long-term warfarin therapy, continuation of warfarin treatment is a safe and efficacious perioperative strategy for during CRD implantations, while interruption of warfarin with a heparin bridge may increase the bleeding risk in these patients.

Topics: Anticoagulants; Blood Loss, Surgical; Hematoma; Heparin; Humans; Pacemaker, Artificial; Perioperative Care; Postoperative Hemorrhage; Prosthesis Implantation; Randomized Controlled Trials as Topic; Warfarin

Topics: Aged; Anticoagulants; Female; Hematoma; Humans; Pectoralis Muscles; Tomography, X-Ray Computed; Warfarin

Periprocedural management of warfarin remains challenging in patients requiring electrophysiological device surgery. For patients at high risk of thromboembolic events, guidelines recommend bridging therapy with heparin; however, this strategy is associated with a high risk of pocket hematoma. This paper systematically reviews studies appraising the risk of pocket hematoma with different perioperative anticoagulation strategies.. All relevant studies identified in MEDLINE/PubMed, The Cochrane Collaboration CENTRAL, clinicaltrials.org and in bibliographies of key articles. Estimates were combined using a fixed effects model. Heterogeneity was assessed by p values of χ2 statistics and I2. Publication bias was assessed by visual examination of funnel plots and by Egger test. Fifteen studies enrolling 5911 patients met all inclusion criteria and were included in this review.. Heparin bridging compared with no heparin was associated with increased risk of pocket hematoma (OR = 4.47, 95% CI 3.21-6.23, p < 0.00001), and prolonged hospital stay (9.13 ± 1.9 days vs. 5.11 ± 1 .39 days, p < 0.00001). Warfarin continuation was not associated with increased pocket hematoma compared to warfarin discontinuation (p = 0.38), but was associated with reduced risk of pocket hematoma compared with heparin bridging (OR = 0.37, 95% CI 0.2-0.69, p = 0.002). Thromboembolic complications were reduced with heparin bridging vs. no heparin (0.50% vs.1.07%, p = 0.02), and no significant differences were reported between heparin bridging vs. warfarin continuation (p = 0.83).. Heparin bridging is associated with a higher risk of pocket hematoma and a prolonged hospital stay. Perioperative continuation of warfarin reduces the occurrence of pocket hematoma compared with heparin bridging without any significant differences in thromboembolic complications.

Topics: Anticoagulants; Defibrillators, Implantable; Drug Administration Schedule; Hematoma; Heparin; Humans; Length of Stay; Observational Studies as Topic; Pacemaker, Artificial; Preoperative Care; Randomized Controlled Trials as Topic; Risk Factors; Warfarin

Spontaneous retroperitoneal hematoma after warfarin therapy is an extremely rare event. Here, we report a 25-year-old man who was brought in to the emergency service with confusion. On arrival, the patient had hypotension, tachycardia, tachypnea, low-grade fever, and Glasgow Coma Scale score of 12. Abdominal examination revealed distention and mild tenderness in the right upper quadrant of the abdomen. The patient had a history of aortic valve replacement surgery and was on warfarin treatment at an international normalized ratio of 2.4. Our patient progressed to cardiorespiratory arrest. The resuscitation was initiated promptly. Despite all resuscitation measures, including transfusion and administration of high doses of catecholamine, the patient died of hypovolemic shock 3 hours after admission. At autopsy, the external surface of the abdominal great vessels (descending aorta and mesenteric vessels) showed scattered petechial hemorrhages without any visible site of perforation. After comprehensive exploration of the abdomen, no evidence of traumatic event was identified and the cause of internal blood loss was noted as warfarin adverse effect.

Topics: Adult; Anticoagulants; Aorta, Thoracic; Fatal Outcome; Heart Valve Prosthesis; Hematoma; Humans; Male; Mesenteric Arteries; Mesenteric Veins; Purpura; Retroperitoneal Space; Shock; Warfarin

Anticoagulant drugs are used to reduce the incidence of thromboembolic events in patients at risk. However, minor and major bleeding complications may occur during anticoagulation therapy. Femoral neuropathy secondary to retroperitoneal hematoma is a well known complication of anticoagulant drugs. However, treatment of these patients is still controversial, both conservative and surgical treatments have been advocated. Herein, we report a male patient receiving warfarin for 7 years who developed femoral neuropathy due to retroperitoneal hematoma and was successfully treated with conservative methods. We suggest that conservative treatment and appropriate rehabilitation program should be given to the patients who do not demonstrate any signs of a continued bleeding and any progressive neurological deficits.

Topics: Adult; Anticoagulants; Femoral Neuropathy; Hematoma; Humans; Male; Retroperitoneal Space; Risk Factors; Thromboembolism; Treatment Outcome; Warfarin; Young Adult

Warfarin is commonly used for prevention of embolic events. Bleeding is the main side effect of warfarin. Lingual and sublingual haematoma are rare. In the literature, nine cases have so far been reported. We report the case of a 70-year-old Caucasian woman who developed spontaneous lingual and sublingual haematomas while on warfarin therapy. Spontaneous lingual and sublingual haematoma are rare, but can be potentially life-threatening complications as they cause airway obstruction. To the best of our knowledge, this is the first reported case of earliest haematoma after warfarin use.

Topics: Aged; Anticoagulants; Antifibrinolytic Agents; Diagnosis, Differential; Female; Follow-Up Studies; Hematoma; Humans; Mouth Floor; Plasma; Rare Diseases; Tongue; Treatment Outcome; Vitamin K; Warfarin

We are presenting a rare case of a spontaneous extensive perirenal hematoma caused by ruptured renal adenocarcinoma in a patient who was on warfarin therapy because she had atrial fibrillation and three myocardial infarctions. A 77-year-old woman was admitted to our department with acute right flank pain and hemorrhagic shock. The anamnestic data revealed no trauma and hematuria. Abdominal ultrasonography and computed tomography scan showed large retroperitoneal hematoma. The patient underwent urgent surgery and radical nephrectomy was performed. A large retroperitoneal hematoma was found originating from a ruptured renal neoplasm in the upper pole of the right kidney. The pathohistological diagnosis was chromophobe renal cell carcinoma. The clinical, diagnostic and therapeutic peculiarities of this rare condition are presented, along with the literature review on the topic.

Topics: Adenocarcinoma; Aged; Anticoagulants; Atrial Fibrillation; Carcinoma, Renal Cell; Diagnosis, Differential; Female; Hematoma; Humans; Kidney Neoplasms; Warfarin

Topics: Accidental Falls; Adolescent; Anticoagulants; Bed Rest; Bicycling; Hematoma; Humans; Lacerations; Liver; Male; Retroperitoneal Space; Spleen; Tomography, X-Ray Computed; Vena Cava, Inferior; Venous Thrombosis; Warfarin

Many patients requiring cardiac arrhythmia device surgery are on chronic oral anticoagulation therapy. The periprocedural management of their anticoagulation presents a dilemma to physicians, particularly in the subset of patients with moderate-to-high risk of arterial thromboembolic events. Physicians have responded by treating patients with bridging anticoagulation while oral anticoagulation is temporarily discontinued. However, there are a number of downsides to bridging anticoagulation around device surgery; there is a substantial risk of significant device pocket hematoma with important clinical sequelae; bridging anticoagulation may lead to more arterial thromboembolic events and bridging anticoagulation is expensive.. In response to these issues, a number of centers have explored the option of performing device surgery without cessation of oral anticoagulation. The observational data suggest a greatly reduced hematoma rate with this strategy. Despite these encouraging results, most physicians are reluctant to move to operating on continued Coumadin in the absence of confirmatory data from a randomized trial.. We have designed a prospective, single-blind, randomized, controlled trial to address this clinical question. In the conventional arm, patients will be bridged. In the experimental arm, patients will continue on oral anticoagulation and the primary outcome is clinically significant hematoma. Our study has clinical relevance to at least 70 000 patients per year in North America.

Topics: Anticoagulants; Cardiac Surgical Procedures; Cost-Benefit Analysis; Hematoma; Humans; Pacemaker, Artificial; Perioperative Care; Randomized Controlled Trials as Topic; Research Design; Thromboembolism; Warfarin

Spontaneous intestinal hematoma is a rare complication of anticoagulant therapy. The authors reported three cases of intramural and submucosal small bowel hematoma resulting from warfarin administration. The first patient presented with abdominal pain, had intramural hematoma at jejunum, the most common site of intramural small bowel hematoma. Another patient who had submucosal duodenal hematoma presented with massive upper gastrointestinal bleeding, a rare manifestation of small bowel hematoma. The third patient presented with intramural ileal hematoma that caused abdominal pain and palpable mass after a short period of warfarin therapy. Typical findings on abdominal computerized tomography yielded the diagnosis. All patients rapidly improved after conservative treatment. The history of anticoagulant use with prolonged INR value in patients presented with abdominal pain should alert physicians to search for this entity. It is extremely important to recognize this syndrome in order to avoid an unnecessary operation since the outcome is usually excellent after conservative treatment.

Topics: Abdominal Pain; Aged; Anticoagulants; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; International Normalized Ratio; Male; Risk Factors; Thailand; Time Factors; Warfarin

Reports in the literature of retropharyngeal hematoma as a complication of anticoagulation therapy are rare. When this complication does occur, it can become life-threatening if the airway is compromised. However, no consensus exists as to which approach--intubation, tracheotomy, or conservative therapy--is best for managing the airway in these cases. We report a case of retropharyngeal hematoma that occurred as a sequela to a trivial blunt trauma in a 48-year-old man who had been undergoing anticoagulation therapy with warfarin. The hematoma had caused airway obstruction, and the patient was hospitalized. He was treated conservatively, and the hematoma slowly resolved over the course of 2 weeks. On the basis of our experience and the findings of our literature review, we suggest that conservative management can be initiated for small nonexpanding hematomas that do not seriously compromise the airway. Securing the airway with intubation or tracheotomy should be reserved for patients who are in serious respiratory distress; the choice between intubation and tracheotomy should be made on an individual basis.

Topics: Anticoagulants; Heart Valve Prosthesis; Hematoma; Humans; Male; Middle Aged; Pharyngeal Diseases; Warfarin

Pregnant patients with mechanical valves require anticoagulation. The risk of bleeding and embryopathy associated with oral anticoagulation must be weighed against the risk of valve thrombosis. In the presence of a mechanical valve thrombosis, an appropriate treatment modality must be selected, as it is critical for the health of mother and fetus. In this review, we present a pregnant patient with mechanical valve thrombosis (MVT) who underwent thrombolytic therapy, subsequent anticoagulation according to available guidelines, and delivered a healthy baby at full term.

Topics: Adult; Anticoagulants; Blood Transfusion; Cesarean Section; Female; Fibrinolytic Agents; Gestational Age; Heart Valve Prosthesis; Hematoma; Heparin; Humans; Live Birth; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications, Cardiovascular; Recombinant Proteins; Thromboembolism; Tissue Plasminogen Activator; Warfarin

We describe a case of a patient receiving warfarin who presented with a superior pubic ramus fracture after a trivial fall at home. She developed a massive retroperitoneal haematoma as a result of vascular injury and subsequently died. This case emphasises the importance of admitting and observing patients with pubic rami fractures who are receiving antithrombotic treatment, and haemorrhage should be considered if they become haemodynamically compromised.

Topics: Accidental Falls; Aged; Anticoagulants; Fatal Outcome; Female; Fractures, Bone; Hematoma; Humans; Pubic Bone; Retroperitoneal Space; Warfarin

An interesting case of spontaneous bleeding from an ependymoma of the filum terminale is presented.. To document a rare case of rapid neurologic deterioration as a consequence of spinal tumoral hemorrhage and to highlight important issues regarding tumor histologic subtype and the impact of anticoagulation that have emerged from an illuminating review of the literature.. To our knowledge, there have been only 8 reported cases of hemorrhage from an ependymoma of the filum terminale or conus medullaris causing acute cauda equina syndrome. Bleeding is described in the pathology texts as being a consequence of the vascular architecture of the myxopapillary subtype and so postulated to be more common in this group. Anticoagulation is recognized to increase the frequency of tumoral bleeding, but no studies report its effect of severity of clinical presentation.. We report the case of a 57-year-old woman who developed nontraumatic acute cauda equina syndrome, including sphincter compromise. She underwent a lumbosacral laminectomy for evacuation of a hematoma, at which stage a filum terminale ependymoma was excised. Histopathologic analysis demonstrated it to be of a nonmyxopapillary subtype.. The patient demonstrated gradual improvement of the neurologic deficit. At 12-month follow-up, her saddle area sensory deficit has resolved, her right lower limb is much stronger allowing her to walk long distances, and she is successfully performing intermittent self-catheterization of her bladder.. The possibility of an underlying tumor should always be borne in mind so that adequate preoperative planning can be undertaken. The presence of the myxopapillary subtype should not prevent a clinician from excluding other reasons for hemorrhage, and counseling when reinstituting anticoagulation must include warning against a worse prognosis from any future hemorrhage.

Topics: Anticoagulants; Atrial Fibrillation; Cauda Equina; Ependymoma; Female; Hematoma; Hemorrhage; Humans; Laminectomy; Magnetic Resonance Imaging; Middle Aged; Mitral Valve Stenosis; Polyradiculopathy; Rheumatic Heart Disease; Rupture, Spontaneous; Spinal Neoplasms; Thrombophilia; Warfarin

Topics: Abdominal Pain; Aged; Anticoagulants; Diagnosis, Differential; Drug Interactions; Dyspnea; Female; Hematoma; Humans; Hypoprothrombinemias; International Normalized Ratio; Warfarin

Patients receiving anticoagulants offer a challenge to anaesthesiologists. The issue of spinal haematoma following central neuraxial block in such patients is a contentious issue. Although rare, with an estimated incidence of < 1:150,000 for epidural blocks and 1:220,000 for spinal anaesthetics in patients with normal coagulation status, this is an emergency situation with a potentially grave prognosis. The review presents cases of spinal haematomata that have occurred in the last 5 years, both spontaneously and after central neuraxial blockade. Of the 60 cases reported in the literature, 33% occurred following central neuraxial block and, of these, 55% were associated with concomitant use of anticoagulants. The pharmacology of the newer and older anticoagulants is also described. The variety of risk factors and diverse recommendations that have been described in these patients are reviewed.

Topics: Anesthesia, Spinal; Anticoagulants; Hematoma; Heparin; Heparin, Low-Molecular-Weight; Humans; Nerve Block; Platelet Aggregation Inhibitors; Practice Guidelines as Topic; Warfarin

It is well-known that peri-operative and post-operative venous thrombosis are common. Trials in Europe have shown that extended out-of-hospital prophylaxis with a low-molecular-weight heparin reduces the rate of deep vein thrombosis in patients undergoing elective hip surgery. North American investigators of limited-outcome descriptive studies, however, have suggested that out-of-hospital prophylaxis is not necessary. To resolve this uncertainty, NAFT (North American Fragmin Trial) was conducted, the results of which are summarized in this paper. The findings of NAFT support the favourable findings of the European studies on extended prophylaxis. Furthermore, European data have shown extended out-of-hospital prophylaxis to be cost-effective. On the basis of the aggregate data, it is felt that the A2 recommendation made by the Fifth American College of Chest Physicians consensus conference for extended prophylaxis should be changed to an A1 recommendation.

Topics: Anticoagulants; Arthroplasty, Replacement, Hip; Cost-Benefit Analysis; Dalteparin; Decision Making; Double-Blind Method; Drug Administration Schedule; Drug Costs; Elective Surgical Procedures; Follow-Up Studies; Hematoma; Humans; North America; Postoperative Complications; Postoperative Period; Practice Guidelines as Topic; Safety; Treatment Outcome; Venous Thrombosis; Warfarin

Spermatic cord hematoma is a rare diagnosis. The etiology may be idiopathic, traumatic, secondary to anticoagulation therapy, or as an extension of a retroperitoneal hemorrhage. It has been misdiagnosed as an incarcerated inguinal hernia, a testicular torsion, or a tumor. A review of the English literature is presented. An additional case is presented here as a complication of anticoagulation therapy after aortic valve replacement. Risk factors for a spermatic cord hematoma may warrant an ultrasound examination.

Topics: Anticoagulants; Cardiac Surgical Procedures; Diagnosis, Differential; Diagnostic Errors; Genital Diseases, Male; Hematoma; Humans; Male; Middle Aged; Risk Factors; Spermatic Cord; Warfarin

We report on a case of massive bleeding into the liver parenchyma during treatment with a combination of warfarin sodium and trimethoprim-sulfamethoxazole. A fifty-five-year-old woman was put on long-term anticoagulant therapy with warfarin sodium. Two years later a course of trimethoprim-sulfamethoxazole was given to treat bronchitis. Following a bout of severe epigastric pain, ultrasonography and computed tomography (CT) then showed an enlarged liver containing several large hematomas. Subsequent CT scans, after tentative treatment only, showed regression of the liver hematomas, with almost complete disappearance after eight months. Bleeding complications and drug interactions related to this case are discussed, together with a review of the only six previous reports in the world literature of liver hematomas following anticoagulant therapy. Also mentioned are five patients in whom thrombolytic therapy gave rise to the same adverse reaction.

Topics: Chemical and Drug Induced Liver Injury; Drug Interactions; Drug Therapy, Combination; Female; Hematoma; Humans; Liver; Liver Diseases; Middle Aged; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Warfarin

Topics: Biopsy; Drug Eruptions; Drug Interactions; Eosinophils; Erythromycin; Female; Fluocortolone; Hematoma; Humans; Leukocytes, Mononuclear; Middle Aged; Mitral Valve Insufficiency; Neutrophils; Prothrombin Time; Respiratory Tract Infections; Skin Diseases, Vesiculobullous; Trimethoprim, Sulfamethoxazole Drug Combination; Warfarin

Spontaneous intraspinal haematomas due to anticoagulants are uncommon, and usually extradural or subdural. Intramedullary haematomas are particularly rare, and only two case reports were found in the literature. We report a case of a thoracic intramedullary haemorrhage in a 61 year old man who had been commenced on warfarin 1 month previously, following aortic valve replacement. The literature is reviewed and reversal of warfarin effects, imaging and recommendations for treatment are discussed.

Topics: Hematoma; Humans; Male; Middle Aged; Spinal Cord Diseases; Thoracic Vertebrae; Tomography, X-Ray Computed; Warfarin

Sublingual hematoma is a rare but potentially fatal complication of oral warfarin sodium. Less than ten cases are reported in the English-language literature with only two of these appearing in the otolaryngologic literature. Spontaneous bleeding into the sublingual and submaxillary spaces creates a "pseudo-Ludwig's" phenomenon with elevation of the tongue and floor of mouth and subsequent airway compromise. Two new cases, along with a review of the literature are presented. Management is directed at prompt control of the airway and reversal of the coagulopathy. Sore throat is a uniform, early complaint that should be taken seriously in any patient receiving oral anticoagulation therapy.

Topics: Aged; Airway Obstruction; Emergencies; Female; Hematoma; Humans; Middle Aged; Oral Hemorrhage; Tongue Diseases; Warfarin

This study aims to illustrate the impact of applying the tranexamic acid impregnated in a gelatin sponge between the anterior rectus sheath and the Rectus Abdominis muscle during Cesarean section (CS) in minimizing rectus sheath hematoma (RHS) in women treated with Warfarin.. A clinical trial was carried out on 63 pregnant women attended for elective CS, who on antenatal warfarin anticoagulation started from 13 weeks gestation to 36 weeks then shifted to low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH), and with an indication for postnatal warfarin anticoagulation. They were randomly assigned on the day of the scheduled CS into three equal groups (21 women for each). Group 1 had two pieces of gelatin sponges soaked with one ampoule of tranexamic acid. Group 2 had two pieces of gelatin sponges not soaked with tranexamic acid. Group 3 (control group) had no gelatin sponge applied. All patients underwent postoperative assessment done for hemoglobin (Hb), hematocrit (HCT), estimated blood loss (EBL), amount and nature of discharge collected from the sub-rectus drain, complications (RHS, wound infection, thromboembolism), need for re-operation, and need for blood transfusion.. Statistically significant differences were found between Group 1 and Group 2 regarding the postoperative Hb (10.66 ± 1.13 vs. 9.77 ± 0.69, P = 0.009), between Group 1 and Group 2 regarding the postoperative HCT (31.87 ± 3.59 vs. 28.54 ± 1.85, P = 0.001), between Group 1 and Group 2 regarding EBL (442.19 ± 244.46 vs. 744.38 ± 267.05, P = 0.003), between Group 1 and Group 3 regarding EBL (442.19 ± 244.46 vs. 664.29 ± 343.97, P = 0.040), and between Group 1 and Group 3 regarding the discharge amount from the sub rectus drain (190.48 ± 100.77 vs. 307.14 ± 127.76, P = 0.004).. Tranexamic acid-soaked gelatin sponges are safe and effective in reducing postoperative drainage and EBL.. At ClinicalTrials.gov in June 2022 (NCT05439694).

Topics: Anticoagulants; Cesarean Section; Female; Gelatin; Hematoma; Heparin; Heparin, Low-Molecular-Weight; Humans; Pregnancy; Tranexamic Acid; Warfarin

Intracerebral hemorrhage (ICH) patients commonly have concomitant white matter lesions (WML) which may be associated with poor outcome. We studied if WML affects hematoma expansion (HE) and post-stroke functional outcome in a post hoc analysis of patients from randomized controlled trials.. In ICH patients from the clinical trials MISTIE II and CLEAR III, WML grade on diagnostic computed tomography (dCT) scan (dCT, < 24 h after ictus) was assessed using the van Swieten scale (vSS, range 0-4). The primary outcome for HE was > 33% or > 6 mL ICH volume increase from dCT to the last pre-randomization CT (< 72 h of dCT). Secondary HE outcomes were: absolute ICH expansion, > 10.4 mL total clot volume increase, and a subgroup analysis including patients with dCT < 6 h after ictus using the primary HE definition of > 33% or > 6 mL ICH volume increase. Poor functional outcome was assessed at 180 days and defined as modified Rankin Scale (mRS) ≥ 4, with ordinal mRS as a secondary endpoint.. Of 635 patients, 55% had WML grade 1-4 at dCT (median 2.2 h from ictus) and 13% had subsequent HE. WML at dCT did not increase the odds for primary or secondary HE endpoints (P ≥ 0.05) after adjustment for ICH volume, intraventricular hemorrhage volume, warfarin/INR > 1.5, ictus to dCT time in hours, age, diabetes mellitus, and thalamic ICH location. WML increased the odds for having poor functional outcome (mRS ≥ 4) in univariate analyses (vSS 4; OR 4.16; 95% CI 2.54-6.83; P < 0.001) which persisted in multivariable analyses after adjustment for HE and other outcome risk factors.. Concomitant WML does not increase the odds for HE in patients with ICH but increases the odds for poor functional outcome.. http://www.clinicaltrials.gov trial-identifiers: NCT00224770 and NCT00784134.

Topics: Cerebral Hemorrhage; Hematoma; Humans; Risk Factors; Warfarin; White Matter

Oral anticoagulant use is common among patients undergoing pacemaker or defibrillator surgery. BRUISE CONTROL (Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial; NCT00800137) demonstrated that perioperative warfarin continuation reduced clinically significant hematomas (CSH) by 80% compared with heparin bridging (3.5% versus 16%). BRUISE-CONTROL-2 (NCT01675076) observed a similarly low risk of CSH when comparing continued versus interrupted direct oral anticoagulant (2.1% in both groups). Using patient level data from both trials, the current study aims to: (1) evaluate the effect of concomitant antiplatelet therapy on CSH, and (2) understand the relative risk of CSH in patients treated with direct oral anticoagulant versus continued warfarin.. We analyzed 1343 patients included in BRUISE-CONTROL-1 and BRUISE-CONTROL-2. The primary outcome for both trials was CSH. There were 408 patients identified as having continued either a single or dual antiplatelet agent at the time of device surgery.. Concomitant antiplatelet therapy doubled the risk of CSH during device surgery. No difference in CSH was found between direct oral anticoagulant versus continued warfarin. In anticoagulated patients undergoing elective or semi-urgent device surgery, the patient specific benefit/risk of holding an antiplatelet should be carefully considered.. URL: https://www.clinicaltrials.gov. Unique identifiers: NCT00800137, NCT01675076.

Topics: Administration, Oral; Aged; Anticoagulants; Canada; Defibrillators, Implantable; Drug Therapy, Combination; Female; Hematoma; Humans; Incidence; Male; Pacemaker, Artificial; Platelet Aggregation Inhibitors; Risk Assessment; Risk Factors; Warfarin

Anti-platelet therapy is commonly used in patients receiving oral anticoagulation and may increase bleeding risk among patients undergoing cardiac implantable electronic device (CIED) surgery. We sought to determine the proportion of anticoagulated patients who are concomitantly receiving anti-platelet therapy, the associated risk of clinically significant hematoma (CSH), and the proportion of patients in whom anti-platelet usage is guideline-indicated.. A secondary analysis of the Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial (BRUISE CONTROL). Patients who were receiving warfarin, had an annual predicted risk of thromboembolism of ≥5% and were scheduled to undergo non-emergent CIED surgery were randomized to continued warfarin versus heparin bridging. In the current analysis, patients were divided into those receiving anti-platelet therapy and those not receiving anti-platelet therapy. The incidence of CSH was compared in both groups. The proportion of patients on potentially inappropriate and potentially interruptible antiplatelet therapy was estimated.. All 681 patients enrolled in BRUISE CONTROL were included, of whom 280 received and 401 did not receive anti-platelet therapy. Anti-platelet therapy increased the risk of CSH (relative risk, 1.72; 95% confidence interval (CI), 1.09 to 2.72; P = 0.02). Of the 280 patients receiving anti-platelet therapy, 97 (34.6%) had no guideline indication for concomitant anti-platelet therapy and an additional 146 (52.1%) were on anti-platelet therapy that could potentially have been interrupted around CIED surgery.. Concomitant anti-platelet therapy in patients receiving anticoagulation is associated with a significant risk of CSH. The majority of concomitant anti-platelet therapy is potentially inappropriate or interruptible.. clinicaltrials.gov Identifier: (NCT00800137).

Topics: Administration, Oral; Anticoagulants; Arrhythmias, Cardiac; Aspirin; Canada; Defibrillators, Implantable; Drug Therapy, Combination; Follow-Up Studies; Hematoma; Incidence; Pacemaker, Artificial; Platelet Aggregation Inhibitors; Retrospective Studies; Risk Factors; Single-Blind Method; Thromboembolism; Warfarin

Cardiac implantable electronic device (CIED) surgery is commonly performed in patients with atrial fibrillation (AF). The current analysis was undertaken to compare peri-operative anticoagulation management, bleeding, and thrombotic events in AF patients treated with dabigatran vs. warfarin.. This study included 611 patients treated with dabigatran vs. warfarin who underwent CIED surgery during the RE-LY trial. Among 201 warfarin-treated patients, warfarin was interrupted a median of 144 (inter-quartile range, IQR: 120-216) h, and 37 (18.4%) patients underwent heparin bridging. In dabigatran-treated patients (216 on 110 mg bid and 194 on 150 mg bid), the duration of dabigatran interruption was a median of 96 (IQR: 61-158) h. Pocket hematomas occurred in 9 (2.20%) patients on dabigatran and 8 (3.98%) patients on warfarin (P = 0.218). The occurrence of pocket hematomas was lower with dabigatran compared with warfarin with heparin bridging (RD: -8.62%, 95% CI: -24.15 to - 0.51%, P = 0.034) but not when compared with warfarin with no bridging (P = 0.880). Ischemic stroke occurred in 2 (0.3%) patients; one in the warfarin group (without bridging) and one in the dabigatran 150 mg bid group (P = 0.735).. In patients treated with dabigatran undergoing CIED surgery, interruption of dabigatran is associated with similar or lower incidence of pocket hematoma, when compared with warfarin interruption without or with heparin bridging, respectively. Whether uninterrupted dabigatran can reduce pocket hematoma or ischemic stroke remains to be evaluated.

Topics: Aged; Aged, 80 and over; Anticoagulants; Antithrombins; Atrial Fibrillation; Dabigatran; Defibrillators, Implantable; Drug Administration Schedule; Drug Substitution; Female; Hematoma; Hemorrhage; Heparin; Humans; Male; Middle Aged; Pacemaker, Artificial; Prosthesis Implantation; Thrombosis; Time Factors; Treatment Outcome; Warfarin

Because patients with warfarin-associated intracerebral hemorrhage (WAICH) have a high risk of ongoing bleeding, disability, and death, urgent coagulopathy reversal should be considered. On the other hand, thromboembolism may occur with reversal or withholding of anticoagulant therapy. The current status of acute hemostatic treatments and clinical outcomes in WAICH patients was investigated.. WAICH patients admitted within 3 days of onset were prospectively enrolled in 10 stroke centers. Thromboembolic and hemorrhagic complications and functional outcomes were followed-up for one year.. Of 50 WAICH patients (31 men, 73 ± 9 years old) enrolled, all stopped warfarin on admission. Elevated prothrombin time-international normalized ratios (PT-INR) were normalized in 43 (86%). Anticoagulant therapy was resumed with intravenous full-dose unfractionated heparin followed by warfarin in 9 (18%), intravenous low-dose unfractionated heparin followed by warfarin in 14 (28%) and warfarin alone in 14 (28%) at a median of 2.5 (IQR 1.25-9), 4 (2-5.5) and 6 (3-11) days after onset, respectively, after emergent admission. Onset-to-admission time (per 1-hour increase; OR 0.55, 95% CI 0.19-0.84) was inversely associated with hematoma expansion. Anticoagulant therapy was resumed with intravenous full-dose unfractionated heparin in 9 (18%), low-dose heparin in 14 (28%) and warfarin alone in 14 (28%) at a median of 2.5, 4 and 6 days after onset, respectively. During one-year follow-up (n=47), 11 thromboembolic and 6 hemorrhagic complications were documented. Twenty four patients showed unfavorable outcomes, corresponding to a modified Rankin Scale score of 4-6. Thromboembolic complications (OR, 10.62; 95% CI, 1.05-227.85), as well as advanced age (per 1 year; OR, 1.27; 95% CI, 1.10-1.61) and higher National Institutes of Health Stroke Scale (NIHSS) score (per 1 point; OR, 1.24; 95% CI 1.07-1.55), were independently associated with unfavorable outcome.. PT-INR normalization on admission and early anticoagulant resumption were common in WAICH patients. Thromboembolic complications were independently associated with unfavorable outcome.

Topics: Aged; Aged, 80 and over; Anticoagulants; Cerebral Hemorrhage; Cohort Studies; Female; Hematoma; Humans; Male; Middle Aged; Observation; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

Perioperative management with reduced-dose warfarin is of potential interest by eliminating the need for bridging while still maintaining a degree of anticoagulation. The outcomes of this regimen have not been well determined.. In a randomized controlled trial we compared two regimens for management of anticoagulation with warfarin in patients with implantation of a pacemaker or defibrillator. Half dose of warfarin for 3-6 days, depending on the baseline international normalized ratio (INR), before surgery aiming at an INR of ≤ 1.7 was compared with interrupted warfarin for 5 days with preoperative bridging with low-molecular-weight heparin (LMWH) at therapeutic dose for 2.5 days. Main safety outcome was pocket hematoma. Secondary outcomes were major bleeding, thromboembolism - all within 1 month, days of hospitalization and number of patients requiring correction of INR with vitamin K.. The study was planned for 450 patients but it was discontinued prematurely due to a change in practice. Pocket hematoma occurred in 4 of 85 patients (5%) randomized to the bridged regimen and in 3 of 86 patients (3%) randomized to reduced-dose warfarin. One pocket hematoma in each group was severe. There were no major hemorrhages or thromboembolism within the 1-month window. Duration of hospitalization was similar in the two groups. Correction of INR the day before surgery with vitamin K had to be used for significantly more patients in the reduced-dose warfarin group (41%) than in the bridged regimen group (6%).. The reduced-dose warfarin regimen appeared to have similar safety after device implantation as interrupted warfarin with preoperative LMWH bridging. Due to premature discontinuation no firm conclusion can be drawn. The reduced-dose warfarin regimen often failed to achieve the intended preoperative INR. ClinicalTrials.gov Identifier: NCT 02094157.

Topics: Anticoagulants; Defibrillators, Implantable; Female; Hematoma; Hemorrhage; Heparin, Low-Molecular-Weight; Humans; International Normalized Ratio; Male; Pacemaker, Artificial; Preoperative Care; Preoperative Period; Thromboembolism; Vitamin K; Warfarin

Many patients requiring pacemaker or implantable cardioverter-defibrillator (ICD) surgery are taking warfarin. For patients at high risk for thromboembolic events, guidelines recommend bridging therapy with heparin; however, case series suggest that it may be safe to perform surgery without interrupting warfarin treatment. There have been few results from clinical trials to support the safety and efficacy of this approach.. We randomly assigned patients with an annual risk of thromboembolic events of 5% or more to continued warfarin treatment or to bridging therapy with heparin. The primary outcome was clinically significant device-pocket hematoma, which was defined as device-pocket hematoma that necessitated prolonged hospitalization, interruption of anticoagulation therapy, or further surgery (e.g., hematoma evacuation).. The data and safety monitoring board recommended termination of the trial after the second prespecified interim analysis. Clinically significant device-pocket hematoma occurred in 12 of 343 patients (3.5%) in the continued-warfarin group, as compared with 54 of 338 (16.0%) in the heparin-bridging group (relative risk, 0.19; 95% confidence interval, 0.10 to 0.36; P<0.001). Major surgical and thromboembolic complications were rare and did not differ significantly between the study groups. They included one episode of cardiac tamponade and one myocardial infarction in the heparin-bridging group and one stroke and one transient ischemic attack in the continued-warfarin group.. As compared with bridging therapy with heparin, a strategy of continued warfarin treatment at the time of pacemaker or ICD surgery markedly reduced the incidence of clinically significant device-pocket hematoma. (Funded by the Canadian Institutes of Health Research and the Ministry of Health and Long-Term Care of Ontario; BRUISE CONTROL ClinicalTrials.gov number, NCT00800137.).

Topics: Aged; Anticoagulants; Defibrillators, Implantable; Female; Hematoma; Heparin; Humans; Incidence; Male; Pacemaker, Artificial; Perioperative Period; Thromboembolism; Warfarin

The aim of our study was to establish the efficiency of fibrin sealant in the prevention of pocket related complications in patients undergoing pacemaker implantation who are receiving anticoagulant treatment.. The study was performed on 40 and 41 patients prospectively randomized into treatment and control groups who underwent pacemaker implantation procedure between January 2002 and July 2004 at the Pacemaker Center - Clinical Centre Nis, Serbia. Both groups of patients were receiving anticoagulant treatment with either heparin or warfarin. Surgical procedures between the groups differed only in the application of fibrin sealant prior to wound closure in the treatment group.. In the treatment group, there were no pocket related complications while in the control group six patients (14.63%) had minor haematomas that required no treatment. Four patients (9.76%) had significant haematomas (two patients were treated conservatively while the other two needed reintervention). The INR in the treatment group was 2.76+/-0.85 and in the control group 2.65+/-0.79 (P=ns). In the follow-up period (2-27 months) no late complications were registered in either group.. Fibrin sealant is an effective haemostatic agent. The results obtained in our study show that the administration of fibrin sealant in patients receiving anticoagulant treatment eliminates postoperative haematomas after pacemaker implantation.

Topics: Aged; Anticoagulants; Female; Fibrin Tissue Adhesive; Hematoma; Hemostatics; Heparin; Humans; Male; Pacemaker, Artificial; Postoperative Care; Prospective Studies; Prostheses and Implants; Prosthesis-Related Infections; Warfarin

The purpose of this randomized study was to evaluate the prevalence of pocket hematomas in patients treated with heparin 6 h or 24 h after pacemaker or defibrillator implantation.. The risks of pocket hematoma and need for evacuation after device implantation have not been defined in patients who require anticoagulation.. Forty-nine consecutive patients with an indication for anticoagulation with heparin after implantable defibrillator or pacemaker implantation were randomized to receive intravenous heparin either 6 h (n = 26) or 24 h (n = 23) postoperatively. Both groups also received warfarin on a daily basis starting the evening of surgery. Twenty-eight patients who received postoperative warfarin alone and 115 patients who did not receive anticoagulation were followed up in a study registry.. A pocket hematoma developed in 6 of 26 patients (22%) who were treated with intravenous heparin 6 h postoperatively, as compared with 4 of 23 patients (17%) who were treated with intravenous heparin 24 h postoperatively (p = 0.7). In total, a pocket hematoma developed in 10 of 49 patients (20%) treated with heparin, 1 of 28 patients (4%) treated with warfarin alone and 2 of 115 (2%) patients who received no anticoagulation (p < 0.001).. Intravenous heparin initiation 6 h or 24 h after pacemaker or defibrillator implantation is associated with a 20% prevalence of pocket hematoma formation. Warfarin therapy or no anticoagulation is associated with only a 2% to 4% risk of pocket hematoma formation.

Topics: Anticoagulants; Defibrillators, Implantable; Drug Administration Schedule; Female; Hematoma; Heparin; Humans; Male; Middle Aged; Pacemaker, Artificial; Prevalence; Prospective Studies; Time Factors; Warfarin

It is well-known that peri-operative and post-operative venous thrombosis are common. Trials in Europe have shown that extended out-of-hospital prophylaxis with a low-molecular-weight heparin reduces the rate of deep vein thrombosis in patients undergoing elective hip surgery. North American investigators of limited-outcome descriptive studies, however, have suggested that out-of-hospital prophylaxis is not necessary. To resolve this uncertainty, NAFT (North American Fragmin Trial) was conducted, the results of which are summarized in this paper. The findings of NAFT support the favourable findings of the European studies on extended prophylaxis. Furthermore, European data have shown extended out-of-hospital prophylaxis to be cost-effective. On the basis of the aggregate data, it is felt that the A2 recommendation made by the Fifth American College of Chest Physicians consensus conference for extended prophylaxis should be changed to an A1 recommendation.

Topics: Anticoagulants; Arthroplasty, Replacement, Hip; Cost-Benefit Analysis; Dalteparin; Decision Making; Double-Blind Method; Drug Administration Schedule; Drug Costs; Elective Surgical Procedures; Follow-Up Studies; Hematoma; Humans; North America; Postoperative Complications; Postoperative Period; Practice Guidelines as Topic; Safety; Treatment Outcome; Venous Thrombosis; Warfarin

Patients with marginal venous conduit, poor arterial runoff, and prior failed bypass grafts are at high risk for infrainguinal graft occlusion and limb loss. We sought to evaluate the effects of anticoagulation therapy after autogenous vein infrainguinal revascularization on duration of patency, limb salvage rates, and complication rates in this subset of patients.. This randomized prospective trial was performed in a university tertiary care hospital and in a Veterans Affairs Hospital. Fifty-six patients who were at high risk for graft failure were randomized to receive aspirin (24 patients, 27 bypass grafts) or aspirin and warfarin (WAR; 32 patients, 37 bypass grafts). All patients received 325 mg of aspirin each day, and the patients who were randomized to warfarin underwent anticoagulation therapy with heparin immediately after surgery and then were started on warfarin therapy to maintain an international normalized ratio between 2 and 3. Perioperative blood transfusions and complications were compared with the Student t test or with the chi2 test. Graft patency rates, limb salvage rates, and survival rates were compared with the Kaplan-Meier method and the log-rank test.. Sixty-one of the 64 bypass grafts were performed for rest pain or tissue loss, and 3 were performed for short-distance claudication. There were no differences between the groups in ages, indications, bypass graft types, risk classifications (ie, conduit, runoff, or graft failure), or comorbid conditions (except diabetes mellitus). The cumulative 5-year survival rate was similar between the groups. The incidence rate of postoperative hematoma (32% vs 3.7%; P = .004) was greater in the WAR group, but no differences were seen between the WAR group and the aspirin group in the number of packed red blood cells transfused, in the incidence rate of overall nonhemorrhagic wound complications, or in the overall complication rate (62% vs 52%). The immediate postoperative primary graft patency rates (97.3% vs 85.2%) and limb salvage rates (100% vs 88.9%) were higher in the WAR group as compared with the aspirin group. Furthermore, the cumulative 3-year primary, primary assisted, and secondary patency rates were significantly greater in the WAR group versus the aspirin group (74% vs 51%, P = .04; 77% vs 56%, P = .05; 81% vs 56%, P = .02) and cumulative limb salvage rates were higher in the WAR group (81% vs 31%, P = .01).. Perioperative anticoagulation therapy with heparin increases the incidence rate of wound hematomas, but long-term anticoagulation therapy with warfarin improves the patency rate of autogenous vein infrainguinal bypass grafts and the limb salvage rate for patients at high risk for graft failure.

Topics: Aged; Anticoagulants; Arteries; Aspirin; Female; Hematoma; Heparin; Humans; Inguinal Canal; Leg; Male; Postoperative Complications; Prospective Studies; Survival Rate; Transplantation, Autologous; Treatment Outcome; Vascular Patency; Vascular Surgical Procedures; Veins; Warfarin

No controlled studies exist with regard to the risks of continuing therapy with warfarin sodium or platelet inhibitors or the benefits of briefly discontinuing therapy with these agents in patients who are undergoing cutaneous surgical procedures. Our objective was to determine the frequency of complications of cutaneous surgery in patients who were receiving warfarin or platelet inhibitors and to evaluate whether preoperative discontinuation reduces complications. A retrospective, controlled study was performed of complications of excisional and Mohs micrographic surgery in 653 patients who were being treated with warfarin or platelet inhibitors or with their medications being briefly withheld.. Severe complications of cutaneous surgery in patients who are taking warfarin or platelet inhibitors are uncommon, occur in 1.6% of cases, and are not significantly increased compared with complications in control subjects. Furthermore, there was no statistically significant reduction in the rates of severe complications in patients who had their medications preoperatively held.. Cutaneous surgery in patients who receive warfarin or platelet inhibitors is associated with a low risk of severe complications, not significantly reduced by brief preoperative discontinuation.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Dermatologic Surgical Procedures; Female; Hematoma; Humans; Male; Middle Aged; Mohs Surgery; Postoperative Complications; Postoperative Hemorrhage; Retrospective Studies; Warfarin

Topics: Aged; Female; Hematoma; Hip; Humans; Iodine Radioisotopes; Male; Middle Aged; Phlebography; Postoperative Complications; Thrombophlebitis; Warfarin

Topics: Aged; Anticoagulants; Gastrointestinal Hemorrhage; Hematoma; Humans; Male; Multiple Myeloma; Warfarin

The objective of this study was to evaluate clinical outcomes associated with time to administration and dose of four-factor prothrombin complex concentrate (4F-PCC) in patients with ICH on warfarin.. This was a single-center retrospective analysis of patients with ICH on warfarin who received 4F-PCC.. The site of the study was a large, Level I trauma, academic medical center with a dedicated neurologic intensive care unit and an emergency department (ED) that has approximately 72,000 visits annually.. Patients were included if they were ≥18 years of age, diagnosed with ICH, had an INR >1 due to warfarin use, and received both 4F-PCC and IV vitamin K for anticoagulation reversal. Exclusion criteria included patients who were less than 18 years of age, were not currently taking warfarin, had a bleeding site other than ICH, were pregnant or incarcerated, had an inadequate medical record, had a left ventricular assist device, had known liver disease with Child-Pugh Class C, received anticoagulation with heparin therapy within 24 h of anticoagulation reversal, or did not receive vitamin K within 24 h of hospital admission.. Our primary outcome was a composite of hematoma expansion or death due to neurologic injury. Treatment groups were defined as receipt of 4F-PCC within 0-30, 31-60, 61-90, 91-120 min, or greater than 120 min. Hematoma expansion was defined as any increase in hematoma size as assessed by a radiologist via standard 6-h CT. Death due to neurologic injury was defined as death prior to a repeat CT being performed or documentation of a neurologic cause of death. Adequate INR reversal (INR ≤1.3 on repeat INR) vs. inadequate INR reversal and weight-based vs. fixed-dose 4F-PCC were also assessed.. A total of 94 patients met the inclusion criteria. Forty-one patients (43.6%) met the composite endpoint, including 60% of the 31-60 min group, 47.6% of the 61-90 min group, 71.4% of the 91-120 min group, and 30.6% of the >120-min group. A significant difference in primary outcome occurred between the 91-120 min and >120-min groups (71.4% vs. 30.6%; p= 0.005), but this difference was not observed when accounting for disparities in Glasgow Coma Scale (GCS). Patients with adequate INR reversal were less likely to meet the primary endpoint than those with inadequate INR reversal (28.1% vs. 58.6%; p= 0.0059). There was less failure of anticoagulation reversal with weight-based dosing compared with fixed dosing (24.2% vs. 65.0%; p< 0.001).. No difference in clinical outcomes among 4F-PCC dosing strategies or time windows to administration was observed in patients with GCS <15. Rates of repeat INR ≤1.3 were higher with weight-based dosing, suggesting investigation of populations in which fixed dosing may be inappropriate is warranted.

Topics: Anticoagulants; Blood Coagulation Factors; Factor IX; Hematoma; Humans; International Normalized Ratio; Intracranial Hemorrhages; Retrospective Studies; Vitamin K; Warfarin

The incidence of postoperative complications following cardiac implantable electronic device (CIED) procedures in patients treated with antithrombotic drugs has not been studied sufficiently. Here we present a comparison of complications after CIED implantations.. Using an observational study design, the study included 1807 patients with a taking antiplatelet drugs (n: 1601), nonvitamin K anticoagulants (NOAC) (n: 136), and warfarin (n: 70) undergoing CIED surgery. Primary endpoint was accepted as cumulative events including composite of clinically significant hematoma (CSH), pericardial effusion or tamponade, pneumothorax, and infection related to device system. Secondary outcomes included each compenent of cumulative events. Multivariable analysis was performed to identify predictors of cumulative events.. The overall cumulative event rate was 3.7% (67 of 1807). Cumulative events occured 3.1% (50 of 1601) in the antiplatelet, 5.1% (7 of 136) NOAC, and 14.3% (10 of 70) warfarin groups (p < 0.001). CSH occurred in 2 of 70 patients (2.9%) in the warfarin group, as compared with 5 of 1601 (0.3%) in the antiplatelet group (p: 0.032). However, no significant differences were found between NOAC and warfarin groups in terms of CSH (0.7% vs. 2.9% respectively, p: 0.267). Warfarin treatment was an independent predictor of cumulative events and increased 2.9-fold the risk of cumulative events. Major surgical complications were rare and did not differ significantly between the study groups.. The incidence and severity of complications may be lower in patients treated with periprocedurally antiplatelet or NOAC therapy when compared with warfarin therapy. Further randomized control studies are required to confirm our findings.

Topics: Anticoagulants; Defibrillators, Implantable; Electronics; Fibrinolytic Agents; Hematoma; Humans; Pacemaker, Artificial; Postoperative Complications; Warfarin

Topics: Anticoagulants; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestine, Small; Warfarin

This is a case presentation of a man in his late 80s who presented to emergency department with a sublingual haematoma secondary to warfarin usage for atrial fibrillation. His international normalised ratio was rapidly reversed, and he was taken to theatre for successful surgical drainage of the haematoma. He was kept intubated and ventilated for 48 hours postoperatively to allow swelling to settle then extubated and rehabilitated prior to discharge home.

Topics: Atrial Fibrillation; Drainage; Hematoma; Humans; International Normalized Ratio; Male; 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

Performing percutaneous renal biopsy procedures in lupus nephritis (LN) and nephrotic syndrome presents a unique challenge to the nephrologist because of the risk of bleeding from the procedure and the hypercoagulable state in hypoalbuminemia. The management of a patient with venous thrombosis with perinephric hematoma post renal biopsy can be difficult if occurred.. We are presenting a case of perinephric hematoma following percutaneous renal biopsy in a 23-year-old man with lupus nephritis, nephrotic syndrome, and lower limbs deep vein thrombosis (DVT). The patient developed persistent frank haematuria, flank pain and acute urinary retention post-procedure. We have withheld his oral warfarin three days before the procedure, and no anticoagulation was given subsequently. Initial CT Angiography (CTA) renal showing stable hematoma and no visible evidence of vascular injury. Three weeks later, the patient still has persistent frank haematuria and a repeated CTA renal revealed new bilateral renal vein thrombosis. Considering the high risk of worsening symptomatic venous thrombosis, we gave subcutaneous enoxaparin sodium and restart oral warfarin despite ongoing haematuria. The frank haematuria resolved within two days of anticoagulation with no radiological evidence of worsening of the perinephric hematoma. The follow-up ultrasonography a month later showed resolution of the hematoma and renal vein thrombosis with no adverse effect.. Our experience, in this case, highlighted the importance of case selection for percutaneous renal biopsy among high-risk patients. Additionally, a prolonged frank haematuria in post-renal biopsy with nephrotic syndrome warranted a reassessment, as a clinical presentation of post-procedure perinephric hematoma and renal vein thrombosis can overlap. We also demonstrated that restarting anticoagulation earlier than four weeks in a patient with renal vein thrombosis and post-renal biopsy perinephric hematoma can be safe in the selective case.

Topics: Adult; Biopsy; Enoxaparin; Gastrointestinal Hemorrhage; Hematoma; Hematuria; Humans; Kidney Diseases; Lupus Nephritis; Male; Nephrotic Syndrome; Renal Veins; Ureteral Diseases; Venous Thrombosis; Warfarin; Young Adult

Spontaneous intramural small-bowel hematoma (SISBH) is a rare complication of anticoagulation therapy. Presentation of SISBH can vary from mild abdominal pain to an acute abdomen.. A 70-year-old woman was brought to the emergency department because of severe abdominal pain for 1 day. She had a medical history of coronary artery disease and paroxysmal atrial fibrillation and was receiving anticoagulation therapy with warfarin for 3 years.. Computed tomography disclosed disproportional dilatation of the segmental small bowel and near-total obstruction of the intestinal lumen at the level of the jejunum, indicating an acute abdomen.. We performed laparoscopic exploration and found a segmental distal jejunum was tense, heavy, firm, and discolored with a blue hue. Histopathological examination of the resected jejunum revealed diffuse hemorrhage and necrosis at the mucosa and submucosal layers, indicating SISBH.. The patient had an uneventful recovery and was discharged in a relatively stable condition.. Warfarin-induced SISBH presenting as an acute abdomen is an emergency condition that needs early diagnosis and timely management. Surgical intervention may be indicated for intestinal obstruction, ischemia, perforation, peritonitis, and intra-abdominal hemorrhage.

Topics: Abdomen, Acute; Abdominal Pain; Aged; Anticoagulants; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Warfarin

To assess the safety of needle electromyography in patients on non-vitamin K oral anticoagulants (NOACs) compared with warfarin.. A retrospective chart review was done in patients who underwent needle electromyography studies while they were using warfarin and NOACs. After the needle electromyography, all the patients were monitored for 2 hours and ultrasound of high-risk muscle groups was done. The complications were classified based on the International Society on Thrombosis and Hemostasis definitions.. Fifty-eight patients were included: 29 were using NOACs and the other 29 were on warfarin. The mean age was 59.33 ± 16 years. Hemorrhagic complications from needle electromyography were noted in 9 patients: 7 (77.7%) NOACs and 2 (22.3%) warfarin. Among them, 6 patients (66.6%) met the diagnostic criteria for Clinically Relevant Non-Major Bleeding criteria proposed by International Society on Thrombosis and Hemostasis and 3 patients (33.4%) had an asymptomatic hematoma on ultrasound evaluation. A total of 267 muscles were tested and only 9 (3.3%) muscles had hemorrhagic complications. One patient (rivaroxaban) had acute bleeding requiring pressure bandage, five patients (two apixaban, two rivaroxaban, and one warfarin) had clinical hematoma that required ice packs, and three patients (two rivaroxaban and one warfarin) had a hematoma on ultrasound of deep muscles.. Patients on NOACs had minimal risk of clinically relevant hemorrhagic complications, and the risk is not significantly different from those on warfarin.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anticoagulants; Dabigatran; Electromyography; Female; Hematoma; Humans; Male; Middle Aged; Pyrazoles; Pyridones; Retrospective Studies; Rivaroxaban; Warfarin

A man in his 70s on warfarin attended the emergency department three times over a 24-hour period, complaining of a sore throat, neck swelling and difficulty swallowing. He was initially diagnosed with pharyngitis, given antibiotics and discharged home, which was reconfirmed on the second attendance after an episode of haemoptysis. On the third, he was diagnosed with a pharyngeal haematoma causing partial airway obstruction and admitted to critical care. His international normalised ratio (INR) was reported initially as unreadable by the laboratory, then eventually came back as >20. After a thorough medication history, he said that he had recently been prescribed topical miconazole oromucosal gel by his dentist for oral candidiasis, which had interacted with the warfarin to cause this life-threatening haematoma.

Topics: Airway Obstruction; Anticoagulants; Drug Interactions; Hematoma; Humans; International Normalized Ratio; Male; Miconazole; Warfarin

Topics: Accidental Falls; Aged; Anticoagulants; Atrial Fibrillation; Buttocks; Deprescriptions; Embolization, Therapeutic; Enoxaparin; Hematoma; Hemoptysis; Humans; International Normalized Ratio; Male; Pulmonary Disease, Chronic Obstructive; Risk Assessment; Warfarin

Topics: Aged; Angiography; Anticoagulants; Embolization, Therapeutic; Female; Flank Pain; Hematoma; Humans; Kidney Diseases; Renal Artery; Tomography, X-Ray Computed; Ultrasonography; Warfarin

A 77-year-old man with a mechanical mitral valve on warfarin presented with an acute drop in haemoglobin and large spontaneous haematoma. He was found to have a new coagulopathy with initial labs notable for a prolonged activated partial thromboplastin time (APTT). Further workup revealed factor VIII levels less than 1%, abnormal mixing studies and elevated Bethesda titres, which was consistent with an acquired factor VIII inhibitor. Given his bone marrow biopsy result, which was positive for plasma cell myeloma, this coagulopathy was thought to be an acquired haemophilia A secondary to multiple myeloma. Anticoagulation was a challenge in this patient given his mechanical mitral valve and acquired haemophilia A. Although the patient was at risk of thrombosis due to a mechanical mitral valve, he had a bleeding diathesis and anaemia not responsive to transfusion. The decision was made to hold anticoagulation and the patient was started on myeloma treatment which included CyBorD, rituximab and daratumumab. After initiation of treatment APTT and factor VIII normalised. He eventually restarted anticoagulation under direction of his primary care doctor.

Topics: Aged; Anticoagulants; Antineoplastic Agents; Drug Therapy, Combination; Heart Valve Prosthesis; Hematoma; Hemophilia A; Humans; Male; Multiple Myeloma; Partial Thromboplastin Time; Warfarin

Topics: Aged; Aged, 80 and over; Anticoagulants; Aspirin; Blood Coagulation Factors; Cerebral Hemorrhage, Traumatic; Cerebral Intraventricular Hemorrhage; Clopidogrel; Deamino Arginine Vasopressin; Female; Fractures, Bone; Hematoma; Hematoma, Subdural, Intracranial; Hemostatics; Humans; International Normalized Ratio; Intracranial Hemorrhage, Traumatic; Male; Middle Aged; Pelvic Bones; Platelet Aggregation Inhibitors; Pyrazoles; Pyridones; Retrospective Studies; Rivaroxaban; Subarachnoid Hemorrhage, Traumatic; Thrombosis; Warfarin

A 91-year-old Caucasian man on warfarin for atrial fibrillation presented in view of sudden-onset haemoptysis with fresh bleeding with clots immediately after having eaten a piping-hot traditional cheesecake (pastizz) and burning the soft-palate of his mouth. The haemoptysis had resolved by the time that the patient had arrived to hospital. On examination, a 2 cm by 2 cm dark red, solitary mass could be seen just anterior to the uvula. This was not causing any pain or discomfort to the patient. Blood results were mostly unremarkable except for a raised international normalised ratio (INR) of 3.53. The patient was administered 5 mg vitamin K orally in attempt to lower the INR level and warfarin was subsequently omitted for 7 days. He was also prescribed oral steroids on discharge. The lesion resolved in 7 days and warfarin was restarted then with no further consequences.

Topics: Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Blood Coagulation; Burns; Food; Hematoma; Hemoptysis; Hot Temperature; Humans; International Normalized Ratio; Male; Palate, Soft; Uvula; Vitamin K; Warfarin

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

Topics: Anticoagulants; Atrial Fibrillation; Contusions; Hematoma; Humans; Platelet Aggregation Inhibitors; Warfarin

A 74-year-old woman receiving long-term anticoagulation with warfarin for chronic atrial fibrillation presented with severe acute abdominal pain, diarrhoea and vomiting. Initial laboratory workup revealed a deranged coagulation profile. Computed tomography of the abdomen and pelvis demonstrated spontaneous distal jejunal intramural haematoma with associated reactive ileus. No overt pneumatosis intestinalis, intraperitoneal free gas or haemoperitoneum was seen. Based on clinical and imaging findings, a diagnosis of over-anticoagulation complicated by small bowel intramural haematoma was made. The patient was managed non-operatively with analgesia, cessation of warfarin and reversal therapy with vitamin K. Warfarin therapy was recommenced upon resolution of symptoms and optimisation of coagulation status. The clinical presentation, radiological features and overall management of anticoagulation-induced bleeding are further discussed in this article.

Topics: Abdominal Pain; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Ileus; International Normalized Ratio; Intestinal Obstruction; Intestines; Male; Middle Aged; Risk Factors; Tomography, X-Ray Computed; Warfarin

BACKGROUND Intramural hematoma of the esophagus (IHE), a rare manifestation of acute mucosal injuries of the esophagus, can be caused by trauma such as endoscopic surgeries. Coagulation disorders increase the risk of IHE. The most common location of IHE is in the distal esophagus. The characteristic clinical triad of manifestations comprises acute retrosternal pain, odynophagia or dysphagia, and hematemesis. It is important to distinguish IHE from other acute conditions such as acute coronary syndrome, aortic dissection, and pulmonary embolism. CASE REPORT An 84-year-old male was scheduled for coil embolization for an endoleak after endovascular aneurysm repair. For this reason, he was taking aspirin and warfarin. A nasogastric tube had been inserted during surgery and subsequently removed without any problems reported. Postoperatively, he experienced chest pain and hematemesis of sudden onset. Urgent esophagogastroduodenoscopy demonstrated a large, dark red, non-pulsatile, submucosal, esophageal mass in the area of the mid-esophagus with a little oozing. He was diagnosed as having an IHE; other possible diagnoses were excluded by contrast-enhanced computed tomography and aortography. He was treated with fasting, a proton pump inhibitor, and cessation of anti-thrombotic drugs; he recovered completely. The bleeding spot in the esophagus was in the area of the mid-esophagus, which was around the second natural constriction site. It was possible that the nasogastric tube had contact with the esophageal wall at this second natural constriction, and caused intramural esophageal bleeding. CONCLUSIONS Nasogastric tubes are not generally recognized as a cause of IHE. However, they can cause them, especially when a patient is taking anti-thrombotic drugs.

Topics: Aged, 80 and over; Anticoagulants; Aspirin; Esophageal Diseases; Hematoma; Humans; Intubation, Gastrointestinal; Male; Platelet Aggregation Inhibitors; Warfarin

Intraneural hematomas are an uncommon cause of a focal mononeuropathy. When they do occur, it is usually in the setting of inherited or iatrogenic coagulopathies or as a consequence of injections targeting nerves. We report a man aged 68 years on warfarin therapy for a prior pulmonary embolism who presented with a 6-month history of progressive weakness of knee flexion and ankle movement, excruciating pain, and dense numbness in his posterior left thigh and below the knee, consistent with a severe high sciatic palsy. Imaging depicted a contiguous cystic mass of mixed T1 and T2 intensities involving the left sciatic nerve in the thigh, which was radiologically interpreted as a hip arthroplasty-associated pseudotumor. The patient underwent surgical exploration, which revealed a thick hemorrhagic pseudocompartment within the sciatic nerve. The histopathologic diagnosis was consistent with chronic hemorrhage. These impressive lesions should be included in the differential diagnosis of nerve masses.

Topics: Aged; Anticoagulants; Hematoma; Humans; Male; Pulmonary Embolism; Sciatic Neuropathy; Warfarin

Spontaneous mesenteric hematoma isinfrequent. It has been related to prolonged anticoagulation, mainly with warfarin. No definitive treatment has been established; A treatment is suggested in hemodynamically stable patients, while in patients in shock, the surgical treatment is suggested. Our goal is topresent the case of a mesenteric hematoma associated with prolonged conservative anticoagulation with surgical resolution. Female patient with 67 years old, consulted for 24 hours of evolution abdominal pain and signs of peritonism; Computed tomography was performed with a diagnosis of spontaneous mesenteric hematoma. In the context of a clinically stable patient anticoagulated with warfarin, emergency laparotomy with intestinal resection of the segment affected by the hematoma was decided. Pathological anatomy reports massive submucosal hemorrhage. Conclusion: Surgical behavior in patients with hemodynamically stable peritonism can be safe and effective. El hematoma mesentérico espontáneo es una entidad infrecuente. Se lo ha relacionado con anticoagulación prolongada, principalmente con el uso de warfarina. No se ha establecido un tratamiento estándar hasta la fecha; sugiriéndose en pacientes hemodinámicamente estables un tratamiento conservador, mientras que en pacientes inestables el tratamiento quirúrgico. Nuestro objetivo es presentar el caso de un hematoma mesentérico asociado a anticoagulación prolongada con resolución quirúrgica. Paciente de sexo femenino de 67 años de edad, consultó por dolor abdominal de 24 horas de evolución y signos de peritonismo; se realizó tomografía computada con diagnóstico de hematoma mesentérico espontáneo. En el contexto de una paciente clínicamente estable anticoagulada con warfarina, se decidió laparotomía de urgencia con resección intestinal del segmento afectado por el hematoma. El informe de anatomía patológica revela hemorragia masiva submucosa. Conclusión: La conducta quirúrgica en pacientes con peritonismo, estables hemodinámicamente, puede considerarse seguro y efectivo.

Topics: Aged; Anticoagulants; Female; Hematoma; Humans; Mesentery; Peritoneal Diseases; Tomography, X-Ray Computed; Warfarin

The perioperative management of anticoagulation with the use of subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation is still evolving.. The purpose of this study was to assess whether it is safe to perform S-ICD implantation with uninterrupted warfarin.. This is a multi-center retrospective review of patients undergoing S-ICD implantation between October 1, 2012 and June 30, 2017. Forty-eight patients underwent successful S-ICD implantation during the study period. The most common indication for implantation was primary prevention of sudden cardiac death. In 23 (47.9%) patients, warfarin was continued without any interruption. In 25 (52.1%) patients, warfarin was interrupted prior to implantation. The incidence of clinically significant lateral pocket hematoma was compared in the two groups.. The mean international normalized ratio was 2.0 ± 0.4 in the uninterrupted group and 1.4 ± 0.4 for the interrupted group. A total of seven patients developed a hematoma at the lateral pocket. No patient developed a hematoma at the parasternal pockets. Six patients in the uninterrupted group (26.1%) and one patient in the interrupted group (0.04%) developed a significant lateral pocket hematoma (P = .04). The concomitant use of dual antiplatelet therapy did not increase the risk of hematoma. There was no significant difference between HASBLED and CHA. The uninterrupted use of warfarin in the perioperative period of S-ICD implantation is associated with an increased risk of lateral pocket hematoma.

Topics: Adult; Aged; Anticoagulants; Defibrillators, Implantable; Female; Hematoma; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Assessment; Warfarin

Rhabdomyolysis is a relatively common and life-threatening disease that is sometimes complicated by acute kidney injury (AKI). Several causes have been reported, divided into traumatic and non-traumatic causes. We herein report a patient with rhabdomyolysis with AKI caused by bilateral iliopsoas hematoma. This patient had atrial fibrillation that was poorly controlled with warfarin, and bilateral iliopsoas hematoma was caused by turnover without a history of high-energy injury. Treatment with the rapid neutralization of warfarin improved his clinical condition without complications. We should pay close attention to episodes of turnover among elderly patients receiving anticoagulant therapy.

Topics: Acute Kidney Injury; Aged; Anticoagulants; Atrial Fibrillation; Hematoma; Humans; Male; Muscle, Skeletal; Retroperitoneal Space; Rhabdomyolysis; Tomography, X-Ray Computed; Warfarin

Topics: Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestine, Small; Male; Middle Aged; Tomography, X-Ray Computed; Warfarin

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

Topics: Adult; Cesarean Section; Delivery, Obstetric; Diagnosis, Differential; Female; Follow-Up Studies; Hematoma; Humans; Ovary; Pregnancy; Pregnancy, Multiple; Puerperal Disorders; Pulmonary Embolism; Rectus Abdominis; Risk Factors; Sepsis; Tinzaparin; Tomography, X-Ray Computed; Venous Thrombosis; Warfarin

Topics: Anticoagulants; Hematoma; Humans; Lung Diseases; Male; Middle Aged; Warfarin

The safety of perioperative anticoagulation (AC) and antiplatelet (AP) therapy with subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation is unknown. The purpose of this study was to identify the risk factors associated with hematoma complicating S-ICD implantation.. Records were retrospectively reviewed from 200 consecutive patients undergoing S-ICD implantation at two academic medical centers. A hematoma was defined as a device site blood accumulation requiring surgical evacuation, extended hospital stay, or transfusion.. Among 200 patients undergoing S-ICD implantation (age 49 ± 17 years, 67% men), 10 patients (5%) had a hematoma, which required evacuation in six patients (3%). Warfarin was bridged or uninterrupted in 12 and 13 patients, respectively (6% and 6.5%). Four of 12 patients with warfarin and bridging AC (33%) and two of 13 patients with uninterrupted warfarin (15%) developed a hematoma. Neither of the two patients with uninterrupted DOAC had a hematoma. No patients on interrupted AC without bridging (n = 26, 13 with warfarin, 13 with DOAC) developed a hematoma. A hematoma was also more likely with the use of clopidogrel (n = 4/10 vs 10/190, 40% vs 5.3%, P < 0.0001) in combination with aspirin in 12/14 patients. Any bridging AC (odds ratio [OR] 10.3, 1.8-60.8, P = 0.01), clopidogrel (OR 10.0, 1.7-57.7, P = 0.01), and uninterrupted warfarin without bridging (OR 11.1, 1.7-74.3, P = 0.013) were independently associated with hematoma formation.. AC and/or AP therapy with clopidogrel appears to increase the risk for hematoma following S-ICD implantation. Interruption of AC without bridging should be considered when it is an acceptable risk to hold AC.

Topics: Anticoagulants; Aspirin; Clopidogrel; Defibrillators, Implantable; Female; Hematoma; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors; Postoperative Complications; Prosthesis Implantation; Retrospective Studies; Risk Factors; Warfarin

Topics: Aged; Anticoagulants; Antifungal Agents; Drug Interactions; Female; Fluconazole; Hematoma; Humans; Pharyngeal Diseases; Warfarin

Background and Purpose- The aim of this study was to prospectively validate our prior findings of smaller hematoma volume and lesser neurological deficit in nonvitamin K oral anticoagulant (NOAC) compared with Vitamin K antagonist (VKA)-related intracerebral hemorrhage (ICH). Methods- Prospective 12-month observational study in 15 tertiary stroke centers in the United States, Europe, and Asia. Consecutive patients with premorbid modified Rankin Scale score of <2 with acute nontraumatic anticoagulant-related ICH divided into 2 groups according to the type of anticoagulant: NOAC versus VKA. We recorded baseline ICH volume, significant hematoma expansion (absolute [12.5 mL] or relative [>33%] increase), neurological severity measured by National Institutes of Health Stroke Scale score, 90-day mortality, and functional status (modified Rankin Scale score). Results- Our cohort comprised 196 patients, 62 NOAC related (mean age, 75.0±11.4 years; 54.8% men) and 134 VKA related (mean age, 72.3±10.5; 73.1% men). There were no differences in vascular comorbidities, antiplatelet, and statin use; NOAC-related ICH patients had lower median baseline hematoma volume (13.8 [2.5-37.6] versus 19.5 [6.6-52.0] mL; P=0.026) and were less likely to have severe neurological deficits (National Institutes of Health Stroke Scale score of >10 points) on admission (37% versus 55.3%, P=0.025). VKA-ICH were more likely to have significant hematoma expansion (37.4% versus 17%, P=0.008). NOAC pretreatment was independently associated with smaller baseline hematoma volume (standardized linear regression coefficient:-0.415 [95% CI, -0.780 to -0.051]) resulting in lower likelihood of severe neurological deficit (odds ratio, 0.44; 95% CI, 0.22-0.85) in multivariable-adjusted models. Conclusions- Patients with NOAC-related ICH have smaller baseline hematoma volumes and lower odds of severe neurological deficit compared with VKA-related ICH. These findings are important for practicing clinicians making anticoagulation choices.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Cerebral Hemorrhage; Female; Hematoma; Humans; Male; Middle Aged; Neuroimaging; Prospective Studies; Treatment Outcome; Vitamin K; Warfarin

Topics: Anticoagulants; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestine, Small; Male; Middle Aged; Warfarin

Patients undergoing anticoagulation therapy often experience intracerebral hemorrhages (ICHs), and warfarin in particular is known to increase hematoma expansion in ICHs, which results in a poor outcome. Recent studies reported that, in comparison with warfarin, direct oral anticoagulants (DOACs) cause fewer ICHs with better functional outcome. However, since it is still unknown whether DOACs are associated with a smaller hematoma volume of ICHs, we aimed to compare the volume, hematoma expansion, and outcomes associated with ICHs treated with DOACs and warfarin.. We performed a prospective multicenter cross-sectional study. The subjects included patients with acute ICHs who received either DOACs or warfarin. We evaluated the clinical characteristics, and measured initial and follow-up ICH volumes. The volume of ICHs and hematoma expansion were compared between the DOAC and warfarin groups. Mortality and modified Rankin score at discharge were evaluated as outcomes.. There were 18 patients in the DOAC group and 71 in the warfarin group. The baseline characteristics were similar between the 2 groups. Initial median hematoma volume of ICHs in the DOAC group was significantly lower than that in the warfarin group (6.2 vs. 24.2 mL, respectively; p = 0.04). In cases involving follow-up computed tomography scanning, the median hematoma volume of ICHs at follow-up was lower in the DOAC group than in the warfarin group (initial: DOACs 4.4 vs. warfarin 13.5 mL; follow-up: 5.0 vs. 18.4 mL, respectively; p = 0.05). Further, the hematoma in ICHs associated with DOACs did not expand. Although the mortality of ICHs associated with DOACs (11%) was lower than that associated with warfarin (24%), this difference was not statistically significant. The univariate analysis showed that the anticoagulant type (DOACs vs. warfarin) and sex (male vs. female) were associated with ICH volume. The multivariable linear regression showed that the use of DOACs (compared to warfarin; β: -0.23, p = 0.03) and female sex (compared to male; β: -0.25, p = 0.02) were associated with a small hematoma volume.. Based on the results of the present study, in terms of the risks associated with ICHs, the use of DOACs appears to be safer than warfarin for anticoagulation therapy. Further studies are required to validate these findings.
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Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Antithrombins; Blood Coagulation; Cerebral Hemorrhage; Chi-Square Distribution; Cross-Sectional Studies; Dabigatran; Disability Evaluation; Factor Xa Inhibitors; Female; Hematoma; Humans; Japan; Linear Models; Male; Middle Aged; Multivariate Analysis; Patient Discharge; Prospective Studies; Pyrazoles; Pyridones; Registries; Risk Factors; Rivaroxaban; Tomography, X-Ray Computed; Treatment Outcome; 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

Objective In modern cardiology practice, implantation of cardiac electronic devices in patients taking anticoagulant or antiplatelet therapy is a common clinical scenario. Bleeding complications are of particular concern in this patient population and pocket haematoma is one of the most frequent complications. We sought to determine the relationship between periprocedural antiplatelet/anticoagulant therapy and pocket haematoma formation in patients undergoing cardiac implantable electronic device (CIED) implantation. Methods We conducted a retrospective study including 232 consecutive patients undergoing CIED implantation in the department of cardiology of the Medipol University Hospital. Patients were divided into six groups: clopidogrel group (n = 12), acetylsalicylic acid (ASA) group (n = 73), ASA + clopidogrel group (n = 29), warfarin group (n = 34), warfarin + ASA group (n = 21) and no antiplatelet-anticoagulant therapy group as the control group (n = 63). CIED implantations were stratified under four subtitles including implantable cardioverter/defibrillator (ICD), cardiac resynchronization therapy (CRT), permanent pacemaker and the last group as either device upgrade or generator replacement. Results The mean age of the patients was 63 ± 14 years and 140 patients were male (60.3%). A pocket haematoma was documented in 6 of 232 patients (2.6%). None of the patients with pocket haematoma needed pocket exploration or blood transfusion. The type of the device did not have a significant effect on pocket haematoma incidence (P = 0.250). Univariate logistic regression showed that platelet level and ASA plus clopidogrel use were significantly associated with haematoma frequency after CIED implantations, respectively (OR: 0.977, CI 95% [0.958-0.996]; OR: 16.080, CI 95% [2.801-92.306]). Multivariate analysis revealed that dual antiplatelet treatment (β = 3.016, P = 0.002, OR: 2.410, 95% CI [3.042-136.943]) and baseline platelet level (β = -0.027, p:0.025, OR: 0.974, 95% CI [0.951-0.997]) were independent risk factors for pocket haematoma formation. Conclusion Dual antiplatelet therapy and low platelet levels significantly increased the risk of pocket haematoma formation in patients undergoing CIED implantations.

Topics: Anticoagulants; Arrhythmias, Cardiac; Aspirin; Defibrillators, Implantable; Drug Therapy, Combination; Female; Hematoma; Humans; Male; Middle Aged; Pacemaker, Artificial; Platelet Aggregation Inhibitors; Retrospective Studies; Risk Factors; Warfarin

Spontaneous hepatic rupture without underlying liver diseases is uncommon entity. We report a rare case of spontaneous rupture of liver hematoma in patient treated with warfarin end enoxaparin sodium because of pulmonary embolism. Two day after admission the patient complained generalized abdominal pain and hemodynamic instability. The abdominal US and TC scan revealed free fluid and lesion at right liver lobe. The patient, despite intravenous fluid support and blood transfusion, was hemodinamically instable and urgent laparotomy was needed. At laparotomy, it was found that a subcapsular haematoma, involving the diaphragmatic face of the right liver, had ruptured into peritoneum. Hepatic bleeding was stopped using a conservative approach by Pringle manoeuvre, parenchymal suture and fibrin sealant. There was no complication related to hepatic surgery but the patient died because of new massive pulmonary embolism 10 days after surgery. The absence of underlying liver pathology was confirmed by autopsy examination. This case report suggests that the possibility of spontaneous liver rupture should be considered in patients being treated with oral anticoagulants. Early diagnosis are critically important given the high morbidity and mortality. Aggressive resuscitation and immediate exploratory laparotomy is needed when hemodynamic instability occurs. In our case a quick, safe and effective control of bleeding was provided by partial vascular occlusion, parenchymal suture and topical haemostatic agent.. Anticoagulant therapy, Araumatic hemoperitoneum, Liver hematoma.. La rottura spontanea di fegato in assenza di malattie epatiche concomitanti è un evento abbastanza raro. Nel nostro lavoro illustriamo un raro caso di rottura spontanea di fegato in un paziente in trattamento con warfarin ed enoxaparina sodica a causa di una embolia polmonare. Due giorni dopo la dimissione il paziente lamentava dolori addominali generalizzati e presentava instabilità emodinamica. L’ecografia addominale e la TC addome mostravano versamento libero in addome ed una lesione a carico del fegato destro. Nonostante la terapia infusionale di supporto e le trasfusioni, il paziente continuava ad essere instabile da un punto di vista emodinamico; si decideva pertanto di eseguire una laparotomia d’urgenza. Alla apertura della cavità addominale vi è stato il riscontro di un ematoma sotto-glissoniano che coinvolgeva la faccia diaframmatica del fegato di destra e che si era aperto in addome. Il sanguinamento è stato controllato con approccio conservativo utilizzando la manovra di Pringle, sutura del parenchima ed uso di emostatici. Non si sono osservate complicanze correlate all’intervento ma il paziente è deceduto a causa di un nuovo episodio di embolia polmonare massiva, in decima giornata postoperatoria. L’esame autoptico ha confermato l’assenza di patologie epatiche concomitanti. La possibilità di una rottura spontanea di fegato andrebbe sempre considerata in pazienti in trattamento con anticoagulanti. La diagnosi precoce è fondamentale date l’alta morbilità e mortalità. Una terapia rianimatoria aggressiva ed una laparotomia esplorativa d’urgenza sono indicate in caso di instabilità emodinamica. Nel nostro caso, un rapido e sicuro controllo dell’emostasi sono stati possibili grazie ad una emostasi compressiva, sutura diretta del parenchima ed uso di emostatici.

Topics: Anticoagulants; Drug Therapy, Combination; Enoxaparin; Fatal Outcome; Hematoma; Hepatectomy; Humans; Liver Diseases; Pulmonary Embolism; Recurrence; Rupture, Spontaneous; Warfarin

Non-vitamin K antagonist oral anticoagulant (NOAC) use has significantly reduced intracerebral hemorrhagic (ICH) risk compared with standard anticoagulant treatment. Hematoma expansion (HE) is a known predictor of mortality in warfarin-associated ICH. Little is known about HE in patients using NOACs.. We conducted a retrospective chart review of patients with ICH admitted to Cedars-Sinai Medical Center from October 2010 to June 2016. We identified patients with concomitant administration of an oral anticoagulant and collected data including evidence of HE on imaging and modified Rankin Scale (mRS) at discharge. We defined HE as relative (≥33% increase) or absolute expansion (≥12 mL). We compared outcomes of patients with and without HE.. Out of 814 patients with ICH who were admitted, we identified 9 patients with recent NOAC use and 18 intentionally matched controls on warfarin. We found no significant differences in National Institutes of Health Stroke Scale or ICH score on presentation (median [interquartile range] 15 [5,21] versus 7 [1.25,19.5] [P = .41] and 2 [1,4] versus 1 [1,3] [P = .33]) between patients on NOACs and those on warfarin. Four out of the 9 patients on NOAC and 5 of the 18 patients on warfarin demonstrated HE, with no significant difference (P = .42). There were no significant differences in mRS on discharge between groups (P = .52).. In our coagulopathic NOAC patient population, HE occurs within 6 hours in 44% of patients. This case series did not have sufficient statistical power to detect significant differences between the groups. To our knowledge, this is one of the largest case series reporting on HE with concomitant NOAC use.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Cerebral Hemorrhage; Disability Evaluation; Female; Hematoma; Humans; Los Angeles; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Risk Factors; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

Intracerebral hemorrhage (ICH) during oral anticoagulation therapy with an oral vitamin K epoxidase reductase such as warfarin is a life-threatening complication. However, whether direct oral anticoagulants (DOACs) are associated with larger hematoma volume and higher mortality rates remains controversial. We evaluated the hematoma volume and pathophysiology of ICH during anticoagulation with warfarin or rivaroxaban, an orally active direct factor Xa inhibitor.. Mice were orally pretreated with rivaroxaban (10 or 30 mg/kg), warfarin (4 mg/kg), or vehicle. ICH was induced by intrastriatal collagenase-injection. Hematoma volume and neurological deficits 24 h after ICH induction were significantly decreased in the rivaroxaban-pretreated group in comparison with the warfarin-pretreated group. Rivaroxaban did not increase the hematoma volume relative to that observed for vehicle, and improved survival rate 7 days after ICH induction compared with warfarin.. We evaluated blood-brain barrier (BBB) permeability 6 h after ICH induction using Evans blue spectrophotometry. Evans blue extravasation was significantly reduced in the rivaroxaban group compared with the warfarin group. To investigate the mechanism underlying hematoma expansion and BBB permeability, we focused on thrombin, a clot-derived factor and one of the major contributors to ICH-induced brain injury. To investigate the effects of anticoagulant agents on thrombin-induced injuries, human brain endothelial cells were used in membrane permeability assays. Rivaroxaban, but not warfarin, significantly mitigated the thrombin-induced increase in membrane permeability.. These findings indicate that rivaroxaban decreases BBB disruption after ICH, and limits early hematoma expansion in these experimental models compared with warfarin. Our study suggests that rivaroxaban has advantages over warfarin with respect to ICH, an important complication during long-term anticoagulation therapy.

Topics: Animals; Anticoagulants; Blood-Brain Barrier; Cells, Cultured; Cerebral Hemorrhage; Disease Models, Animal; Electric Impedance; Endothelial Cells; Factor Xa Inhibitors; Hematoma; Isothiocyanates; Mice; Neurologic Examination; Permeability; Rivaroxaban; Treatment Outcome; Warfarin

The management of Dengue virus infection can be challenging. Varied presentations and numerous complications intrinsic to dengue by itself increase the complexity of treatment and potential mortality. When burdened with the presence of additional comorbidities and the need to continue compulsory medications, clear stepwise definitive guidance is lacking and patients tend to have more complex complications and outcomes calling to question the clinical decisions that may have been taken. The use and continuation of warfarin in dengue virus infection is one such example.. We report a 65 year old South Asian female who presented with dengue fever. She had a history bronchial asthma, a prior abdominal surgery, and was on warfarin and maintained a therapeutically appropriate internationalized normalized ratio for a mechanical aortic valve replacement. Though preemptive decision to stop warfarin was taken with decreasing platelet counts, her clinical course was complicated with the development of bilateral rectus sheath haematoma's requiring resuscitation with blood transfusions.. Though management of dengue viral fever has seen drastic evolution with recent updated guidance, clinical scenarios seen in the course of the illness still pose challenges to the managing physician. The need to continue obligatory anticoagulation which may seem counterintuitive during a complex disease such as dengue virus infection must be considered after understanding the potential risks versus that of its benefits. Though case by case decisions maybe warranted, a clear protocol would be very helpful in making clinical decisions, as the correct preemptive decision may potentially avert catastrophic and unpredictable bleeding events.

Topics: Aged; Anticoagulants; Aortic Valve; Dengue; Dengue Virus; Female; Heart Valve Diseases; Heart Valve Prosthesis; Hematoma; Hemorrhage; Humans; International Normalized Ratio; Muscle, Skeletal; Risk Factors; Warfarin

Warfarin is the most commonly used oral anticoagulant and is widely prescribed to prevent thromboembolic events. Warfarin-dependent spontaneous breast hematoma is a very rare complication. Presently described is rare case of warfarin-induced breast hematoma.

Topics: Anticoagulants; Breast; Female; Heart Failure; Hematoma; Humans; Middle Aged; Warfarin

This study aimed at identifying the determinants and prognostic significance of a sedimentation level (fluid-blood level) in the hematoma among patients with acute intracerebral hemorrhage (ICH) who participated in the main Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2).. Post-hoc analysis of the INTERACT2 dataset, a randomized controlled trial of patients with acute ICH with elevated systolic blood pressure (SBP), randomly assigned to intensive (target SBP <140 mm Hg) or guideline-based (<180 mm Hg) BP management. Patients with a sedimentation level at baseline assessment on CT, and modified Rankin Scale score at 90-day, were included in these analyses. Factors associated with a sedimentation level and its significance in relation to 90-day clinical outcomes were assessed in univariable and multivariable logistic regression models.. Of 2,065 participants, 19 (1%) had sedimentation level on baseline CT, which was independently associated with warfarin use (p = 0.006) and lobar ICH (p = 0.025). Sedimentation level was also associated with death or major disability at 90-day in both crude (84 vs. 53%; p = 0.014) and multivariable analyses adjusted for age, gender, Chinese region, warfarin use, baseline National Institutes of Health Stroke Scale score, onset to CT time, volume and location of ICH, intraventricular extension, and randomized intensive BP lowering (OR 3.94, 95% CI 1.01-15.37; p = 0.049).. The presence of hematoma sedimentation level on baseline CT is associated with warfarin use and lobar location of ICH, and predicts a worse outcome. Although uncommon, sedimentation level is an easily detectable prognostic factor in acute ICH.

Topics: Aged; Aged, 80 and over; Anticoagulants; Antihypertensive Agents; Cerebral Hemorrhage; Disease Management; Female; Hematoma; Humans; Hypertension; Logistic Models; Male; Middle Aged; Multivariate Analysis; Prognosis; Risk Factors; Tomography, X-Ray Computed; Warfarin

Warfarin is the oldest and most commonly used anticoagulant in the outpatient setting. Major bleeding events remain as the most life threatening complication of this medication. Bleeding into enclosed structures and body cavities can be fatal in acute scenarios or cause continuous exsanguination if left unnoticed. Pectoral haematomas are an unusual presentation of bleeding diathesis, and are also seldom reported in the literature. We present three cases of patients with development of spontaneous pectoral haematoma during therapy with warfarin alone or with heparin bridging in the treatment of atrial fibrillation and thromboembolism.

Topics: Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Female; Hematoma; Humans; Male; Thromboembolism; Warfarin

Topics: Aged; Anticoagulants; Connective Tissue Diseases; Hematoma; Humans; Lower Extremity; Male; Subcutaneous Tissue; Warfarin

The perioperative use of antithrombotic therapy is associated with increased bleeding risk after cardiac implantable electronic device (CIED) implantation. Topical application of tranexamic acid (TXA) is effective in reducing bleeding complications after various surgical operations. However, there is no information regarding local TXA application during CIED procedures. The purpose of our study was to evaluate bleeding complications rates during CIED implantation with and without topical TXA use in patients receiving antithrombotic treatment.. We conducted a retrospective analysis of consecutive patients undergoing CIED implantation while receiving warfarin or dual antiplatelet (DAPT) or warfarin plus DAPT treatment. Study population was classified in two groups according to presence or absence of topical TXA use during CIED implantation. Pocket hematoma (PH), major bleeding complications (MBC) and thromboembolic events occuring within 90 days were compared.. A total of 135 consecutive patients were identified and included in the analysis. The mean age was 60 ± 11 years old. Topical TXA application during implantation was reported in 52 patients (TXA group). The remaining 83 patients were assigned to the control group. PH occurred in 7.7 % patients in the TXA group and 26.5 % patients in the control group (P = 0.013). The MBC was reported in 5.8 % patients in the TXA and 20.5 % patients in control group (P = 0.024). Univariate logistic regression analysis identified age, history of recent stent implantation, periprocedural spironolactone use, periprocedural warfarin use, perioperative warfarin plus DAPT use, cardiac resynchronization therapy, and topical TXA application during CIED implantation as predicting factors of PH. Multivariate analysis showed that perioperative warfarin plus DAPT use (OR = 10.874, 95 % CI: 2.496-47.365, P = 0.001) and topical TXA application during CIED procedure (OR = 0.059, 95 % CI: 0.012-0.300, P = 0.001) were independent predictors of PH. Perioperative warfarin plus DAPT use and topical TXA application were also found to be independent predictors of MBC in multivariate analyses. No thromboembolic complications was recorded in the study group.. The present study demonstrated that the topical TXA application during CIED implantation is associated with reduced PH and MBC in patients with high bleeding risk.

Topics: Administration, Topical; Aged; Antifibrinolytic Agents; Blood Loss, Surgical; Chi-Square Distribution; Drug Administration Schedule; Drug Therapy, Combination; Female; Fibrinolytic Agents; Hematoma; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Platelet Aggregation Inhibitors; Prosthesis Implantation; Retrospective Studies; Risk Factors; Time Factors; Tranexamic Acid; Treatment Outcome; Warfarin

A 73-year-old man with chronic kidney disease stage G5 was admitted to our hospital because of a worsening kidney dysfunction. He had undergone prosthetic valve replacement of the mitral valve 5 years previously and was currently taking warfarin. He showed excessive anticoagulation on admission, with a prothrombin time-international normalized ratio (PT-INR) of 3.91. The use of warfarin was ceased and PT-INR decreased to 2.1. Since the patient would need renal replacement therapy, he underwent arteriovenous fistula surgery for hemodialysis access on day 16. However, on day 18, he suddenly complained of lumbago and went into shock. His blood pressure dropped to 73/49 mmHg, and the hemoglobin level fell to 4.9 g/dL. Computed tomography revealed a huge retroperitoneal hematoma. Emergent lumbar artery embolization was performed on two consecutive days; however, the bleeding persisted, with subsequent development of abdominal compartment syndrome with impaired respiratory and cardiovascular function, and the patient died. Autopsy revealed a hematoma measuring 30×20×20 cm involving the psoas muscle and external iliac artery; the hematoma was covered with fibrous tissue instead of muscle. The psoas muscle is supplied by the internal iliac artery; however, a collapsed artery could not be confirmed in our patient. The closest major artery to the hematoma was located at the intersection of the psoas muscle and the external iliac artery. All arteries showed severe atherosclerosis. In patients with advanced chronic kidney disease, anticoagulant therapy should be administered carefully, and the etiology of retroperitoneal hematoma should be further investigated.

Topics: Aged; Anticoagulants; Arteriovenous Shunt, Surgical; Autopsy; Embolization, Therapeutic; Fatal Outcome; Hematoma; Humans; Iliac Artery; International Normalized Ratio; Male; Prothrombin Time; Renal Dialysis; Renal Insufficiency, Chronic; Retroperitoneal Space; Tomography, X-Ray Computed; Warfarin

The neuroradiological findings and its outcomes of intracerebral hemorrhage (ICH) were compared between the non-vitamin K antagonist oral anticoagulant (NOAC) therapy and warfarin therapy. In the latest 3 years, 13 cases of nonvalvular atrial fibrillation on NOAC therapy were admitted for ICH. For comparison, 65 age- and gender-comparable patients with ICH on warfarin therapy were recruited. Three NOACs had been prescribed: dabigatran (n = 4), rivaroxaban (n = 2), and apixaban (n = 7). The average ages were 76 ± 9 and 78 ± 8 years in the warfarin (n = 65) and NOAC groups (n = 13), respectively. There was no difference in the clinical features, including the CHADS2 score or HAS-BLED score: 2.62 ± 1.31 versus 2.62 ± 1.33, or 1.09 ± 0.43 versus 1.00 ± 0.41, for the warfarin and NOAC groups, respectively. The volume of ICH <30 ml was found in 84.6% of the patients on NOACs, but it was found in 53.8% of the patients on warfarin (p = 0.0106). The expansion of hematoma was limited to 7 patients (10.8%) of the warfarin group. A lower hospital mortality and better modified Rankin Scale were observed in the NOAC group than in the warfarin group: 1 (7.7%) versus 27 (41.5%; p = 0.0105) and 3.2 ± 1.4 versus 4.5 ± 1.6 (p = 0.0057), respectively. In conclusion, ICH on NOAC therapy had smaller volume of hematoma with reduced rate of expansion and decreased mortality compared with its occurrence on warfarin.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Antithrombins; Atrial Fibrillation; Brain; Case-Control Studies; Cerebral Hemorrhage; Dabigatran; Factor Xa Inhibitors; Female; Hematoma; Hospital Mortality; Humans; Male; Pyrazoles; Pyridones; Retrospective Studies; Rivaroxaban; Stroke; Tomography, X-Ray Computed; Warfarin

Implantable cardioverter defibrillator (ICD) implantation is being performed differently at many hospitals, with some keeping patients overnight after procedure while others discharge patients home same day. In addition, many centers are now performing ICD surgery while on warfarin anticoagulation. There are, however, limited data on outpatient ICD surgery on anticoagulated (AC) patients.. We wished to evaluate the safety of performing outpatient ICD surgery with and without warfarin anticoagulation.. We evaluated 866 patients who underwent outpatient ICD surgery between April 2010 and September 2014. Patients who were on novel oral anticoagulants, or did not have an international normalized ratio drawn within 24 hours of the procedure were excluded and the remainder were divided into two groups based on whether they were on (n = 230) or off (n = 518) warfarin anticoagulation. We evaluated both procedural and 30-day complications in both groups.. The complication rate at 30 days in the warfarin AC group was 4.3%, while in the nonanticoagulated (NAC) group was 2.9% and not significantly different (P = 0.31). However, the pocket hematoma rate in the warfarin anticoagulated group was 3.5%, as compared to the NAC group that was 0.4% (P = 0.001).. Complications from ICD surgery are low in the ambulatory setting on or off warfarin anticoagulation and appear to be comparable. However, warfarin use during ICD surgery is associated with an increased risk of pocket hematoma.

Topics: Aged; Ambulatory Care; Anticoagulants; Defibrillators, Implantable; Female; Hematoma; Humans; Male; Postoperative Complications; Prosthesis Implantation; Safety; Warfarin

Children with conditions requiring chronic warfarin therapy have increased. The importance of receiving immunizations in this population is magnified due to potential weakness in their immune response. There is concern about immunizing on therapeutic anticoagulation due to risk of hematomas and the influence of vaccine on warfarin metabolism. This study evaluated the influence of vaccines on warfarin effect as measured by the International Normalized Ratio and the clinically relevant hematomas or bruising postimmunization. There were no clinically relevant negative outcomes postimmunizations. This study demonstrates that immunizations may be safely administered to children receiving therapeutic warfarin therapy.

Topics: Adolescent; Child; Child, Preschool; Cohort Studies; Drug Interactions; Female; Hematoma; Humans; Immunization; Infant; Male; Vaccines; Warfarin

Topics: Aged; Anticoagulants; Hematoma; Humans; Liver; Male; Warfarin

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Administration, Ophthalmic; Anticoagulants; Drug Substitution; Endoscopy, Gastrointestinal; Esophageal Diseases; Female; Follow-Up Studies; Heart Valve Prosthesis Implantation; Hematoma; Humans; Middle Aged; Mitral Valve; Mitral Valve Stenosis; Pantoprazole; Radiography, Thoracic; Rheumatic Diseases; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

The aim of the present study was to assess the safety of cardiac rhythm device implantation during uninterrupted oral anticoagulant therapy.. Patients at high thromboembolic risk (venous thromboembolism <3 months, nonvalvular atrial fibrillation with CHADS2 score >2, valvular atrial fibrillation, prosthetic heart valves) underwent procedures during uninterrupted warfarin (on warfarin group) and were compared to low-risk patients who underwent procedures after warfarin withdrawal (off warfarin group). Primary endpoint was a composite of hematoma requiring warfarin interruption, reoperation, or blood transfusion; death; hemothorax; and tamponade. Secondary endpoints were nonsignificant hematoma and clinical arterial thromboembolism assessed at discharge and at a 2 month follow-up.. One hundred and ninety-one patients were enrolled, 102 in the 'on warfarin group' and 89 in the 'off warfarin group'. The majority of procedures were first implants (73% in the 'on warfarin group' vs. 87% in the 'off warfarin group', P= 0.01). Pacemakers, implantable cardioverter defibrillators, and biventricular devices were included. International normalized ratio at implant was 2 ± 0.28 (range 1.6-3.2) in the 'on warfarin group' and 1.3 ± 0.19 (range 1-1.6) in the 'off warfarin group' (P= 0.0001). Incidence of hemathoma was five of 102 in the 'on warfarin group' vs. three of 89 in the 'off warfarin group' (5 vs. 3%, P = not significant) and all hemathomas resolved spontaneously. There were no significant hemathomas in either group. There was no death, hemothorax, or tamponade. There were no thromboembolic events at 2 months.. Cardiac rhythm device implantation during uninterrupted warfarin was not associated with increased bleeding compared with warfarin interruption.

Topics: Aged; Aged, 80 and over; Anticoagulants; Defibrillators, Implantable; Drug Administration Schedule; Feasibility Studies; Female; Follow-Up Studies; Hematoma; Humans; Male; Middle Aged; Pacemaker, Artificial; Perioperative Care; Postoperative Hemorrhage; Prospective Studies; Prosthesis Implantation; Thromboembolism; Warfarin

Little is known about the pathophysiology of oral anticoagulation-associated intracerebral hemorrhage (OAC-ICH). We compared hematoma volume, number of terminal deoxynucleotidyl dUTP nick-end labeling (TUNEL)-positive cells (indicating cell death), MMP-9 levels, and perilesional edema formation between warfarin-treated mice and controls. Intracerebral hemorrhage was induced by an injection of collagenase into the right striatum. Twenty-four hours later, hematoma volume was measured using a photometric hemoglobin assay. Cell death was quantified using TUNEL staining. MMP-9 levels were determined by zymography, and edema formation was assessed via the wet-dry method. Warfarin increased hematoma volume by 2.6-fold. The absolute number of TUNEL-positive cells in the perihematomal zone was lower in warfarin-treated animals (300.5 ± 39.8 cells/mm2) than in controls (430.5 ± 38.9 cells/mm2; p = 0.034), despite the larger bleeding volume. MMP-9 levels were reduced in anticoagulated mice as compared to controls (p = 0.018). Perilesional edema formation was absent in warfarin mice and modestly present in controls. Our results suggest differences in the pathophysiology of OAC-ICH compared to intracerebral hemorrhage occurring under normal coagulation. A likely explanation is that thrombin, a strong inductor of apoptotic cell death and blood-brain barrier disruption, is produced to a lesser extent in OAC-ICH. In humans, however, we assume that the detrimental effects of a larger hematoma volume in OAC-ICH by far outweigh potential protective effects of thrombin deficiency.

Topics: Animals; Anticoagulants; Brain Edema; Cell Death; Cerebral Hemorrhage; Disease Models, Animal; Drug Administration Schedule; Hematoma; In Situ Nick-End Labeling; Male; Matrix Metalloproteinase 8; Matrix Metalloproteinase 9; Mice; Neurologic Examination; Statistics, Nonparametric; Warfarin

The American Heart Association/American College of Cardiology Foundation recommends vitamin K1 for warfarin-related coagulopathy. In Japan, vitamin K2 is used more commonly for such purpose. The difference between vitamins K1 and K2 in reversing warfarin-related coagulopathy has not been discussed. Herein, we report a case that was reversed with vitamin K2; alterations in vitamins K1 and K2 levels and coagulation markers are also presented.

Topics: Aged, 80 and over; Anticoagulants; Antifibrinolytic Agents; Arm; Blood Coagulation Disorders; Female; Hematoma; Humans; Radiography; Thoracic Wall; Vitamin K 2; Warfarin

Topics: Anticoagulants; Canada; Cost-Benefit Analysis; Defibrillators, Implantable; Hematoma; Heparin; Humans; Length of Stay; Pacemaker, Artificial; Perioperative Period; Randomized Controlled Trials as Topic; Thromboembolism; Warfarin

Topics: Abdominal Pain; Aged; Anemia; Anticoagulants; Erythrocyte Transfusion; Female; Hematoma; Humans; International Normalized Ratio; Muscular Diseases; Rectus Abdominis; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

Spontaneous iliopsoas muscle haematoma is an infrequent complication of anticoagulation, potentially causing neurological dysfunction through compression of the femoral nerve or lumbar plexus. The authors report the case of a puerperal woman admitted for an extensive cerebral venous thrombosis. Anticoagulation was started, with clinical improvement. The patient later reported low back pain irradiating to the right thigh and developed neurological impairment consistent with lumbar plexus dysfunction. A pelvic CT scan revealed a right iliopsoas muscle haematoma. Considering the risk of anticoagulation suspension, a conservative approach was chosen, with maintenance of anticoagulation. Clinical and functional improvement occurred, with mild right hip and knee flexion paresis as sequelae. Anticoagulation complications are challenging, especially when interruption of anticoagulation may threaten vital and functional outcomes. Therefore, a careful evaluation is essential, since no clinical guidelines are available. In this case, continuing anticoagulation provided a good functional outcome.

Topics: Adult; Anticoagulants; Female; Hematoma; Humans; Intracranial Thrombosis; Psoas Muscles; Rare Diseases; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

Lack of specific antidotes is a major concern in intracerebral hemorrhage (ICH) related to direct anticoagulants including dabigatran (OAC-ICH). We examined the efficacy of idarucizumab, an antibody fragment binding to dabigatran, in a mouse model of OAC-ICH. Dabigatran etexilate (DE) dose-dependently prolonged diluted thrombin time and tail-vein bleeding time, which were reversed by idarucizumab. Pretreatment with DE increased intracerebral hematoma volume and cerebral hemoglobin content. Idarucizumab in equimolar dose prevented excess hematoma expansion for both DE doses. In more extensive ICH, idarucizumab significantly reduced mortality. Thus, idarucizumab prevents excess intracerebral hematoma formation in mice anticoagulated with dabigatran and reduces mortality.

Topics: Animals; Antibodies, Monoclonal, Humanized; Anticoagulants; Antithrombins; Benzimidazoles; beta-Alanine; Bleeding Time; Blood Coagulation; Brain; Cerebral Hemorrhage; Dabigatran; Disease Models, Animal; Hematoma; Mice; Thrombin Time; Warfarin

Topics: Adenocarcinoma, Clear Cell; Anticoagulants; Female; Hematoma; Humans; Magnetic Resonance Imaging; Middle Aged; Ovarian Neoplasms; Peritoneal Diseases; Pulmonary Embolism; Tomography, X-Ray Computed; Warfarin

A patient started anticoagulation for secondary prevention of stroke, achieving a prothrombin time-international normalized ratio within the optimal therapeutic range. The patient subsequently complained of pain in the left thigh on hospital day 25, and ultrasonography showed a large intramuscular hematoma in the left hamstring. The intramuscular hematoma gradually reduced without surgical intervention. Ultrasound examination plays an important role in precisely diagnosing intramuscular hematoma and monitoring changes in hematoma size.

Topics: Aged; Anticoagulants; Biomechanical Phenomena; Hematoma; Humans; Male; Muscle, Skeletal; Muscular Diseases; Stress, Mechanical; Thigh; Ultrasonography; Warfarin

We describe a case of a patient on warfarin who developed an extensive haematoma after a hip hemiarthroplasty and was successfully treated with embolisation. This case highlights the importance of regular haematology input, careful consideration of a suitable surgical approach, close monitoring of postoperative wounds in patients on warfarin and the emerging role of embolisation.

Topics: Aged, 80 and over; Arthroplasty, Replacement, Hip; Buttocks; Embolization, Therapeutic; Female; Femoral Neck Fractures; Fracture Fixation, Internal; Hematoma; Hemiarthroplasty; Hip; Hip Fractures; Hip Joint; Hip Prosthesis; Humans; Iliac Artery; Postoperative Complications; Warfarin

Topics: Anticoagulants; Hematoma; Humans; Kidney Failure, Chronic; Kidney Transplantation; Postoperative Complications; Prognosis; Retrospective Studies; Risk Factors; Warfarin

Warfarin is an anticoagulant used in a variety of clinical indications and may rarely cause severe bleeding that can be life-threatening. Although intramuscular bleeding frequently occurs, secondary to trauma, it can be induced in cases with bleeding tendency. Hematoma is often treated with conventional methods. However, surgical decompression can also be applied. In this article, we report a case of gastrocnemius intramuscular hematoma, which was successfully treated with intracavitary tissue plasminogen activator that was recently used in the treatment of abdominal and pelvic abscess.

Topics: Aged; Anticoagulants; Hematoma; Humans; Male; Muscles; Tissue Plasminogen Activator; Warfarin

Topics: Anticoagulants; Defibrillators, Implantable; Hematoma; Humans; Preoperative Care; Warfarin

Topics: Anticoagulants; Defibrillators, Implantable; Female; Hematoma; Heparin; Humans; Male; Pacemaker, Artificial; Warfarin

Topics: Aspirin; Drug Interactions; Hematoma; Humans; Laryngoscopy; Male; Middle Aged; Mouth Diseases; Pharyngitis; Warfarin

An 84-year-old male on oral steroids, coumadin and multiple antiplatelets for stented superficial femoral artery presented to our hospital with chest oppression. His CT scan showed cardiac tamponade with periaortic hematoma. At first, sealed rupture of aortic dissection with thrombosed false lumen was suspected. However, delayed enhancement view revealed extravasation of contrast agent, which appeared to drain into the pericardium or pericardial space. Emergency thoracotomy revealed normal aorta with several small spurting vessels of pulmonary side of the pericardium. To the best of our knowledge, this is the first reported case in the literature of a parietal pleural hematoma without known cause such as malignancy or hematologic disorders.

Topics: Aged, 80 and over; Aortic Aneurysm; Aortic Dissection; Cardiac Tamponade; Coronary Restenosis; Drug Therapy, Combination; Hematoma; Humans; Male; Platelet Aggregation Inhibitors; Steroids; Tomography, X-Ray Computed; Warfarin

Despite extensive studies of supratentorial intracerebral hemorrhage (ICH), limited data are available on determinants of hematoma volume in infratentorial ICH. We therefore aimed to identify predictors of infratentorial ICH volume and to evaluate whether location specificity exists when comparing cerebellar to brainstem ICH.. We undertook a retrospective analysis of 139 consecutive infratentorial ICH cases (95 cerebellar and 44 brainstem ICH) prospectively enrolled in a single-center study of ICH. ICH volume was measured on the CT scan obtained upon presentation to the Emergency Department using an established computer-assisted method. We used linear regression to identify determinants of log-transformed ICH volume and logistic regression to evaluate their role in surgical evacuation.. Median ICH volumes for all infratentorial, cerebellar, and brainstem ICH were nine [interquartile range (IQR), 3-23], ten (IQR, 3-25), and eight (IQR, 3-19) milliliters, respectively. Thirty-six patients were on warfarin treatment, 31 underwent surgical evacuation, and 65 died within 90 days. Warfarin was associated with an increase in ICH volume of 86 % [β = 0.86, standard error (SE) = 0.29, p = 0.003] and statin treatment with a decrease of 69 % (β = -69, SE = 0.26, p = 0.008). Among cerebellar ICH subjects, those on warfarin were five times more likely to undergo surgical evacuation (OR = 4.80, 95 % confidence interval 1.63-14.16, p = 0.005).. Warfarin exposure increases ICH volume in infratentorial ICH. Further studies will be necessary to confirm the inverse relation observed between statins and ICH volume.

Topics: Aged; Anticoagulants; Brain Stem Hemorrhage, Traumatic; Cerebellar Diseases; Cerebral Hemorrhage; Female; Hematoma; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Middle Aged; Radiography; Retrospective Studies; Treatment Outcome; Warfarin

We asked whether patients under long-term warfarin and managed with current guidelines regarding bridging therapy have a higher complications rate within ninety days following total knee arthroplasty. We retrospectively identified 38 patients under long-term warfarin. They were match-paired with 76 control patients. Our results showed a significant increased rate of complications (42.1% vs. 6.9%, P < 0.001) and re-operation (21.1% vs. 5.2%, P < 0.001) in the warfarin group. The difference was related to the number of hematomas requiring surgical evacuation. The warfarin group had a significantly higher rate of blood loss, blood transfusion, and length of hospital stay. Our data suggest that current guidelines for preoperative warfarin management are associated with a high rate of bleeding complications and reoperations following TKA.

Topics: Aged; Aged, 80 and over; Anticoagulants; Arthroplasty, Replacement, Knee; Blood Transfusion; Comorbidity; Female; Hematoma; Hemorrhage; Heparin, Low-Molecular-Weight; Humans; Length of Stay; Male; Morbidity; Postoperative Complications; Reoperation; Retrospective Studies; Warfarin

Topics: Aged, 80 and over; Anemia; Antibiotics, Antitubercular; Anticoagulants; Drug Interactions; Hematoma; Humans; Male; Muscular Diseases; Polypharmacy; Rifampin; Risk; Warfarin

Topics: Abdominal Wall; Anticoagulants; Gastrointestinal Hemorrhage; Hematoma; Humans; Male; Middle Aged; Warfarin

Topics: Aged, 80 and over; Anticoagulants; Bronchoscopy; Comorbidity; Diagnosis, Differential; Female; Hematoma; Humans; Intubation, Intratracheal; Tongue Diseases; Warfarin

Topics: Anticoagulants; Crohn Disease; Diagnosis, Differential; Female; Gastrointestinal Hemorrhage; Hematoma; Hemoperitoneum; Humans; Ileal Diseases; Male; Middle Aged; Radiography; Warfarin

Intramural hematomas of the colon are rare. Intramural hematomas of the gastrointestinal tract often result from blunt trauma, although they may also occur spontaneously in patients taking anticoagulants or those with blood dyscrasia. Affected patients present with abdominal pain and lower gastrointestinal bleeding, as well as occasional signs of intestinal obstruction. The diagnosis is made using colonoscopy and abdominal CT. Resection of the involved bowel segment is accepted as the standard therapy; however, experience with conservative treatment has also been reported. We herein report the case of a 62-year-old woman taking warfarin who was diagnosed with a colonic intramural hematoma and completely recovered with conservative management.

Topics: Anticoagulants; Colon; Colonoscopy; Female; Fluid Therapy; Hematoma; Humans; Intestinal Obstruction; Middle Aged; Thrombosis; Tomography, X-Ray Computed; Warfarin

Topics: Anticoagulants; Crohn Disease; Hematoma; Humans; Male; Middle Aged; Retroperitoneal Space; Warfarin

Warfarin has a narrow therapeutic window and side effects include bleeding causing e.g. hospital admission and death. Monitoring of treatment and review of indication are mandatory. We report a case of more than four years of warfarin treatment without indication. Treatment was not discontinued due to inadequate medical record keeping and communication among health-care providers. Medical-record keeping should follow guidelines from the National Board of Health. In addition, clearly stated treatment duration and indication may prevent unwarranted or premature termination of treatment.

Topics: Aged; Anticoagulants; Hematoma; Humans; Male; Medical Records; Medication Errors; Patient Handoff; Time Factors; Warfarin

Warfarin is increasingly prescribed in the elderly population for a number of medical conditions. Pre-tibial haematomas are a common cause of morbidity in this group. The aim of the study was to identify the proficiency of INR monitoring at a primary care level in correlation with their recommended INR range and to study the treatment outcome in this group. A retrospective single-centre study of patients diagnosed with pre-tibial haematomas was conducted over a two-year period. Length of hospital stay, time delay until operative intervention, blood transfusion and warfarin reversal requirements, social care input and cost to the NHS were considered. A total of 62 patients were admitted with pre-tibial haematomas of which 20 were on Warfarin. Females were predominantly more affected (5.6:1). The mechanism of injury was as a result of minor trauma. The mean INR level was 3.8 with a standard deviation of 3.1. Mean length of hospital stay was 11 days with a standard deviation of 13.6. Nine patients required skin grafting. Average cost for the acute episode was £3500 per patient. INR levels were significantly outwith the target range causing substantial patient morbidity and imposing a significant financial burden on the NHS. Tighter regulation at a primary care level should help reduce this risk.

Topics: Aged; Aged, 80 and over; Ambulatory Care; Anticoagulants; Costs and Cost Analysis; Female; Hematoma; Humans; International Normalized Ratio; Length of Stay; Male; Retrospective Studies; Tibia; Treatment Outcome; Warfarin

Pocket hematoma is a troublesome complication associated with the implantation of cardiac implantable electronic devices (CIEDs). This study aims to determinate the risk factors of pocket hematoma complications in relation to different antithrombotic strategies and severity of thrombocytopenia in Chinese patients.. We conducted a retrospective study of 1093 consecutive patients undergoing implantation of CIEDs and divided them into 3 groups: no antithrombotic group (n = 512), continuing antiplatelet group (n = 477), and temporarily discontinuing warfarin with or without heparin bridging strategy (n = 104).. A pocket hematoma developed in 40 patients (3.7%). The temporarily discontinuing warfarin group (7.7%) had a higher incidence of pocket hematoma than no oral antithrombotic group (2.1%) and continuing antiplatelet group (4.4%) (P = 0.012). The dual antiplatelet group (16.2%) and the heparin bridging strategy group (14.0%) had significantly higher incidence of pocket hematoma compared with the no antithrombotic group (2.1%; P < 0.001, both). Patients having aspirin or clopidogrel alone had low incidence of pocket hematoma (3.9% and 1.2%, respectively), similar to the no antithrombotic group (P = not significant). Multivariate analysis revealed that dual antiplatelet agents (P = 0.004), heparin bridging strategy (P < 0.001), and moderate to severe thrombocytopenia (P = 0.007) were independent predictors for pocket hematoma complications.. The use of dual antiplatelet agents, heparin bridging strategy, and the presence of moderate to severe thrombocytopenia significantly increased the risk of pocket hematoma complications in the periprocedural period of CIED implant. Aspirin or clopidogrel alone did not increase the risk of pocket hematoma complications.

Topics: Aged; Aged, 80 and over; Anticoagulants; Aspirin; China; Clopidogrel; Cross-Sectional Studies; Defibrillators, Implantable; Drug Therapy, Combination; Female; Hematoma; Heparin; Humans; Incidence; Male; Middle Aged; Platelet Aggregation Inhibitors; Postoperative Complications; Retrospective Studies; Risk Factors; Thrombocytopenia; Ticlopidine; Warfarin

Periprocedural management of antiplatelet or anticoagulant therapy at the time of device implantation remains controversial.. We reviewed all cases for whom a pacemaker was implanted in our institution between January 2008 and June 2009. In addition, beginning in June 2009, we prospectively collected data from all patients admitted to our institution, for whom a pacemaker was placed. Clinical characteristics and anticoagulant/antiplatelet drug use were evaluated.. A total of 574 patients underwent a permanent pacemaker implantation. Of these, 20 patients (3.6%, 9 women) experienced a hematoma on pacemaker pocket site. Patients were aged between 35 and 79 years (mean 60.6 ± 12 years). The frequency of hematoma formation was significantly higher (p<0.001) in those who used warfarin than in those who did not. Aspirin (ASA), clopidogrel, dual antiplatelet therapy (DAT), and bridging to low-molecular-weight heparin (LMWH) did not increase the risk of hematoma formation (p>0.05). Eleven pocket revisions for hematoma evacuation were needed in 9 patients (1.6%), six of whom were on warfarin therapy (p>0.05). Co-morbidities were similar in patients with and without hematoma (p>0.05).. The frequency of hematoma is within acceptable ranges after pacemaker placement. The use of warfarin seriously increases the risk of hematoma. Bridging to LMWH safely prevents thromboembolism.

Topics: Adult; Aged; Anticoagulants; Cardiac Pacing, Artificial; Female; Hematoma; Heparin, Low-Molecular-Weight; Humans; Male; Middle Aged; Prospective Studies; Risk; Warfarin

Topics: Aged; Anticoagulants; Hematoma; Humans; Male; Pectoralis Muscles; Shock, Hemorrhagic; Warfarin

Topics: Anticoagulants; Defibrillators, Implantable; Hematoma; Humans; International Normalized Ratio; Pacemaker, Artificial; 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 use increases mortality in patients with intracerebral hemorrhage (ICH). Larger hematoma volume and infratentorial location are both major determinants of poor outcome in ICH. Although warfarin-associated intracerebral hemorrhages have greater volumes, there is uncertainty about the effects of location. We aimed to investigate the influence of warfarin on hematoma volume and location.. We conducted a retrospective study of all patients hospitalized for ICH at a large stroke center from October 2007 to January 2012. Initial CT scans were used to quantify hematoma volumes using the computer-assisted planimetric analysis. Univariate and multivariable analyses determined the influence of warfarin on hemorrhage location. Median regression analysis was performed to estimate the effects of INR on hematoma volumes.. We included 404 consecutive patients with ICH of whom 69 were on warfarin. Patients on warfarin had larger hematoma volumes (median 23.9mL vs. 14.2mL; P=0.046). In patients excessively anticoagulated with warfarin (defined as INR>3.0), compared with those in the therapeutic range, brainstem ICH was more frequent (24.0% vs. 6.1%; P=0.005). Patients with INR>3.0 had increased odds of infratentorial hemorrhage (OR 3.63; 95% CI 1.52-8.64; P=0.004) when compared to non-warfarin ICH patients. After adjustment for hematoma location, there was no significant association between INR and hematoma volume.. Patients with warfarin-associated ICH have a predilection for brainstem ICH. After adjustment for ICH location, no relationship between admission INR and hematoma volume was found.

Topics: Aged; Aged, 80 and over; Anticoagulants; Cerebral Hemorrhage; Female; Hematoma; Humans; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed; Warfarin

Topics: Abdominal Wall; Aged; Anti-Bacterial Agents; Anticoagulants; Aza Compounds; Blood Coagulation Tests; Drug Interactions; Drug Therapy, Combination; Female; Fluoroquinolones; Heart Valve Prosthesis; Hematoma; Hemoperitoneum; Humans; Mitral Valve Insufficiency; Moxifloxacin; Pneumonia, Bacterial; Quinolines; Thromboembolism; Tomography, X-Ray Computed; Warfarin

Nontraumatic spinal intradural extramedullary hematomas are extremely rare. When they occur, they can rapidly lead to spinal cord or cauda equina compression and have devastating consequences.. The aim here was to report a case of this rare phenomenon and discuss the etiology, imaging, management, and outcome of intradural hematomas.. We describe the case of a 76-year-old man on warfarin therapy who presented with severe lower back pain and flaccid paraparesis. Blood tests revealed an international normalized ratio of 6.0. A magnetic resonance imaging result suggested an intradural hematoma extending from L1 to L4 and compressing the spinal cord and cauda equina. Emergency surgical decompression revealed an extensive intradural extramedullary hematoma, which was evacuated. The patient showed only minor neurologic improvement 6 months postoperatively.. Coagulopathy-induced spinal hemorrhage should be included in the differential diagnosis for patients presenting with signs of acute spinal cord compression.

Topics: Aged; Anticoagulants; Decompression, Surgical; Dura Mater; Hematoma; Humans; Male; Spinal Cord Diseases; Warfarin

Topics: Anticoagulants; Defibrillators, Implantable; Female; Hematoma; Heparin; Humans; Male; Pacemaker, Artificial; Warfarin

Topics: Anticoagulants; Atrial Fibrillation; Female; Hematoma; Humans; Middle Aged; Tongue Diseases; Warfarin

Topics: Anticoagulants; Defibrillators, Implantable; Female; Hematoma; Heparin; Humans; Male; Pacemaker, Artificial; Warfarin

Topics: Anticoagulants; Defibrillators, Implantable; Female; Hematoma; Heparin; Humans; Male; Pacemaker, Artificial; Warfarin

Topics: Anticoagulants; Defibrillators, Implantable; Female; Hematoma; Heparin; Humans; Male; Pacemaker, Artificial; Warfarin

Topics: Anticoagulants; Defibrillators, Implantable; Female; Hematoma; Heparin; Humans; Male; Pacemaker, Artificial; Warfarin

Current guidelines recommend interrupting anticoagulation and bridging therapy with heparin or low-molecular-weight heparin for cardiac rhythm device surgeries in patients with high thrombotic risk. However, there are some studies that suggest continuing warfarin may be safe. The study by Birnie et al. investigates this important clinical question in a randomized controlled trial setting. They randomly assigned 681 patients with high thrombotic risk (5% or more per year), in 18 centers, to receive either stopping warfarin combined with heparin bridging (standard of care) or continued uninterrupted warfarin therapy for cardiac rhythm device surgery. The trial was terminated after a second prespecified interim analysis by the data and safety monitoring board. Clinically significant device-pocket hematoma was noted in 12 out of 343 patients (3.5%) in the uninterrupted warfarin group, compared with 54 out of 338 (16.0%) in the heparin-bridging group (relative risk: 0.19; 95% CI: 0.10-0.36; p < 0.001). Uninterrupted warfarin was associated with better patient satisfaction, and there was no significant difference in thromboembolic or surgical complications between the two groups. These results demonstrate that device surgeries can be safely performed with continued warfarin, and bridging with heparin is associated with high risk of device-pocket hematoma.

Topics: Anticoagulants; Defibrillators, Implantable; Female; Hematoma; Heparin; Humans; Male; Pacemaker, Artificial; Warfarin

Warfarin is widely used. Spontaneous bleeding is one of the complications of warfarin treatment. A 70-year-old man was admitted to the emergency room with right back pain. There was no history of trauma. He was using warfarin following a bypass graft. The patient's vital signs were stable. On physical examination, swelling at the level of the right scapula was detected. Laboratory findings showed that the international normalised ratio (INR) was ↑↑ (a very high reading) (1.47 1 month previously). There was no melena on rectal examination. A chest CT was performed to differentiate the swelling of the right scapula. Warfarin was stopped and vitamin K was administered. Fresh frozen plasma was initiated and the patient was hospitalised to the cardiovascular surgical service. The fact that use of warfarin in the elderly may increase the risk of spontaneous bleeding should be especially kept in mind.

Topics: Aged; Anticoagulants; Back Pain; Hematoma; Humans; Male; Scapula; Tomography, X-Ray Computed; Warfarin

Topics: Aged, 80 and over; Anti-Bacterial Agents; Anticoagulants; Cholangiopancreatography, Endoscopic Retrograde; Enterococcus faecium; Gram-Positive Bacterial Infections; Hematoma; Humans; Liver Diseases; Male; Pulmonary Embolism; Warfarin

Topics: Anticoagulants; Defibrillators, Implantable; Hematoma; Heparin; Humans; Pacemaker, Artificial; Randomized Controlled Trials as Topic; Warfarin

Topics: Anticoagulants; Defibrillators, Implantable; Hematoma; Heparin; Humans; Pacemaker, Artificial; Randomized Controlled Trials as Topic; Warfarin

Topics: Aged; Anticoagulants; Female; Hematoma; Humans; Quadriceps Muscle; 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

Topics: Anticoagulants; Hematoma; Humans; Male; Middle Aged; Tomography, X-Ray Computed; Warfarin

Topics: Anticoagulants; Hematoma; Humans; Laryngoscopy; Male; Middle Aged; Tongue Diseases; Warfarin

Topics: Aged; Aneurysm, False; Anticoagulants; Bleeding Time; Defibrillators, Implantable; Diagnosis, Differential; Echocardiography, Doppler; Factor VII Deficiency; Female; Femoral Artery; Follow-Up Studies; Hematoma; Hemorrhage; Humans; Postoperative Care; Risk Assessment; Thigh; Tomography, X-Ray Computed; Warfarin

Oral anticoagulant therapy with warfarin is commonly used to prevent thromboembolic event in patients at risk with atrial fibrillation [1]. Spontaneous intramural hematoma of small intestine is rare complication of anticoagulant therapy and occurs in patient who receives excessive warfarin that may result in potentially serious complications. Small bowel intramural hematoma secondary to warfarin therapy is a recognized complication [2]. In the present report, we report an unusual case of small bowel intramural hemorrhage secondary to anticoagulant therapy after abdominal massage. The emergency physicians should be aware that the potential spontaneous small bowel intramural hemorrhage in the patients has a high index of suspicion because most patients are treated nonoperatively with a good outcome.

Topics: Aged; Anticoagulants; Hematoma; Humans; Intestinal Obstruction; Jejunal Diseases; Male; Massage; Tomography, X-Ray Computed; Warfarin

Splenic injury (SI) is a rare complication after colonoscopy, but should be considered in the differential diagnosis of acute abdominal pain following this procedure. We report a case of delayed rupture and review pertinent literature. A 70-year-old patient on oral warfarin intake underwent colonoscopy that diagnosed obstructive rectal cancer and elongated colon conditioning the endoscope's passage. After 48 h, patient experienced sharp abdominal pain with mild peritoneal signs. Contrast-enhanced CT scan evidenced large amount of abdominal-free blood collection from grade II SI. Hypovolemic shock occurred following brief clinical observation. Urgent laparotomic splenectomy and contextual Hartmann's procedure were then carried out. Postoperative course was uneventful and definitive histology confirmed splenic subcapsular haematoma and locally advanced adenocarcinoma. Perforation and bleeding more likely occurred after colonoscopy, while few cases of SI are reported in literature since 1974. Traction on the splenocolic ligament and direct trauma has been advocated as possible causes. Peritoneal adhesions and splenic diseases usually are predisposing factors although not confirmed in our patient. Anticoagulant therapy favoured delayed filling up of subcapsular haematoma while bowel obstruction added further surgical challenge. Rapid onset of hemorrhagic shock required urgent splenectomy that remains the procedure of choice among the literature reviewed.

Topics: Aged; Anticoagulants; Biopsy; Colonoscopy; Contrast Media; Diagnosis, Differential; Hematoma; Humans; Male; Rectal Neoplasms; Spleen; Splenectomy; Tomography, X-Ray Computed; Warfarin

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Hematoma; Hematuria; Heparin, Low-Molecular-Weight; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Male; Mesalamine; Prednisolone; Pulmonary Embolism; Urinary Bladder Diseases; Warfarin

Spontaneous retroperitoneal hematoma (SRH) can be fatal, requiring immediate recognition and intervention. Current literature is limited, providing little direction in patient care.. To describe clinical characteristics of patients with SRH during an 8-year period.. Observational cohort study of all consecutive patients 18 years and older with SRH from January 2000 to December 2007. SRH was defined as unrelated to invasive procedures, surgery, trauma, or abdominal aortic aneurysm.. Of 346 patients screened, 89 were eligible. Median age was 72 years; 56.2% were male. Overall, 66.3% were anticoagulated: 41.6% on warfarin, 30.3% heparin, and 11.2% low-molecular-weight heparin; 30.3% were on antiplatelet therapy; 16.5% were taking both anticoagulant and antiplatelet medications; 15.3% were taking neither. Primary presentation to the Emergency Department was seen in 36%; 64% developed SRH during inpatient anticoagulation therapy. The most common symptom was pain: abdominal (67.5%), leg (23.8%), hip (22.5%), and back (21.3%); 10.1% were misdiagnosed upon their initial encounter. Computed tomography (CT) was performed in 98.8%, ultrasound in 22.1%, and magnetic resonance imaging in 3.5%. Of all subjects, 40.4% were managed in an intensive care unit; 24.7% underwent interventional radiology (IR) procedures and 6.7% surgical evacuation; 75.3% received blood transfusion. Mortality was 5.6% within 7 days, 10.1% within 30 days, and 19.1% within 6 months.. SRH is uncommon but potentially lethal, with a non-specific presentation that can lead to misdiagnosis. One-third of the cohort was not taking anticoagulants. CT was effective at identification. Most patients received aggressive management with transfusion or IR procedures.

Topics: Aged; Aged, 80 and over; Anticoagulants; Blood Transfusion; Chi-Square Distribution; Critical Care; Female; Hematoma; Heparin, Low-Molecular-Weight; Humans; International Normalized Ratio; Magnetic Resonance Imaging; Male; Middle Aged; Pain; Partial Thromboplastin Time; Platelet Aggregation Inhibitors; Radiology, Interventional; Retroperitoneal Space; Retrospective Studies; Statistics, Nonparametric; Tomography, X-Ray Computed; Warfarin

Based on an experimental model of warfarin-associated intracerebral hemorrhage, we investigated whether the rapid reversal of anticoagulation using prothrombin complex concentrates (PCC) or recombinant activated coagulation factor VII (rFVIIa) reduces hematoma volume.. Mice were orally pretreated with warfarin (2 mg/kg). Intracerebral hemorrhage was induced by collagenase injection into the right striatum. Forty-five minutes later, PCC (100 IE/kg), rFVIIa (1 mg/kg), or an equal volume of saline was administered intravenously. Hematoma volume after 24 hours was quantified using a photometric hemoglobin assay.. International normalized ratio was 4.3±0.4 in saline-treated mice, 0.9±0.1 in rFVIIa mice, and 1.4±0.2 in PCC mice. Intracerebral hemorrhage volume was 29.0±19.7 μL in the saline group (n=7), 8.6±4.3 μL in the rFVIIa group (n=6), and 6.1±1.8 μL in the PCC group (n=7; analysis of variance between-group differences P=0.004; post hoc rFVIIa versus saline P=0.021; PCC versus saline P=0.007). No significant difference was found between PCC- and rFVIIa-treated animals.. Our results suggest that PCC and rFVIIa are equally effective in restoring coagulation and preventing excessive hematoma growth in acute warfarin-associated intracerebral hemorrhage.

Topics: Animals; Blood Coagulation Factors; Brain; Cerebral Hemorrhage; Collagenases; Factor VII; Hematoma; Hemostasis; Male; Mice; Treatment Outcome; Warfarin

Topics: Aged; Airway Obstruction; Anticoagulants; Female; Hematoma; Humans; Mouth Diseases; Tongue Diseases; Warfarin

Intracerebral hemorrhage (ICH) is the most serious bleeding complication of vitamin K antagonist (VKA) therapy, carrying a high mortality. Rapid reversal of VKA in ICH is critical. Plasma therapy, the standard of care in the US, is not optimal. The ideal prothrombin complex concentrate (PCC) containing all vitamin K-dependent factors (VKDFs) is not available in the US. Therefore, the authors developed a Trauma Coumadin Protocol (TCP) consisting of a 3-factor PCC available in the US (which contains insufficient factor VII [FVII]) with a low-dose recombinant FVIIa to rapidly reverse VKA.. Forty-six patients treated with the TCP were retrospectively analyzed. Fourteen patients had pre- and post-TCP plasma samples collected to assess their VKDF increment. Eleven patients had measurable intraparenchymal hematomas, which were evaluated for expansion.. The mean pre- and post-TCP international normalized ratios (INRs) were 3.4 (median 2.9) and 1.0 (median 0.9), respectively. Once corrected, INR was maintained at < 1.3 during a patient's hospital stay. The pre-TCP median values of FII, FVII, FIX, and FX were 28%, 21%, 45%, and 20%, respectively; post-TCP median values increased to 144%, 417%, 102%, and 143%, respectively. Four of the 11 patients with measurable intraparenchymal hemorrhage had expansion at 24 hours after TCP. One patient probably (8 hours post-TCP) and 1 patient possibly (3 days post-TCP) had thrombotic complications.. The TCP was very effective in rapidly reversing VKA-associated coagulopathy; however, this protocol should be used cautiously in patients at high risk for thrombosis.

Topics: Adult; Aged; Anticoagulants; Blood Coagulation Factors; Cerebral Hemorrhage; Clinical Protocols; Drug Combinations; Factor VIIa; Female; Hematoma; Humans; International Normalized Ratio; Male; Middle Aged; Recombinant Proteins; Retrospective Studies; Vitamin K; Warfarin

Although needle electromyography (EMG) appears to be a relatively safe procedure based primarily on clinical experience, no evidence-based guidelines exist for EMG procedures in patients taking anticoagulant or antiplatelet medications. We sought to determine whether there is an increased risk of hematoma formation after EMG of potentially high-risk muscles in patients taking anticoagulant or antiplatelet agents.. After undergoing routine EMG, if any of seven predetermined high-risk muscles were tested, study subjects then underwent ultrasound to evaluate for hematoma formation.. Patients were divided into three groups based on medication (warfarin, aspirin/clopidogrel, no blood-thinning medication), with at least 100 muscles examined per group. Two small, subclinical hematomas were seen on ultrasound; there was no difference in hematoma risk between groups (P = 0.43).. Our findings suggest that hematoma formation from standard needle EMG is rare even in high-risk muscles, which have been avoided historically in anticoagulated patients.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Case-Control Studies; Clopidogrel; Electromyography; Female; Hematoma; Humans; Male; Middle Aged; Muscular Diseases; Needles; Platelet Aggregation Inhibitors; Prospective Studies; Risk Factors; Ticlopidine; Ultrasonography, Doppler; Warfarin; Young Adult

We describe a case of spontaneous sublingual haematoma secondary to warfarin toxicity, leading to impending airway obstruction. The case was handled with the administration of vitamin K and fresh frozen plasma, and without invasive airway handling. Furthermore, we discuss the presentation of the condition and the signs of impending airway obstruction. Preferred management includes a safe airway and reversion of coagulopathy. The prognosis is good when treatment is prompt and correct.

Topics: Administration, Oral; Aged; Airway Obstruction; Anticoagulants; Female; Hematoma; Humans; Mouth Floor; Warfarin

Topics: Aged; Anticoagulants; Hematoma; Humans; Intestinal Diseases; Intestine, Small; Male; Tomography, X-Ray Computed; Warfarin

An 81-year-old man on warfarin was admitted to hospital after 3 days of constipation, straining and mild rectal bleeding. A large, boggy mass was felt posteriorly on direct rectal examination. Investigations revealed a normocytic anaemia and a supratherapeutic international normalised ratio (INR). Fearing a late presentation of malignancy, an urgent CT of abdomen and pelvis was arranged which showed a homogeneous mass arising between the sacrum and the rectum. Given the anaemia in the presence of anticoagulation, and subsequent widespread perineal and scrotal ecchymosis, the patient was diagnosed with atraumatic presacral haematoma. Following resuscitation, the patient was managed non-operatively and was discharged several days later following stabilisation of the haemoglobin and INR. At 3 months, he had complete clinical and radiological resolution of this haematoma.

Topics: Aged, 80 and over; Anemia; Anticoagulants; Hematoma; Humans; International Normalized Ratio; Male; Rectal Diseases; Rectal Neoplasms; Sacrum; Tomography, X-Ray Computed; Warfarin

Topics: Aged, 80 and over; Anticoagulants; Colonoscopy; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Rectal Diseases; Warfarin

Spontaneous hematomas are rare and most occur secondary to hematologic disorders or during anticoagulant therapy. Most spontaneous hematomas occur above the sigmoid colon, and rarely in the rectum. Herein we present the case of a patient with a spontaneous perforating hematoma of the rectum who presented with severe abdominal pain after a bloody stool. The hemoglobin level decreased by 33 g/L within 20 h. An abdominal sonogram showed a hydrops in the lower abdomen with a maximum depth of 7.0 cm. A hematoma, 8 cm × 6 cm × 5 cm in size, was noted intra-operatively in the rectosigmoid junction, with a 1.5-cm perforation in the hematoma and active hemorrhage. Thus, a partial rectectomy and sigmoidostomy were performed. Three months later, a second operative procedure to re-establish intestinal continuity was performed. The patient is in good condition 12 mo after the last surgery. In addition to this case, the causes of spontaneous perforating hematomas and the treatment are discussed.

Topics: Anticoagulants; Gastrointestinal Hemorrhage; Hematoma; Humans; Male; Middle Aged; Rectal Diseases; Warfarin

One day after a minor accident, an 85-year-old man developed headache and proximal left leg weakness. He was on warfarin due to atrial fibrillation. On hospital admission, a right posterior parasagittal subdural haematoma that was visualised on CT was considered as cause of all symptoms. Although no surgical intervention was performed he stayed for 2 weeks in a neurosurgical ward. Clinical deterioration occurred within the first days as he was not able to stand on his left leg or rise up from the sitting position. Headache had ceased, but the patient reported low abdominal pain. This condition remained stable for over 2 months although haematoma size decreased significantly. He was then examined for the first time by a neurologist who documented typical clinical features of femoral nerve palsy. Pelvic CT established the diagnosis of traumatic iliacus- and iliopsoas-muscle haematoma under anticoagulants as cause of subacute femoral mononeuropathy.

Topics: Accidents, Traffic; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Femoral Nerve; Hematoma; Humans; Leg Injuries; Male; Muscle Weakness; Tomography, X-Ray Computed; Warfarin

Every year nearly 300 000 patients have heart valve operations and mostly prosthetic valves are inserted. Coumadin is the mainstay of therapy in these individuals but it has many side effects, mostly related to its anticoagulant effect. Rectus sheath haematoma (RSH) is a rare complication of abdominal trauma, surgery and excessive strain, however, anticoagulant agents may predispose to this condition without any precipitating event. Reversal of anticoagulation and resuscitation with fluids and blood products are necessary but anticoagulation is crucial in patients with prosthetic valves, as they have acquired thrombotic diathesis. Herein we report on a case of spontaneous RSH in a patient with prosthetic mitral and aortic valves and a history of prosthetic valve thrombosis. He was successfully managed medically.

Topics: Adult; Anticoagulants; Aortic Valve; Blood Transfusion; Coagulants; Fluid Therapy; Heart Valve Prosthesis Implantation; Hematoma; Hemorrhage; Humans; Male; Mitral Valve; Rectus Abdominis; Thrombosis; Treatment Outcome; Warfarin

Topics: Abdominal Pain; Adult; Anticoagulants; Aortic Valve; Heart Valve Prosthesis; Hematoma; Hemophilia A; Humans; Male; Muscular Diseases; Psoas Muscles; Tomography, X-Ray Computed; Warfarin

Many commonly prescribed drugs can interact with warfarin and prolong bleeding time beyond therapeutic limits. We report a patient who developed a rectus sheath haematoma following inadvertent over anticoagulation. Despite conservative management, the patient went on to develop large bowel obstruction from the expanding haematoma and operative intervention became necessary.

Topics: Aged; Anticoagulants; Female; Hematoma; Humans; Intestinal Obstruction; Radiography; Rectus Abdominis; Sigmoid Diseases; Warfarin

Topics: Aged, 80 and over; Anticoagulants; Female; Hematoma; Humans; International Normalized Ratio; Jejunal Diseases; Tomography, X-Ray Computed; Warfarin

We evaluated current oral anticoagulant management at our main dialysis unit and three satellite units against British Haematology Society (BHS) standards. These standards include patients meeting their target INR +/- 0.5 INR units for 60% of the time with an appropriate frequency of monitoring.. Data were collected on anticoagulant prescribing and monitoring over one month.. None of the four haemodialysis centres were able to achieve BHS standards for all patients. There was wide variability in monitoring frequency, some patients had 13 INRs and up to 10 dose changes. Satellite C had the most patients (63%) meeting BHS target. Satellite A and B both had 50% of patients meeting target. However, Satellite A, where all patients were dosed by anticoagulant clinic, had the least frequent blood sampling and no patients exceeded the therapeutic INR.. Units that employed dosing by anticoagulant clinics demonstrated best outcome for INR target with the least frequency of sampling. Service design set up and monitoring pathways play a crucial role in achieving warfarin therapeutic targets in haemodialysis units.

Topics: Administration, Oral; Anticoagulants; Hematology; Hematoma; Humans; International Normalized Ratio; Renal Dialysis; Societies, Medical; Treatment Outcome; United Kingdom; Warfarin

Iliopsoas haematoma is a rare complication that occurs in patients receiving anticoagulant therapy. The clinical manifestation of iliopsoas haematoma is non-specific. It can mimic orthopaedic or neurological disorders, including paraesthesia or paresis of the thigh and leg due to compression of the nerve plexus. Among the many available diagnostic modalities, computed tomography is the most useful radiological method for diagnosis. Treatment approaches for iliopsoas haematoma include conservative therapy, surgical intervention, or transcatheter arterial embolisation. Conservative therapy consists of bed rest, restoration of circulating volume, and drug discontinuation for correcting underlying coagulopathy. Although a conservative approach is the first choice, transcatheter arterial embolisation and surgical intervention may be required in patients with hemodynamically unstable and active bleeding. The report described a case of iliopsoas haematoma due to anticoagulant therapy with paraesthesia in the left leg who was successfully treated by conservative approach.

Topics: Abdominal Pain; Aged; Anticoagulants; Female; Femoral Nerve; Hematoma; Humans; Paresis; Psoas Muscles; Rare Diseases; Tomography, X-Ray Computed; Treatment Outcome; Vitamin K; Warfarin

Topics: Acupuncture Therapy; Aged, 80 and over; Anticoagulants; Female; Hematoma; Humans; Thigh; Warfarin

Topics: Abdominal Pain; Acute Disease; Aged, 80 and over; Anticoagulants; Female; Hematoma; Humans; Male; Muscular Diseases; Rectus Abdominis; Treatment Outcome; Warfarin

The number of cases involving patients undergoing vascular procedures who are prescribed clopidogrel or warfarin as treatment options continues to rise. Our aim was to examine outcomes related to antiplatelet or anticoagulation therapy in patients undergoing carotid endarterectomy (CEA).. A retrospective review of 260 consecutive patients undergoing CEA. Data including patient demographics, operative details, perioperative use of aspirin (ASA), clopidogrel, or warfarin, and early and/or late outcome(s) were collected. Endpoints included postoperative morbidity and/or mortality rate(s) and bleeding complications.. The study included 152 men and 108 women (mean age = 69.3 years), with a mean follow-up of 406 days. In all, 46% of endarterectomies were for a symptomatic disease. The technique of eversion endarterectomy was applied in 126 (48.5%), Dacron-patch in 112 (43.1%), and bovine pericardial-patch in 14 (5.4%) of the cases. Among the patients, 171 were taking ASA, 50 were taking clopidogrel ± ASA, and 10 were taking warfarin (mean INR = 1.62; range, 1.2-2.1); the remaining 29 were not on any antiplatelet therapy. All patients who were on warfarin therapy underwent an eversion endarterectomy. Overall, there were 19 (7.3%) complications (12 major and seven minor). The 30-day stroke rate and stroke death rate was 0.7% and 1.1%, respectively. Patients taking clopidogrel developed more number of neck hematomas (16% vs. 1.7%, p = 0.0004) compared with patients who were on ASA alone. For patients taking clopidogrel, Dacron-patch repair resulted in more hematomas than eversion endarterectomy (35% vs. 4.2%, p = 0.012). There was no difference in the incidence of neck hematoma on the basis of endarterectomy technique in patients who were on ASA alone. The patients taking warfarin neither had a perioperative complication nor developed a neck hematoma.. In this study, clopidogrel use during CEA resulted in a significant risk for developing a neck hematoma, particularly when using a Dacron-patch. The risk of a neck hematoma in patients who were on clopidogrel was much less when an eversion endarterectomy was performed.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Aspirin; Chi-Square Distribution; Clopidogrel; Endarterectomy, Carotid; Female; Hematoma; Humans; Male; Middle Aged; Minnesota; Myocardial Infarction; Platelet Aggregation Inhibitors; Postoperative Hemorrhage; Retrospective Studies; Risk Assessment; Risk Factors; Stroke; Ticlopidine; Time Factors; Treatment Outcome; Warfarin

Topics: Anticoagulants; Epiglottis; Hematoma; Humans; Laryngeal Diseases; Male; Middle Aged; Tomography, X-Ray Computed; Vocal Cords; Warfarin

intracerebral hemorrhage associated with oral anticoagulants has a poor prognosis. Current treatment guidelines are based on case series and plausibility only, and a common consensus on effective hemostatic therapy is missing. We compared the effectiveness of diverse hemostatic approaches in a mouse model of warfarin-associated intracerebral hemorrhage.. male C57BL/6 mice received anticoagulant treatment with warfarin (0.4 mg/kg for 3 days). Intracerebral hemorrhage was induced by striatal injection of collagenase, and 30 minutes later, mice received an intravenous injection of saline (200 μL n=15), prothrombin complex concentrate (100 U/kg, n=10), fresh-frozen plasma (200 μL, n=13), recombinant human Factor VII activated (3.5 mg/kg, n=8 and 10 mg/kg, n=8), or tranhexamic acid (400 mg/kg, n=12). Intracerebral hemorrhage volume was quantified on T2-weighted images after 24 hours.. mean hematoma volumes were 7.4 ± 1.8 mm(3) in the nonwarfarin controls and 21.9 ± 5.0 mm(3) in the warfarin group receiving saline. Prothrombin complex concentrate (7.5 ± 2.3 mm(3)) and fresh-frozen plasma (8.7 ± 2.1) treatment resulted in significantly smaller hematoma volume compared with saline. Recombinant human Factor VII activated (10 mg/kg: 14.7 ± 3.4; 3.5 mg/kg: 15.0 ± 6.8 mm(3)) and tranexamic acid (16.2 ± 4.1 mm(3)) were less effective. Water content in the hemorrhagic hemisphere was similar in all groups except for tranexamic acid in which it was significantly increased.. prothrombin complex concentrate and fresh-frozen plasma effectively prevent hematoma growth in murine warfarin-associated intracerebral hemorrhage, whereas Factor VIIa was less effective. Tranexamic acid exacerbates perihematoma edema in this mouse warfarin-associated intracerebral hemorrhage model.

Topics: Animals; Anticoagulants; Blood Coagulation Factors; Cerebral Hemorrhage; Collagenases; Disease Models, Animal; Factor VIIa; Hematoma; Hemostasis; Humans; Male; Mice; Plasma; Recombinant Proteins; Tranexamic Acid; Warfarin

The present study was carried out to determine the effect of prothrombin complex concentrate (PCC) on hematoma enlargement (HE) and the early clinical outcome of intracerebral hemorrhage (ICH) patients on long-term warfarin treatment.. The medical records and computed tomography (CT) images of 50 consecutive ICH patients on long-term warfarin treatment (35 men, 15 women; 69 ± 12 years old) were reviewed. International normalized ratio (INR) values, frequency of HE and clinical outcome were compared between patients treated with and without PCC.. INR values on admission were above 2.0 in 37 patients, of whom 19 were given PCC (PCC group) and 18 were not given PCC (control group). In these 37 patients, the frequency of HE (p = 0.017), the number of patients with a poor clinical outcome (modified Rankin Scale score ≥3 at 30 days or at discharge; p = 0.045) and in-hospital mortality (p = 0.042) were significantly higher in the control than in the PCC group. On multivariate logistic regression analysis with adjustment, PCC administration was independently associated (odds ratio 0.03, 95% confidence interval 0.00-0.63; p = 0.023) with a reduction in poor clinical outcome in ICH patients whose INR values were >2.0 on admission.. Immediate INR reversal with PCC may prevent HE and subsequent poor outcome.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anticoagulants; Blood Coagulation; Blood Coagulation Factors; Case-Control Studies; Cerebral Hemorrhage; Chi-Square Distribution; Coagulants; Female; Hematoma; Hospital Mortality; Humans; International Normalized Ratio; Japan; Logistic Models; Male; Middle Aged; Odds Ratio; Risk Assessment; Risk Factors; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Warfarin; Young Adult

Stabbing headache can be encountered in both primary and secondary forms, but has been infrequently reported among patients with stroke, and is not known to be associated with a small well-circumscribed brain lesion. A 95-year-old woman taking warfarin presented with the sudden onset of stabbing headache strictly in the right frontal and supraorbital regions, along with gait imbalance and dysarthria. Neuroimaging revealed a small left thalamic hematoma. This association of an acute thalamic lesion with stabbing headache in the contralateral trigeminal distribution is discussed, along with a brief review of stabbing headache occurring in cerebrovascular disease.

Topics: Acute Disease; Aged, 80 and over; Anticoagulants; Female; Headache Disorders, Primary; Hematoma; Humans; Intracranial Hemorrhages; Thalamus; Tomography, X-Ray Computed; Warfarin

Sublingual hematoma secondary to excessive anticoagulation is a rare, life-threatening condition. Reports in the literature have emphasized the importance of a prompt reversal of the causative coagulopathy by intravenous administration of vitamin K and fresh frozen plasma. In the event of an unstable airway, surgical intervention via tracheostomy or cricothyroidectomy is advocated. We report a case of sublingual hematoma that was treated conservatively, and we discuss the presentation and management of this entity.

Topics: Blood Transfusion; Diagnosis, Differential; Female; Hematoma; Humans; International Normalized Ratio; Ludwig's Angina; Middle Aged; Mouth Floor; Plasma; Vitamin K; Warfarin

A 61-year-old man receiving anticoagulant therapy after the aortic valve replacement underwent emergency surgery for acute appendicitis. Although the patient was intubated with difficulty, no immediate complications were evident after extubation. On the evening of the first postoperative day he complained of a sore throat, difficulty in swallowing and dysphonia. The swelling of the tongue with right-side predominance and the swelling of the right neck were observed. The right-sided sublingual hematoma was confirmed by CT. The symptoms improved with steroid administration. The possibility of airway obstruction due to hematoma of the tongue should be considered in patients on anticoagulant therapy.

Topics: Acute Disease; Airway Obstruction; Anticoagulants; Appendicitis; Dexamethasone; Emergencies; Hematoma; Humans; Infusions, Intravenous; Laryngoscopy; Male; Middle Aged; Mouth Floor; Treatment Outcome; Warfarin

Acute renal failure due to bilateral hematoma is a rare complication of anticoagulant warfarin therapy. A 43-year-old man presented with complaints of hematuria and abdominal pain. He had been receiving warfarin for six years, after placement of an aortic valve prosthesis. One week prior to admission, he sustained a urinary tract infection which was treated with third-generation cephalosporin and indomethacin. His serum creatinine level was 1.8 mg/dl with an INR of 15. Three days later, he developed anuria and was treated with hemodialysis. Renal ultrasonography disclosed moderate bilateral hydronephrosis. Computed tomography without contrast enhancement showed bilateral extensive hyperdense thickening of the renal and ureteral walls and high-attenuation areas. Conservative treatment was preferred and diuresis resumed spontaneously, lumbar pain disappeared, and serum creatinine level returned to normal. One month later, renal computed tomography was found normal.

Topics: Abdominal Pain; Acute Kidney Injury; Adult; Anticoagulants; Diagnosis, Differential; Emergency Treatment; Hematoma; Hematuria; Humans; Male; Radiography; Renal Dialysis; Warfarin

This is a rare case of a 68-year-old woman who was rehospitalized after uneventful redo double-valve surgery. An 8.3 × 12.9 × 16.4 cm tense right chest wall hematoma was diagnosed. This was precipitated by a single cough. Contrast-enhanced computed tomography revealed a bleeding source. Hematoma evacuation and hemostasis following emergency warfarin reversal produced an excellent outcome.

Topics: Aged; Anticoagulants; Cardiac Surgical Procedures; Contrast Media; Cough; Drainage; Female; Hematoma; Hemostatic Techniques; Humans; Predictive Value of Tests; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

The authors point to the risk of hypocoagulation by patients with colorectal carcinoma, who use warfarin.. 185 patients with colorectal cancer were examined for plattellets, prothrombin time and D-dimer.. Only 64 patients (35%) had haemocoagulation in the standard, 114 patients (61%) were hypercoagulable and only 7 patients (3.7%) were hypocoagulable. The authors present an interesting case report of a patient who used warfarin. This patient has ileos state by sigmoideal cancer, and in parallel a progressive intramural haematoma in the hepatic flexure of the colon.. Hypocoagulation state with an intramural haematoma of colon may be very dangerous complication for patients with colorectal cancer and ileos state. Very careful choice of surgical strategy is necessary.

Topics: Aged; Blood Coagulation Disorders; Colonic Diseases; Hematoma; Humans; Male; Sigmoid Neoplasms; Warfarin

Spontaneous intestinal hematoma is a rare complication of anticoagulant therapy, and small bowel obstruction caused by intramural hematoma secondary to anticoagulant therapy is even rarer. The first symptom is usually abdominal pain, frequently accompanied by nausea and vomiting. A history of anticoagulant use with prolonged international normalized ratios in patients presenting with abdominal pain should alert physicians to search for this entity. Typical findings on abdominal computed tomography yield the diagnosis. Early diagnosis is crucial because most patients are treated non-operatively with a good outcome. Herein, we present the non-enhanced and enhanced computed tomography findings of two cases who were admitted to the emergency clinic with acute abdominal pain and diagnosed as spontaneous intramural ileal hematomas and partial small bowel obstruction secondary to intramural ileal hemorrhage.

Topics: Abdominal Pain; Aged; Anticoagulants; Hematoma; Humans; Ileal Diseases; Intestinal Obstruction; Male; Middle Aged; Warfarin

Hematoma or abscess of the liver ligaments is extremely rare, and hematoma of the falciform ligament has been sporadically reported. We report the case of a 70-year-old female who presented with a three-day history of right upper quadrant abdominal pain, fever and nausea. With a preoperative diagnosis of probable perforated acalculous cholecystitis, the patient underwent emergency surgery. Hematoma of the falciform ligament was found. Wide excision of the falciform ligament including the hematoma with abscess was performed. Although pathology of the falciform ligament is rare, it should be included in the differential diagnosis of acute abdomen, especially in the case of antiaggregant drug usage.

Topics: Abdomen, Acute; Aged; Anticoagulants; Diagnosis, Differential; Female; Hematoma; Humans; Ligaments; Warfarin

Topics: Aged; Anticoagulants; Female; Hematoma; Humans; Orthopedic Procedures; Trigger Finger Disorder; Warfarin

We examined records of patients who underwent ultrasound-guided fine needle aspiration biopsy (USGFNAB) of neck lesions to determine whether there was a significantly increased incidence of bleeding complications in patients on antithrombotic and/or anticoagulant (AT/AC) medications compared to patients not receiving AT/AC therapy. Our institutional review board approved this Health Insurance Portability and Accountability Act-compliant retrospective examination of patients' medical data without requiring informed consent. The records of 593 patients (422 women and 171 men ranging from 18 to 91 years of age) who underwent USGFNAB of 788 total neck lesions over an 18-month period were reviewed to determine AT/AC medication used and evidence of USGFNAB-related bleeding complications. Of these, 144 patients (24.3%) were taking one or more AT/AC medications including aspirin, clopidogrel, heparin, and warfarin. The χ2 test was used to assess statistically significant differences in the incidence of USGFNAB-related bleeding complications between patients who were on daily AT/AC medications (test group) and patients who were not (control group). Six USGFNAB-related hematomas (1.0%) occurred. Two hematomas developed in patients on AT/AC medications, and 4 hematomas developed in patients who did not take AT/AC medications (χ = 0.27, df = 1, P = 0.603). This study shows no statistically significant difference in the incidence of hematoma formation after USGFNAB of neck lesions in patients taking AT/AC medications compared to patients not taking AT/AC medications. On the basis of these data, there is no benefit, with regard to incidence of bleeding complications, to discontinuing AT/AC medications in patients undergoing USGFNAB of neck masses.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anticoagulants; Aspirin; Biopsy, Fine-Needle; Chi-Square Distribution; Clopidogrel; Female; Head and Neck Neoplasms; Hematoma; Hemorrhage; Heparin; Humans; Male; Middle Aged; Retrospective Studies; Ticlopidine; Ultrasonography, Interventional; Warfarin

The direct thrombin inhibitor dabigatran etexilate (DE) may constitute a future replacement of vitamin K antagonists for long-term anticoagulation. Whereas warfarin pretreatment is associated with greater hematoma expansion after intracerebral hemorrhage (ICH), it remains unclear what effect direct thrombin inhibitors would have. Using different experimental models of ICH, this study compared hematoma volume among DE-treated mice, warfarin-treated mice, and controls.. CD-1 mice were fed with DE or warfarin. Sham-treated mice served as controls. At the time point of ICH induction, DE mice revealed an increased activated partial thromboplastin time compared with controls (mean±SD 46.1 ± 5.0 versus 18.0 ± 1.5 seconds; P=0.022), whereas warfarin pretreatment resulted in a prothrombin time prolongation (51.4 ± 17.9 versus 10.4 ± 0.3 seconds; P<0.001). Twenty-four hours after collagenase-induced ICH formation, hematoma volume was 3.8 ± 2.9 μL in controls, 4.8 ± 2.7 μL in DE mice, and 14.5 ± 11.8 μL in warfarin mice (n=16; Welch ANOVA between-group differences P=0.007; posthoc analysis with the Dunnett method: DE versus controls, P=0.899; warfarin versus controls, P<0.001; DE versus warfarin, P=0.001). In addition, a model of laser-induced cerebral microhemorrhage was applied, and the distances that red blood cells and blood plasma were pushed into the brain were quantified. Warfarin mice showed enlarged red blood cell and blood plasma diameters compared to controls, but no difference was found between DE mice and controls.. In contrast with warfarin, pretreatment with DE did not increase hematoma volume in 2 different experimental models of ICH. In terms of safety, this observation may represent a potential advantage of anticoagulation with DE over warfarin.

Topics: Administration, Oral; Animals; Anticoagulants; Antithrombin Proteins; Benzimidazoles; Cerebral Hemorrhage; Collagenases; Dabigatran; Hematoma; Injections; Male; Mice; Mice, Inbred Strains; Microscopy, Fluorescence; Partial Thromboplastin Time; Pyridines; Time Factors; Warfarin

This clinical study was conducted to present the clinical features, treatment and outcomes of rectus sheath hematoma (RSH), which is a complication of anticoagulation therapy that can present as acute abdomen.. Twenty-two spontaneous RSH cases who were on anticoagulation therapy were reviewed. Patient characteristics, anticoagulant therapy form and indications, clinical presentation, radiologic work-up, treatment modalities, recurrence, morbidity, and follow-up data were analyzed.. The majority of the patients were female (64%), and the mean age was 60.6 years. All of the patients (100%) were receiving at least one form of anticoagulation therapy; most (72%) were on warfarin therapy. History of coughing was found in 45% of the cases. The most common presenting signs and symptoms were abdominal pain and mass (77%). International normalized ratio (INR) was >3.0 in all patients on warfarin therapy. The diagnosis was made by abdominopelvic ultrasonography (US) and computerized tomography (CT). CT showed 100% sensitivity. The majority of patients (87%) were treated conservatively. Three patients (13%) were operated and 2 patients (9%) died as a result of RSH. Two patients experienced recurrence in one year.. RSH should be suspected in elderly, coughing patients on anticoagulation therapy, who present with clinical manifestations of acute abdomen. Early diagnosis can help to avoid increased morbidity or unnecessary surgical intervention.

Topics: Abdomen, Acute; Adult; Aged; Aged, 80 and over; Anticoagulants; Emergency Treatment; Female; Hematoma; Humans; Male; Middle Aged; Radiography; Rectal Diseases; Retrospective Studies; Turkey; Ultrasonography; Warfarin

The objective of our study was to identify and describe the spectrum of CT findings in patients with coagulopathy-induced suburothelial hemorrhage involving the renal collecting system.. CT findings of suburothelial hemorrhage are often subtle and are best appreciated on unenhanced CT scans because of the high density of the hemorrhage. After contrast injection, uniformly thickened soft tissue enveloping the collecting system is suggestive of this condition. Clinical information regarding the presence of coagulopathy is essential for the radiologist to entertain this relatively rare diagnosis.

Topics: Adult; Aged; Anticoagulants; Contrast Media; Female; Hematoma; Hematuria; Hemorrhage; Humans; Iohexol; Kidney Diseases; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed; Warfarin

Topics: Aged; Anticoagulants; Endoscopy, Gastrointestinal; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Ultrasonography; Warfarin

Topics: Anticoagulants; Diagnosis, Differential; Female; Hematoma; Humans; Middle Aged; Rectus Abdominis; Tomography, X-Ray Computed; Warfarin

Anticoagulation with warfarin is commonly used for prevention of thromboembolic events in patients with atrial fibrillation. Bleeding is the main side effect of anticoagulation. We report the case of a 66-year-old man who developed two spontaneous synchronous upper airway haematomas while on warfarin therapy. To our knowledge, this is the first reported case of a sublingual haematoma presenting simultaneously with supraglottic laryngeal haematomas. Upper airway haematomas are rare in the absence of a history of trauma but need to be urgently assessed due to their life-threatening potential. Clinicians should be aware of the possibility of haematomas involving the upper airway in patients on anticoagulant therapy, particularly if complaining of red flag symptoms such as acute onset dysphonia, odynophagia or airway/breathing difficulties.

Topics: Aged; Airway Obstruction; Atrial Fibrillation; Hematoma; Humans; Laryngeal Diseases; Male; Mouth Floor; Warfarin

A 64-year-old woman presented with shortness of breath, right-sided pleuritic chest pain and dry cough. She was systemically anticoagulated with warfarin for a pulmonary embolism diagnosed 3 months previously, with an international normalised ratio (INR) of 3.0 on presentation. Chest radiograph demonstrated a new right paratracheal abnormality, and CT scan showed a large mediastinal mass not present 3 weeks earlier. MRI demonstrated an ovoid mass with a fluid/fluid level with high T2 and dark T1 signal consistent with a mediastinal haematoma. The patient's anticoagulation was emergently reversed and a temporary inferior vena cava filter was placed. The haematoma slowly resolved on serial follow-up with no additional intervention. Spontaneous mediastinal haematoma is a rare but life-threatening diagnosis that frequently presents with chest pain, dry cough and dysphagia. It is frequently associated with therapeutic anticoagulation and may potentially be caused by sudden, atraumatic rise in intrathoracic pressure (ie, cough or emesis).

Topics: Anticoagulants; Female; Hematoma; Humans; Mediastinal Diseases; Middle Aged; Warfarin

With the increase in the number of patients undergoing warfarin therapy, reports of complications due to such therapy have become frequent. Although upper airway obstruction secondary to bleeding resulting from warfarin therapy is rare, it is a life-threatening complication because of the risk of airway obstruction. Only one previous case of hematoma of the epiglottis and arytenoids has been reported. We here in report a case of an 83-year-old woman on warfarin therapy who presented with a sore throat. On flexible nasoendoscopy, edema of the epiglottis and bilateral arytenoids with a red and purple hue were observed. The left true vocal cord was erythematous, but the airway was adequately maintained. The PT-INR of the patient was 10. She was managed conservatively and had a good course.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Arytenoid Cartilage; Cefazolin; Epiglottis; Female; Fibrinolytic Agents; Hematoma; Humans; Hydrocortisone; Infusions, Intravenous; Nasal Obstruction; Pharyngitis; Warfarin

Hematoma volume is a major determinant of outcome in patients with intracerebral hemorrhage (ICH). Accurate volume measurements are critical for predicting outcome and are thought to be more difficult in patients with oral anticoagulation-related ICH (OAT-ICH) due to a higher frequency of irregular shape. We examined hematoma shape and methods of volume assessment in patients with OAT-ICH.. We performed a case-control analysis of a prospectively identified cohort of consecutive patients with ICH. We retrospectively reviewed 50 consecutive patients with OAT-ICH and 50 location-matched non-OAT-ICH controls. Two independent readers analyzed CT scans for hematoma shape and volume using both ABC/2 and ABC/3 methods. Readers were blinded to all clinical variables including warfarin status. Gold-standard ICH volumes were determined using validated computer-assisted planimetry.. Within this cohort, median INR in patients with OAT-ICH was 3.2. Initial ICH volume was not significantly different between non-OAT-ICH and OAT-ICH (35 +/- 38 cc vs. 53 +/- 56 cc, P = 0.4). ICH shape did not differ by anticoagulation status (round shape in 10% of OAT-ICH vs. 16% of non-OAT-ICH, P = 0.5). The ABC/3 calculation underestimated median volume by 9 (3-28) cc, while the ABC/2 calculation did so by 4 (0.8-12) cc.. Hematoma shape was not statistically significantly different in patients with OAT-ICH. Among bedside approaches, the standard ABC/2 method offers reasonable approximation of hematoma volume in OAT-ICH and non-OAT-ICH.

Topics: Aged; Aged, 80 and over; Anticoagulants; Case-Control Studies; Cerebral Hemorrhage; Cohort Studies; Female; Hematoma; Humans; Image Processing, Computer-Assisted; International Normalized Ratio; Male; Point-of-Care Systems; Prognosis; Retrospective Studies; Software; Tomography, X-Ray Computed; Warfarin

Topics: Anticoagulants; Hematoma; Humans; Jejunal Diseases; Male; Middle Aged; Warfarin

Pomegranate juice is growing in popularity in the UK. We report a potential interaction between pomegranate juice and warfarin. Laboratory studies have shown that pomegranate juice inhibits cytochrome P450 enzymes involved in warfarin metabolism. As with previous reports of interactions between food and warfarin, this case does not definitively prove the association between pomegranate juice consumption and increased warfarin bioactivity but highlights the importance of taking a complete drug, food and juice history when assessing patients with unstable anticoagulation.

Topics: Anticoagulants; Female; Food-Drug Interactions; Fruit; Hematoma; Humans; International Normalized Ratio; Lythraceae; Middle Aged; Warfarin

Many patients requiring permanent pacemaker (PPM) or implantable cardiac defibrillator (ICD) placement are anticoagulated with warfarin, aspirin (ASA), and clopidogrel for a number of thromboembolic risk indications. The present review sought to evaluate the relationship between continuation of these medications in the peri-procedural period and the incidence of hematoma formation after implantation.. We retrospectively reviewed consecutive patients undergoing PPM and ICD implantation at our hospital from January 2007-2009. All patients on warfarin, aspirin, and clopidogrel were maintained on these medications peri-operatively. We collected data on the use of warfarin at implantation, INR prior to device implantation, use of dual-antiplatelet therapy (DAPT), such as concomitant aspirin and clopidogrel and subsequent formation of hematoma in the peri-procedure period.. PPM and ICD implantations were performed in 194 men and six women. The mean age was 73 years old. Fifty eight patients were taking warfarin with an average international normalized ratio of 1.9 +/- 0.6; 112 were on ASA, 23 on clopidogrel, and 20 of them on DAPT. Only five patients were on DAPT and warfarin combined at the time of device implantation. Hematomas formed in a total of seven patients (3.5%), five of whom were on DAPT consisting of ASA and clopidogrel (P < 0.0001) while only two of them were on warfarin (P = 0.67). Pocket revision for hematoma evacuation was needed in four patients (2%), three of whom were on DAPT and only one on warfarin.. This study suggests that hematoma formation after PPM or ICD implantation is rare, even among those who are anticoagulated. There were more patients with hematoma on DAPT than warfarin therapy and half of these patients with this complication needed pocket revision for evacuation. (PACE 2010; 385-388).

Topics: Aged; Aged, 80 and over; Anticoagulants; Aspirin; Clopidogrel; Defibrillators, Implantable; Female; Hematoma; Humans; International Normalized Ratio; Male; Pacemaker, Artificial; Perioperative Care; Platelet Aggregation Inhibitors; Postoperative Hemorrhage; Prosthesis Implantation; Retrospective Studies; Ticlopidine; Warfarin

Clopidogrel, a new antiplatelet agent that irreversibly inhibits platelet aggregation, is widely used today. This prospective work was conducted to evaluate the safety of performing skin surgery on patients taking clopidogrel. Patients undergoing surgery for excision of skin or subcutaneous lesions under local anesthesia taking clopidogrel were the study group. The control group comprised 2073 historical patients who had undergone a similar procedure. Data collected included: age, sex, past medical history, medications, and late complications. Follow-up was done at 1 to 2 weeks and 3 to 6 months. There were 32 patients on clopidogrel, having 38 lesions removed. Of these, seven patients were on aspirin and clopidogrel combined. The groups taking clopidogrel, aspirin, and warfarin had significantly more males, were older, and had significantly more comorbid medical conditions. There was no significant difference in the incidence of any of the complications in any of the groups. This study shows that patients taking clopidogrel before skin surgery, though older and with more associated medical conditions, do not experience a greater rate of complications. We conclude that patients undergoing minor excisional cutaneous surgery should continue taking clopidogrel because there is no apparent risk for increased complications when good meticulous surgical techniques are used.

Topics: Aged; Anticoagulants; Aspirin; Case-Control Studies; Clopidogrel; Dermatologic Surgical Procedures; Drug Therapy, Combination; Drug-Related Side Effects and Adverse Reactions; Erythema; Female; Follow-Up Studies; Hematoma; Humans; Male; Platelet Aggregation Inhibitors; Postoperative Complications; Surgical Wound Dehiscence; Surgical Wound Infection; Ticlopidine; Warfarin

A 72-year-old woman presented pulmonary embolism. Continuous intravenous administration of heparin was controlled with values of activated clotting time targeted from 150 to 180 s. On the sixth intensive care unit (ICU) day, a central vein (CV) catheter was inserted through the right axillary vein. On the ninth ICU day, her blood pressure dropped and her right breast was obviously larger than the left. Chest computed tomography showed a large hematoma under the greater pectoral muscle. CV catheterization under anticoagulant therapy is risky for bleeding, but catheterization of the internal jugular vein rarely leads to hemorrhagic shock, even if it causes airway obstruction. The axillary vein is in a compartment filled with loose tissue. As there is no structure to cover the bleeding site, the hematoma would expand from the lateral region of the thorax to near the fifth or sixth rib, to which greater and smaller pectoral muscles are attached. Ultrasound-guided catheterization from the axillary vein is introduced as a new and promising alternative to that from the subclavian vein because of its safety, but we should be conservative about applying the axillary approach to patients with anticoagulant therapy, especially in case of an unskilled operator, and be aware of the possibility of late-onset bleeding.

Topics: Aged; Anticoagulants; Axillary Vein; Blood Coagulation Tests; Catheterization; Female; Hematoma; Heparin; Humans; Shock, Hemorrhagic; Suction; Treatment Outcome; Warfarin

Many patients who need cardiac resynchronization therapy (CRT) require chronic anticoagulation. Current guidelines recommend discontinuation of warfarin and the initiation of anticoagulant "bridging" therapy during these procedures. We evaluated the safety of CRT-device (CRT-D) implantation without interruption of warfarin therapy.. A total of 123 consecutive patients requiring CRT-D therapy were enrolled, 49 identified as high risk for thromboembolic events who received either intravenous heparin, low molecular weight heparin, or warfarin therapy. The control group comprised 74 patients with low risk of thromboembolic events who required only cessation of warfarin perioperatively. Patients were evaluated at discharge and 15 and 30 days postoperatively for pocket hematomas, thromboembolic events, and bleeding. Patients' length of stay was also catalogued.. Patients in the bridging arm had a significant increase in the rate of pocket hematomas (4.1%[control] vs 5.0%[warfarin] vs 20.7%[bridging], P = 0.03) and subsequent longer length of stay (1.6 +/- 1.6 [control] vs 2.9 +/- 2.7 [warfarin] vs 3.7 +/- 3.2 [bridging], P < 0.001). Hematoma formation postoperatively was not different among patients undergoing an upgrade procedure versus those without preexisting cardiac rhythm devices (12% vs 6.2%, P = NS). Patients with a prosthetic mechanical mitral valve had a higher incidence of pocket hematoma formation (1.8% vs 20%, P = 0.03).. Our findings suggest that implantation of CRT-Ds without interruption of warfarin therapy in patients at high risk of thromboembolic events is a safe alternative to routine bridging therapy. This strategy is associated with reduced risk of pocket hematomas and shorter length of hospital stay. (PACE 2010; 400-406).

Topics: Aged; Aged, 80 and over; Anticoagulants; Female; Hematoma; Heparin; Humans; Incidence; International Normalized Ratio; Length of Stay; Male; Middle Aged; Pacemaker, Artificial; Postoperative Hemorrhage; Prosthesis Implantation; Retrospective Studies; Warfarin; Withholding Treatment

The relationship between warfarin administration and the frequent development of enlarged hematomas in patients with acute intracerebral hemorrhage (ICH) is controversial. The present study was carried out to examine this issue.. This study reviewed 41 patients with nontraumatic ICH within 24 h after stroke onset from 1999 to 2003 who received long-term warfarin treatment (29 men and 12 women, 70 +/- 12 years old) and 323 patients who had not been on warfarin (177 men and 146 women, 66 +/- 13 years old). The hematoma volume (HV) on admission, final HV, frequency of hematoma enlargement (HE) and other background characteristics were investigated.. Both the HV on admission (p = 0.031) and final HV (p = 0.001) were larger in patients on warfarin than in those not receiving warfarin. HE occurred more frequently (p < 0.001), and mortality at 30 days or at discharge was higher (p = 0.003) in the warfarin group than in the control group. A multivariate adjusted logistic regression analysis showed that warfarin treatment (OR = 5.75, 95% CI = 2.41-13.8, p < 0.001), liver disease (OR = 2.59, 95% CI = 1.12-5.99, p = 0.026), and the National Institutes of Health Stroke Scale score (OR = 1.10, 95% CI = 1.04-1.15, p < 0.001, per 1-score increase) on admission were independently related to HE.. Acute ICH in patients on long-term warfarin treatment appears to be associated with HE.

Topics: Aged; Aged, 80 and over; Anticoagulants; Case-Control Studies; Cerebral Hemorrhage; Dose-Response Relationship, Drug; Female; Hematoma; Humans; Logistic Models; Longitudinal Studies; Male; Middle Aged; Retrospective Studies; Stroke; Tomography, X-Ray Computed; Warfarin

Topics: Aged, 80 and over; Anticoagulants; Female; Gastrointestinal Hemorrhage; Hematoma; Hemoperitoneum; Humans; Intestine, Small; Medication Adherence; Warfarin

Warfarin is a widely used drug for the prevention of thromboembolic events. Knowledge of its adverse effects is necessary for patient follow-up. Although the development of blood dyscrasias is a potential complication in these patients, retroperitoneal bleeding is rare. This article reports the case of a patient who developed iliopsoas muscle hematoma during treatment with warfarin after implantation of a metallic prosthetic aortic valve. The clinical manifestations involved important differential diagnoses.

Topics: Aged; Anticoagulants; Diagnosis, Differential; Femoral Nerve; Gastrointestinal Hemorrhage; Heart Valve Prosthesis; Hematoma; Humans; Male; Nerve Compression Syndromes; Postoperative Complications; Psoas Muscles; Warfarin

Spontaneous intramural hematoma of the small intestine is a rare clinical condition that may result in potentially serious complications. The purpose of this study was to present our experience with the diagnosis and management of spontaneous intramural hematoma of the small intestine.. The medical records of the patients with spontaneous intramural hematoma of the small intestine were retrospectively reviewed. Six patients were included in this study.. Anticoagulation therapy and factor VIII deficiency were found to be responsible for the intramural hemorrhage in five patients (83%) and one patient, respectively. Acute abdominal pain followed by nausea and vomiting were the most common presenting symptoms. Abdominal computed tomography scan was diagnostic in five of the six patients. Four patients were followed up with conservative therapy. Surgical intervention was required in two patients due to acute abdomen. All patients were discharged from the hospital uneventfully.. The patient's medical history, physical examination and radiological evaluation proved adequate for the diagnosis. Conservative therapy provides regression of the hematoma in most patients. Surgery should be reserved only for the complicated cases.

Topics: Adult; Aged; Anticoagulants; Aspirin; Hematoma; Hemophilia A; Humans; Intestinal Diseases; Intestine, Small; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

Topics: Aged; Anticoagulants; Canrenoic Acid; Drug Interactions; Female; Genetic Predisposition to Disease; Hematoma; Humans; Mineralocorticoid Receptor Antagonists; Warfarin

The haematoma in the sheath of musculus rectus abdominis is a rare clinical entity. Its diagnosis is often difficult. Authors observed it in three patients who were on anticoagulant therapy. All subjects were female; two of them had decreased renal function. All three patients received thrombocyte aggregation inhibitor therapy as well. The anticoagulant treatment (low molecular weight heparin in two cases, warfarin in one case) caused excessive anticoagulant effect. The diagnosis, which could be suspected after the physical examination, was established in two cases by ultrasonography and in one case by computed tomography. Two patients were surgically treated while the third patient was healed with conservative treatment. To prevent the rectus sheath haematoma, authors suggest a particularly careful control of anticoagulant treatment in older females and in subjects with decreased renal function, especially if the patient takes thrombocyte aggregation inhibitors, too.

Topics: Aged; Anticoagulants; Female; Hematoma; Heparin, Low-Molecular-Weight; Humans; Muscular Diseases; Platelet Aggregation Inhibitors; Rectus Abdominis; Tomography, X-Ray Computed; Ultrasonography; Warfarin

Topics: Aortic Valve Stenosis; Coronary Artery Bypass; Coronary Artery Disease; Enoxaparin; Fibrinolytic Agents; Heart Valve Prosthesis Implantation; Hematoma; Humans; International Normalized Ratio; Male; Middle Aged; Postoperative Complications; Rupture; Sigmoid Diseases; Warfarin

A 71-year-old man was stable on warfarin (2.25 mg daily) therapy with an international normalized ratio (INR) of 1.8-2.2 after a heart valve replacement surgery. Recently, he consumed the liquid-like herbal product called shengmai-yin (10 mL daily) against medical advice. Seven days after the daily consumption of shengmai-yin, he was admitted to the intensive care unit because of consciousness disturbance [Glasgow Coma Scale (GCS) score 7] with an INR of 5.08. Head computed topography revealed intracerebral hematoma in the left temporoparietal region. Both warfarin therapy and the herbal product were withdrawn. At the same time, therapy with intravenous vitamin K1 40 mg was started. On the second day of admission, craniectomy was performed to remove the intacerebral hematoma under general anesthesia. He remained confused and restless for 2 days, but then showed progressive recovery in the consciousness level as well as motor and verbal functions. Shengmai-yin contains herbal ingredients that can interact with warfarin. The Drug Interaction Probability Scale (DIPS) indicated that warfarin and shengmai-yin were highly probable causes of intracerebral hematoma. Patients on warfarin therapy should be discouraged from taking herbal medicines, especially preparations that are already known to have antiplatelet and antithrombotic effects.

Topics: Aged; Anticoagulants; Cerebral Hemorrhage; Drug Interactions; Drugs, Chinese Herbal; Hematoma; Humans; Male; Treatment Outcome; Vitamin K 1; Warfarin

Compartment syndrome can be a complication of warfarin treatment after a minor trauma. We report a case of an elderly woman who had an uncontrolled, high Internationalised Normalized Ratio (INR) level and had incurred a large haematoma on the left upper arm after a fall. After two days, the patient developed a massive oedema and clinical compartment syndrome. It is essential to be aware of symptoms and signs of compartment ischaemia, as early fasciotomy can prevent late complications such as muscle necrosis and contracture or at worst amputation. The patient should be hospitalized for observation for compartment syndrome and control of the INR level.

Topics: Aged, 80 and over; Anticoagulants; Arm Injuries; Compartment Syndromes; Fasciotomy; Female; Hematoma; Humans; International Normalized Ratio; Upper Extremity; Warfarin

Haematoma formation is a recognised complication after permanent pacemaker (PPM) implantation. The contribution of peri-procedural anticoagulation to the risk of haematoma formation is unclear.. The records of 518 consecutive patients, mean age 76.9±9.8 years, receiving their first PPM (2004-2007) in a single tertiary referral centre were reviewed. Follow-up was complete for 506 patients (97.7%) up to six weeks. Haematomas were diagnosed clinically, and further subdivided according to the need for evacuation.. There were 27 instances of haematoma formation in 25 patients (4.9%) with 19 requiring drainage or evacuation. Twenty-one of the 25 patients who developed a haematoma had stopped warfarin and received bridging therapeutic anticoagulation pre- and post-PPM. The incidence of haematoma was significantly greater in those receiving peri-operative therapeutic anticoagulation (26.9% vs 0.9%, p<0.001), but was unaffected by the use of anti-platelet therapy. Most haematomas developed in patients whose heparin was recommenced within 24 hours of implantation. The development of haematoma post-PPM increased median hospital stay significantly (p<0.001). The main indication for anticoagulation in these patients was atrial fibrillation (79.5%) and most of these patients had a low to intermediate risk of peri-procedural thromboembolic events.. Peri-operative therapeutic anticoagulation is associated with more than 25-fold increase in haematoma formation post-pacemaker implantation. The risk-benefit ratio of therapeutic anticoagulation should be carefully considered, particularly in patients with a low risk of thromboembolic events.

Topics: Aged; Aged, 80 and over; Anticoagulants; Cardiac Surgical Procedures; Female; Hematoma; Heparin; Humans; Incidence; Length of Stay; Male; Multivariate Analysis; Pacemaker, Artificial; Perioperative Period; Retrospective Studies; Risk Factors; Warfarin

In patients on high-level anticoagulant therapy (prothrombin time-international normalized ratio [PT-INR] ≥ 4.5), surgical procedures can be carried out with bridging therapy using heparin. However, surgical treatment options are severely limited in patients on high-level anticoagulant therapy and who have heparin-induced thrombocytopenia (HIT), as heparin use is contraindicated. We performed tooth extraction using prothrombin complex concentrate (PCC) in 2 HIT patients on high-level anticoagulation therapy (PT-INR ≥ 4.5). Five hundred units of PCC were administered intravenously, and after 15 minutes, it was confirmed that PT-INR was less than 2.0. Tooth extraction was then performed and sufficient local hemostasis was achieved. At 3 hours after tooth extraction, PT-INR was 2.0 or higher and later increased to 4.0 or higher, but postoperative bleeding was mostly absent. When performing tooth extraction in HIT patients on high-level anticoagulant therapy, favorable hemostatic management was achieved through sufficient local hemostasis and transient warfarin reversal using PCC.

Topics: Adult; Aspirin; Blood Coagulation Factors; Blood Loss, Surgical; Cellulose, Oxidized; Contraindications; Electrocoagulation; Female; Fibrinolytic Agents; Gingival Hemorrhage; Heart Failure; Heart-Assist Devices; Hematoma; Hemostatics; Heparin; Humans; International Normalized Ratio; Male; Molar, Third; Periapical Periodontitis; Pericoronitis; Plasma; Postoperative Hemorrhage; Prothrombin Time; Thrombosis; Tooth Extraction; Tooth, Impacted; Warfarin

Spontaneous rectus sheath hematoma (RSH) is an uncommon and frequently misdiagnosed cause of acute abdominal pain. The purpose of this study is to present our experiences in the diagnosis and treatment of spontaneous RSH.. This is a retrospective study of the medical histories of 15 patients admitted to our emergency surgery unit between January 2000 and July 2009 and diagnosed with spontaneous RSH (12 females, 3 males; mean age, 64.5 years; range, 20-79 years).. All cases presented with acute abdominal pain or abdominal wall mass, or both. Eleven of the cases (73%) had been receiving some form of anticoagulation therapy. The leading indications for anticoagulation and/or anti-platelet therapy were atrial fibrillation in 5 patients (33%) and mitral valve replacement in 3 patients (20%). Diagnosis was made by abdominal ultrasonography and/or computerized tomography in 14 patients (93%). Twelve (80%) of the 15 patients were discharged uneventfully after conservative management following a mean hospital stay of 8.8 days (range, 3-24 days). The mortality rate was 20%.. Spontaneous RSH must be suspected in patients with advanced age who are using anticoagulation medications and present with acute abdominal pain. Early diagnosis permits conservative management and avoids unnecessary surgical interventions.

Topics: Abdominal Pain; Adult; Aged; Anticoagulants; Female; Hematoma; Humans; Male; Middle Aged; Partial Thromboplastin Time; Radiography; Rectus Abdominis; Retrospective Studies; Treatment Outcome; Warfarin

Topics: Adult; Anemia, Hypochromic; Anticoagulants; Heart Valve Prosthesis; Hematoma; Humans; Male; Mesocolon; Peritoneal Diseases; Warfarin

Topics: Aged; Hematoma; Humans; Intestinal Diseases; Intestine, Small; Male; Radiography, Abdominal; Tomography; Warfarin

To determine whether the use of oral antithrombotic agents before the onset of intracerebral hemorrhage (ICH) affects hematoma features and early patient outcome.. A retrospective, multicenter study involving 1,006 consecutive Japanese patients (607 men, 67 +/- 12 years of age) hospitalized within 24 h after the onset of nontraumatic ICH was conducted.. One hundred and eighty patients were taking oral antiplatelet agents (17.9%, AP group), 67 were taking warfarin (6.7%, W group), and 21 were taking both (2.1%, W + AP group). After adjustment for age, sex, and known confounders, the taking of each kind of antithrombotic therapy was independently related to cerebellar hemorrhage; the odds ratios (OR) and 95% CI, with patients taking no antithrombotic agents as the reference group, were 2.31 (1.23-4.32) for the AP group, 2.90 (1.26-6.63) for the W group, and 3.43 (1.02-11.59) for the W + AP group. Similarly, the taking of each kind of antithrombotic therapy was independently related to hematoma enlargement within the initial 24 h (OR and 95% CI: AP group, 1.92, 1.10-3.34; W group, 4.80, 2.12-10.87; W + AP group, 4.94, 1.31-18.61) and mortality at 3 weeks post-ICH (OR and 95% CI: AP group, 2.70, 1.56-4.68; W group, 2.50, 1.05-5.96; W + AP group, 9.41, 2.78-31.88).. Prior medication with antiplatelet agents, warfarin, or both was predictive of cerebellar hemorrhage, hematoma enlargement, and early death in Japanese ICH patients.

Topics: Administration, Oral; Aged; Cerebral Hemorrhage; Drug Therapy, Combination; Female; Fibrinolytic Agents; Hematoma; Humans; Japan; Male; Middle Aged; Multivariate Analysis; Platelet Aggregation Inhibitors; Retrospective Studies; Risk Factors; Treatment Outcome; Warfarin

While mortality from trauma increases, there has been a decline in mortality from cardiovascular and cerebrovascular diseases which parallels advances in antithrombotic and anticoagulation therapy. Warfarin (coumadin) is the most common oral anticoagulant used for chronic anticoagulant therapy and most patients requiring such therapy are elderly (greater than 65 years old). The most common complication of warfarin use is adverse bleeding. It is becoming increasingly evident the population at highest risk for sustaining a complication related to anticoagulation is that group presenting with traumatic brain injury. Recent studies show that patients with other injury patterns do not appear to have significant differences post trauma, although the data about such outcomes is sparse. Significant bleeding from retroperitoneal hematomas is more often associated with major pelvic fractures from high energy blunt force mechanisms, and the blood loss may be tamponaded by the retroperitoneal structures if natural clotting mechanisms are intact. Recombinant Factor VIIa (FVIIa) can be used to reverse coagulopathy in patients on coumadin who sustain a traumatic injury.

Topics: Aged, 80 and over; Anticoagulants; Factor VIIa; Female; Fluid Therapy; Hematoma; Humans; Recombinant Proteins; Retroperitoneal Space; Time Factors; Warfarin; Wounds and Injuries

Intramural hematoma of the small bowel is an infrequent complication of the use of oral anticoagulants. Diagnosis can only be performed when these symptoms are associated with a history of oral anticoagulant use and radiological tests. We report the case of a patient admitted for epigastric pain associated with oral anticoagulation therapy with warfarin and a 48-h history of retention vomiting. Ultrasound and abdominal computed tomography scans revealed a jejunal loop with diffuse parietal thickening, suggesting an intramural hematoma. Conservative therapy was provided with symptomatic regression on the second day and reabsorption of the jejunal intramural hematoma. Anticoagulation therapy was reintroduced with no recurrences.

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

Increasing numbers of patients requiring arrhythmia device implantation are taking warfarin. The common practice of warfarin interruption and perioperative bridging with heparin is associated with a high rate of postoperative hemorrhagic complications. We assessed the safety of device implantation without interruption of warfarin therapy.. Three patient groups were studied: Group 1 consisted of 117 consecutive patients on long-term warfarin therapy with significant risk of thromboembolism (atrial fibrillation with CHADS(2) score > or =2, mechanical heart valve, recent venous thromboembolism) who underwent arrhythmia device implantation without interruption of warfarin. Group 2 was 117 patients who served as age- and sex-matched controls matched to procedure type not taking warfarin. Group 3 consisted of 38 similar thromboembolic risk historical control patients who underwent interruption of warfarin therapy and bridging with dalteparin before and 24 hours after surgery. Active fixation leads were used by subclavian or axillary vein puncture, with septal fixation in the ventricle in 56% of patients. Hemorrhagic and thromboembolic complications were assessed at discharge and at 7 and 30 days after surgery.. During an 18-month period, 1,562 consecutive adult patients underwent heart rhythm device implantation or replacement. One hundred seventeen of the 447 patients on warfarin were considered high risk and remained on warfarin for their procedure. The mean international normalized ratio in group 1 patients was 2.2 +/- 0.4 (age 79 +/- 11 years, 73 male). Significant hematoma was noted in 9 patients (7.7%), and one required surgical revision (0.9%). Five group 2 patients (control) had significant hematomas (4.3%), none of which required revision (P = .41). In group 3, 9 patients developed significant hematomas (23.7%, P = .012), 3 of whom required reoperation (7.9%, P = .046). There were no deaths, thromboembolic events, cardiac tamponade, or hemothorax in any patient. The only risk factor for hematoma in the warfarin patients was the number of leads implanted.. Arrhythmia devices can be implanted safely in patients with high thromboembolic risk without interruption of warfarin. This strategy may be associated with reduced risk of significant pocket hematoma compared with dalteparin bridging.

Topics: Aged; Aged, 80 and over; Anticoagulants; Dalteparin; Defibrillators, Implantable; Female; Fibrinolytic Agents; Hematoma; Humans; Male; Middle Aged; Preoperative Care; Risk Assessment; Risk Factors; Thromboembolism; Warfarin

Rectus sheath haematoma (RSH) is an uncommon condition with a propensity for difficult and mistaken diagnosis. We describe a case where management was complicated by the patient's requirement for anticoagulation.

Topics: Abdominal Pain; Aged, 80 and over; Anticoagulants; Disease Progression; Emergency Service, Hospital; Fatal Outcome; Hematoma; Heparin; Humans; Male; Muscular Diseases; Pulmonary Embolism; Rectus Abdominis; Risk Assessment; Tomography, X-Ray Computed; Warfarin

Topics: Aged; Anticoagulants; Heart Valve Diseases; Hematoma; Humans; Male; Mitral Valve; Oral Hemorrhage; Tongue Diseases; Warfarin

To determine whether there are modifiable risk factors for spontaneous intracerebral hemorrhage in patients receiving oral anticoagulation (OAC) therapy.. Retrospective chart review between January 2002 and December 2004.. A total of 315 consecutive patients presenting with spontaneous intracerebral hemorrhage.. Overall mortality rates and surgical mortality rates, and discharge home compared with discharge to a long-term care facility.. Of the 315 patients reviewed, 65 (20.6%) were receiving OAC therapy. Age, Glasgow Coma Scale score, and size of hematoma at presentation were similar in the 65 patients taking OAC and the 250 patients not taking it. Mean arterial pressure at presentation was significantly higher in the OAC group than in the control group (132 mm Hg vs 107 mm Hg, P = .01) as was the number of hematomas that progressed (52% vs 14%, P = .01). Overall mortality rates were higher in the OAC group than in the control group (52% vs 41%, P = .03) as were surgical mortality rates (62% vs 41%, P = .04). There were no significant differences in morbidity between the 2 groups.. Mortality rates were higher among patients taking OAC therapy despite their having similarly sized hematomas at presentation. The higher initial mean arterial pressure among such patients has not been described previously in this setting. This higher mean arterial pressure correlates with the propensity of these patients' hematomas to expand after initial imaging and might partially mediate the mortality effect. In patients taking OAC, hypertension appears to be a modifiable risk factor for morbidity and mortality from intracerebral hemorrhage.

Topics: Administration, Oral; Adult; Age Distribution; Aged; Aged, 80 and over; Anticoagulants; Case-Control Studies; Cerebral Hemorrhage; Female; Follow-Up Studies; Glasgow Coma Scale; Hematoma; Humans; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Reference Values; Retrospective Studies; Risk Factors; Severity of Illness Index; Sex Distribution; Survival Analysis; Treatment Outcome; Warfarin

Guidelines and local hospital protocols dealing with anticoagulation at the time of surgery vary, but most suggest stopping Warfarin at least three days preoperatively with or without interim low-molecular-weight heparin or intravenous heparin infusion. This study addresses whether it is safe to perform inguinal hernia surgery on the patient who is fully anticoagulated with Warfarin.. We performed a retrospective case note analysis of consecutive patients who underwent elective inguinal hernia repair at the Plymouth Hernia Service between 1999 and 2007. All patients on therapeutic oral anticoagulation with Warfarin were selected. Data analysis was of complications and patient-related, hernia-related, and surgery-related variables. International normalising ratio (INR) was measured on the day preceding surgery.. A total of 49 patients had been operated on whilst anticoagulated with Warfarin. The mean age of the patients was 75 years (range 44-96 years). Thirty patients were on Warfarin for atrial fibrillation, seven for previous PE, three for previous DVT, and nine for mechanical heart valves. Forty patients had a desired INR range of 2-3, and nine a desired range of 3-4. Forty-five (91.8%) patients had no complications or mild bruising requiring no further management. Three (6.1%) patients developed haematomas requiring surgical management and there was one death of unrelated cause. An INR of greater than 3 increased the risk of postoperative haematoma (P = 0.03). None of the other measured patient-related, hernia-related, or surgery-related variables predicted complications (P > 0.05).. Patients can safely undergo inguinal hernia repair whilst on Warfarin as long as the INR is less than 3.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Elective Surgical Procedures; Hematoma; Hernia, Inguinal; Humans; Middle Aged; Postoperative Complications; Retrospective Studies; Warfarin

Future demographic changes predict an increase in the number of patients with atrial fibrillation. As long-term anticoagulation for the prevention of ischemic strokes becomes more prevalent, the burden of warfarin-associated intracerebral hemorrhage (W-ICH) is likely to grow. However, little is known about the clinical aspects and pathophysiologic mechanisms of W-ICH. This study describes the development of a mouse model of W-ICH in which hematoma growth and outcomes can be correlated with anticoagulation parameters.. CD-1 mice were treated with warfarin (2 mg/kg per 24 hours) added to drinking water. ICH was induced by stereotactic injection of collagenase type VII (0.075 U) into the right striatum. Hemorrhagic blood volume was quantified by means of a photometric hemoglobin assay 2 and 24 hours after hemorrhage induction. Neurologic outcomes were assessed on a 5-point scale.. The international normalized ratio in nonanticoagulated mice was 0.8+/-0.1. After 24 (W-24) and 30 (W-30) hours of warfarin pretreatment, international normalized ratio values increased to 3.5+/-0.9 and 7.2+/-3.4, respectively. Compared with nonanticoagulated mice, mean hemorrhagic blood volume determined 24 hours after hemorrhage induction was found to be 2.5-fold larger in W-24 mice (P=0.019) and 3.1-fold larger in W-30 mice (P<0.001, n=10 per group). Mortality at 24 hours after hemorrhage induction was 0% in nonanticoagulated mice, 10% in W-24 mice, and 30% in W-30 mice. Hematoma enlargement between 2 and 24 hours after hemorrhage induction was -1.4% for nonanticoagulated mice, 22.9% for W-24 mice, and 62.2% for W-30 mice.. This study characterizes the first experimental model of W-ICH. It may be helpful in gaining further insights into the pathophysiology of W-ICH and may be used for testing the efficacy of treatment strategies, such as hemostatic therapy, in this severe subtype of stroke.

Topics: Administration, Oral; Animals; Anticoagulants; Brain Damage, Chronic; Cerebral Hemorrhage; Collagenases; Corpus Striatum; Disease Models, Animal; Disease Progression; Hematoma; Injections; International Normalized Ratio; Male; Mice; Microbial Collagenase; Movement Disorders; Warfarin

Topics: Aged; Aged, 80 and over; Compartment Syndromes; Debridement; Fasciotomy; Fatal Outcome; Female; Hematoma; Humans; Leg Injuries; Male; Middle Aged; Muscle, Skeletal; Trauma Severity Indices; Treatment Outcome; Warfarin

Topics: Administration, Oral; Anticoagulants; Hematoma; Hemorrhage; Humans; Male; Middle Aged; Muscular Diseases; Shock, Hemorrhagic; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

The case of a 66-year-old patient with acute intramural haematoma in descending aorta, receiving anticoagulant treatment with warfarin for chronic atrial fibrillation, is presented. Transoesophageal echocardiography was fundamental in the diagnosis of the intramural haematoma, assessment of the cardioembolic risk of atrial fibrillation and in follow-up the evolution of the intramural haematoma, which facilitated therapeutic management. Although no established recommendation exists on anticoagulation in aortic intramural haematoma, individual risk-benefit assessment of anticoagulation and follow-up with imaging techniques are essential to elect the most appropriate therapeutic management.

Topics: Aged; Anticoagulants; Aorta, Thoracic; Aortic Diseases; Atrial Fibrillation; Diagnosis, Differential; Echocardiography, Transesophageal; Female; Hematoma; Humans; Warfarin

Although relatively infrequent, groin hematoma following inguinal herniorrhaphy is a morbid complication with major ramifications of mesh infection and hernia recurrence. We have sensed an increasing frequency of this complication in our tertiary referral practice and sought to determine whether or not significant risk factors could be identified.. In this matched case-control study (1995-2003), we identified 53 patients with groin hematomas and paired them with 106 age- and gender-matched controls. Patient and procedure characteristics were analyzed using chi-square and both univariate and multivariable, conditional logistic regression analysis.. The 53 patients developing groin hematoma following inguinal hernia repair (mean age=65, range 22-87, 90% male) were well matched with 106 controls (mean age=65, range 22-87, 90% male). There was no significant difference in the location (left, right, bilateral), type (direct, indirect, pantaloon, first repair, or recurrent), or technique of hernia repair (Bassini, Lichtenstein, mesh plug, endoscopic, or McVay) between groups. While univariate analysis identified Coumadin usage (P<0.001, hazard ratio 19.1), valvular disease (P<0.001, hazard ratio 10.9), atrial fibrillation (P=0.02, hazard ratio 4.2), vascular disease (P=0.04, hazard ratio 2.2), blood abnormalities (P=0.02, hazard ratio 3.2), and previous bleeding episodes (P=0.02, hazard ratio 4.9) as significant factors, only preoperative Coumadin usage was important in multivariate analysis.. The crucial risk factor for groin hematoma developing in patients undergoing inguinal hernia repair is preoperative need for Coumadin therapy. Although the perioperative management of anticoagulation in patients undergoing inguinal herniorrhaphy is not clearly defined, meticulous management of patients requiring Coumadin therapy seems prudent.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Case-Control Studies; Chi-Square Distribution; Female; Groin; Hematoma; Hernia, Inguinal; Humans; Logistic Models; Male; Middle Aged; Minnesota; Postoperative Complications; Proportional Hazards Models; Retrospective Studies; Risk Factors; Surgical Mesh; Warfarin

Topics: Aged; Female; Hematoma; Humans; Rectus Abdominis; Tomography, X-Ray Computed; Warfarin

Topics: Aged; Anticoagulants; Atrial Fibrillation; Colonic Neoplasms; Diagnosis, Differential; Gastrointestinal Hemorrhage; Hematoma; Humans; Male; Neoplasm Recurrence, Local; Warfarin

The most common coagulation disorder associated with warfarin use is bleeding, but compressive femoral neuropathy is an unusual presentation. A 63-year-old man with compressive femoral neuropathy from an iliacus haematoma is reported. The diagnosis was confirmed on magnetic resonance imaging and treated conservatively with good clinical response and radiological evidence of resolution.

Topics: Anticoagulants; Femoral Neuropathy; Hematoma; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Psoas Muscles; Warfarin

Case report.. To describe a case of spinal epidural hematoma arising from the synovial joint due to anticoagulation therapy.. Spontaneous spinal epidural hematoma is a rarity in the literature with a variety of etiologies. In 1 study, it was reported to originate from a synovial joint due to osteoarthritis of the joint.. A case of hematoma of the lumber synovial joint is presented.. A 67-year-old man who was on anticoagulation therapy presented with progressive neurologic symptoms in the right lower limb. Magnetic resonance imaging scan revealed what was thought to be a L4-L5 synovial joint cyst. During surgery, it was proven to be an epidural hematoma originating from the synovial joint. Microscopic examination confirmed the diagnosis and excluded the possibility of spinal synovial cyst. After spinal decompression, neurologic symptoms improved completely in 2 weeks.. This is the first report of a synovial cyst hematoma due to anticoagulation therapy. Its magnetic resonance imaging features can be similar to synovial cyst, especially when it is hemorrhagic. Spinal decompression was the definitive treatment.

Topics: Aged; Anticoagulants; Cardiovascular Diseases; Diagnosis, Differential; Hematoma; Hematoma, Epidural, Spinal; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Synovial Cyst; Warfarin

A fifty-year-old woman with developmental dysplasia of the hip underwent total hip arhtroplasty, and subsequently developed recurrent venous thrombophilia of the lower extremities. Hematological examination revealed an inherited disorder of blood coagulation (homozygous mutation of the 5,10-methylenetetrahydrofolate reductase gene) and therefore longterm Warfarin anticoagulation therapy was started. A year later she was diagnosed with a large pelvic posthemorrhagic pseudocyst (hematoma) located below the musculus iliacus and adhering to bone in the region of posterior acetabulum. The condition was complicated by usuration and focal osteolysis of the adjacent pelvic bone. Histological examination of the hematoma showed characteristics of an unusual pseudoxanthoma mimicking Erdheim-Chester disease. The differential diagnosis of histological findings is discussed and recent relevant literature is reviewed.

Topics: Anticoagulants; Arthroplasty, Replacement, Hip; Blood Coagulation Disorders, Inherited; Bone Diseases; Diagnosis, Differential; Erdheim-Chester Disease; Female; Hematoma; Hip Dislocation, Congenital; Humans; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Pelvic Bones; Warfarin

Topics: Anticoagulants; Hematoma; Humans; International Normalized Ratio; Male; Middle Aged; Pancreatic Pseudocyst; Peritoneal Diseases; Retroperitoneal Space; Rupture, Spontaneous; Tomography, X-Ray Computed; Warfarin

The aim was to identify risk factors for postoperative bleeding following skin cancer surgery.. This was a prospective study of 5950 skin lesions excised in 2394 patients. No patient stopped taking aspirin or warfarin unless the international normalized ratio (INR) exceeded 3.0.. The rate of postoperative bleeding was 0.7 per cent overall and 2.5 per cent in the 320 patients taking warfarin. The rate of bleeding was 1.0 per cent for skin flap repairs, 0.4 per cent for simple excision and closure, and 5.0 per cent for skin grafts. Diabetic patients and smokers were not at increased risk of bleeding. There were four independent factors for bleeding: age 67 years or older (odds ratio (OR) 4.7 (95 per cent confidence interval 1.8 to 12.2); P = 0.002), warfarin therapy (OR 2.9 (1.4 to 6.3); P = 0.006), surgery on or around the ear (OR 2.6 (1.2 to 5.7); P = 0.012) and closure with a skin flap or graft (OR 2.7 (1.4 to 5.3); P = 0.004). Aspirin therapy was not an independent risk factor for bleeding.. Most postoperative bleeds were inconvenient but not life threatening, unlike the potential risk of thromboembolism after stopping warfarin or aspirin. There was no case for discontinuing aspirin before skin surgery, but the INR should be monitored in patients taking warfarin.

Topics: Aged; Anticoagulants; Aspirin; Female; Hematoma; Humans; Male; Neoplasms; Platelet Aggregation Inhibitors; Postoperative Hemorrhage; Prospective Studies; Risk Factors; Warfarin

Warfarin sodium is a commonly used oral anticoagulant agent. It has been well documented that, when effective anticoagulant therapy is employed in treating thromboembolic disease, hemorrhage is a possible complication that can be spontaneous without a history of trauma. The numerous sites of bleeding are the genitourinary and gastrointestinal tracts, the central nervous system, the nose (epistaxis), the penis (priapism), the retroperitoneum, wounds (surgical or traumatic), and subcutaneous tissues during warfarin therapy, but the hemorrhage rarely causes bleeding compromising a patient's airway. We report a case of a spontaneous lingual hematoma that developed during oral anticoagulation therapy. This life-threatening complication of warfarin therapy and its successful management without surgery indicates that observation, close monitoring and reversal of anticoagulation can be a reasonable management option.

Topics: Airway Obstruction; Anticoagulants; Hematoma; Humans; Male; Middle Aged; Tongue Diseases; Warfarin

Warfarin-dependent spontaneous intramural hematoma of the small intestine is a rare complication. The first symptom is usually abdominal pain, frequently accompanied by nausea and vomiting. In some cases, concomitant gastrointestinal bleeding might be seen. Ultrasonography and computed tomography are the most useful radiographic methods for the diagnosis of an intramural hematoma of the intestines. Although it is usually treated conservatively, surgical intervention is required in cases involving active bleeding, intestinal obstruction, or acute abdominal symptoms. Here we present two patients who were treated surgically. Both patients had intestinal obstruction and ischemia, and one had concomitant gastrointestinal bleeding and intussusception due to an intramural hematoma.

Topics: Abdomen, Acute; Adult; Aged; Anastomosis, Surgical; Anticoagulants; Hematoma; Humans; Intestine, Small; Intussusception; Male; Tomography, X-Ray Computed; Warfarin

Topics: Anticoagulants; Compartment Syndromes; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Middle Aged; Retroperitoneal Space; Warfarin

Topics: Anticoagulants; Blood Transfusion; Cerebral Hemorrhage; Clinical Trials as Topic; Hematoma; Humans; International Normalized Ratio; Plasma; Random Allocation; Stroke; Warfarin

Hematoma volume and impaired level of consciousness are the most potent predictors of outcome after spontaneous intracerebral hemorrhage (ICH). The effect of preceding aspirin-use on outcome after ICH is poorly investigated. We investigated short-term mortality and hematoma enlargement in subjects with ICH to find the predictors for these outcomes.. This population-based study included all subjects with ICH during a period of 33 months in the population of Northern Ostrobothnia, Finland. The subjects were identified, and their clinical characteristics and outcomes were checked from hospital records or death records.. Three-month mortality of the 208 identified subjects with ICH was 33%. The independent risk factors for death were regular aspirin-use at the onset of ICH (relative risks [RR], 2.5; 95% CI, 1.3 to 4.6; P=0.004), warfarin-use at the onset of ICH (RR, 3.2; 95% CI, 1.6 to 6.1; P=0.001), and ICH score higher than 2 on admission (RR, 13.8; 95% CI, 6.0 to 31.4; P<0.001). Regular aspirin-use preceding the onset of ICH associated significantly with hematoma enlargement during the first week after ICH (P=0.006).. We observed poor short-term outcomes and increased mortality, probably attributable to rapid enlargement of hematomas, in the subjects with ICH who had been taking regularly moderate doses of aspirin (median 250 mg) immediately before the onset of the stroke.

Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Aspirin; Cerebral Hemorrhage; Cohort Studies; Female; Hematoma; Hemorrhage; Humans; Iatrogenic Disease; Male; Middle Aged; Models, Statistical; Platelet Aggregation Inhibitors; Platelet Transfusion; Risk; Risk Factors; Time Factors; Treatment Outcome; Warfarin

Several commonly prescribed antibiotics are known to interact with warfarin, increasing its anticoagulant effect by different mechanisms. Retroperitoneal bleeding with consequent haematoma is recognised as a complication of over-anticoagulation. Consequences, which are potentially fatal, include hypovolaemic shock and compression of retroperitoneal structures such as the ureter and inferior vena cava.

Topics: Aged; Anti-Bacterial Agents; Anticoagulants; Drug Interactions; Drug Therapy, Combination; Female; Hematoma; Humans; Middle Aged; Retroperitoneal Space; Tomography, X-Ray Computed; Warfarin

We present a case of endocapsular hematoma, a rare form of intraocular hemorrhage that developed in a patient with pseudophakia receiving oral anticoagulants for previous mitral valve replacement and cerebrovascular disease.

Topics: Administration, Oral; Aged; Anticoagulants; Aspirin; Drug Therapy, Combination; Fibrinolytic Agents; Hematoma; Humans; Laser Therapy; Lens Capsule, Crystalline; Lens Diseases; Male; Mitral Valve; Pseudophakia; Stroke; Warfarin

Topics: Aged; Anticoagulants; Coronary Artery Bypass; Factor IX; Follow-Up Studies; Hematoma; Hemorrhage; Humans; Male; Warfarin

A 65-year-old man on warfarin therapy with a sudden spontaneous onset of sub-conjunctival haematoma associated with bloody tears was assessed in the clinic following a referral from an optometrist. Due to discomfort, diplopia and lagophthalmos, the haematoma necessitated suspension of warfarin therapy and a surgical evacuation. The sub-conjunctival haematoma in a patient receiving warfarin can pose a significant management challenge.

Topics: Aged; Anticoagulants; Atrial Fibrillation; Conjunctival Diseases; Eye Hemorrhage; Hematoma; Humans; Male; Warfarin

Topics: Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Enoxaparin; Female; Hematoma; Humans; Rectal Diseases; Warfarin

Airway obstruction secondary to bleeding from warfarin therapy is difficult to manage and uncommon but has been previously described. Previous reports have emphasized the need for reversal of therapy using vitamin K and fresh frozen plasma (FFP). Where a definitive airway has been required, cricothyroidotomy or tracheostomy seem to have been favoured. Several authors have reported failed attempts at endotracheal intubation due to the obstructive effects of a sublingual haematoma. We report here a case which illustrates how endotracheal intubation can be used successfully under the right conditions. It also highlights the superiority of prothrombin complex concentrate over FFP in achieving rapid reversal of abnormal international normalized ratio in the emergency situation.

Topics: Aged, 80 and over; Airway Obstruction; Anticoagulants; Blood Coagulation Factors; Critical Care; Hematoma; Humans; Intubation, Intratracheal; Male; Treatment Outcome; Warfarin

Topics: Anticoagulants; Compartment Syndromes; Enoxaparin; Fatal Outcome; Female; Hematoma; Hemorrhage; Humans; Middle Aged; Muscle Neoplasms; Peritoneal Diseases; Radionuclide Imaging; Rectus Abdominis; Warfarin

Retropharyngeal haematomas (RPHs) are rare but potentially life-threatening conditions that require a prompt diagnosis. However, the clinical scenario is not always straightforward as their presentation may be insidious, with no specific signs or symptoms. Treatment of RPH is conservative in the majority of cases, with close observation. Nevertheless, surgical intervention is sometimes indicated for large, non-resolving haematomas. We present the case of a 53-year-old woman on anticoagulant therapy who required evacuation of a traumatic RPH. We also propose a clinical protocol for the management of these entities according to our experience and previous literature reports.

Topics: Accidental Falls; Anticoagulants; Aortic Valve; Chronic Disease; Diagnosis, Differential; Drainage; Heart Valve Prosthesis; Hematoma; Humans; Male; Mediastinum; Middle Aged; Pharyngeal Diseases; Pharynx; Tomography, X-Ray Computed; Warfarin

Chronic expanding hematoma is a rare presentation of a hematoma characterized by a persistent increase in size for more than a month after the initial hemorrhage. We present a 65-year-old man with a chronic expanding hematoma in his ilium who was receiving anticoagulant treatment. The patient had a delayed manifestation of a femoral neuropathy with massive bone destruction. 2-Deoxy-[18F]fluoro-D: -glucose (FDG) positron emission tomography (PET) imaging revealed an increased uptake in the rim of the mass in images acquired 1 h after FDG injection. FDG-PET scans were performed using a dedicated PET scanner (HeadtomeV/SET2400 W, Shimadzu, Kyoto, Japan), and the PET data for the most metabolically active region of interest (ROI) were analyzed. The maximum standardized uptake value (SUVmax) was set to a cut-off point of 3.0 to distinguish between benign and malignant lesions. The SUVmax of the patient's lesion was 3.10, suggesting a malignant lesion. The characteristics of FDG-PET images of chronic expanding hematomas, including the uptake of FDG in the peripheral rim of the mass as a result of inflammation, should be recognized as a potential interpretive pitfall in mimicking a sarcoma.

Topics: Aged; Anticoagulants; Bone Diseases; Chronic Disease; Fluorodeoxyglucose F18; Hematoma; Humans; Ilium; Male; Positron-Emission Tomography; Radiopharmaceuticals; Warfarin

Lateral abdominal wall hematomas are rare. We describe a patient with a delayed rupture of a femoral artery pseudoaneurysm, who presented with such a hematoma. In contrast to other types of abdominal wall hematomas, which are often managed conservatively, a ruptured femoral artery pseudoaneurysm frequently requires emergent surgical intervention. Rupture of a pseudoaneurysm can be catastrophic. Due to the rising incidence of femoral artery pseudoaneurysms and shorter hospital stays, it is useful for the emergency physician to be familiar with the diagnosis and management of femoral artery pseudoaneurysms and their potentially life-threatening complications.

Topics: Abdominal Wall; Aged; Aneurysm, False; Anticoagulants; Atrial Fibrillation; Diagnosis, Differential; Emergency Medicine; Enoxaparin; Female; Femoral Artery; Heart Septal Defects, Atrial; Hematoma; Humans; Hypotension; Radiography; Rupture, Spontaneous; Treatment Outcome; Warfarin

Intraluminal ureteral hematoma is a rare disease and only a few cases have been previously described. We report a case of intraluminal ureteral hematoma induced by anticoagulant therapy. A 65-year old man having the oral anticoagulant therapy for prevention of secondary thrombolism following atrial fibrillation was referred to us for gross hematuria. Ultrasound sonography (US) revealed right renal mild wide pelvis. Computed tomography (CT) showed the right ureteral submucosal hematoma. This ureteral hematoma penetrated the ureteral mucosa and caused macrohematuria. The patient had been anticoagulated on Warfarin with Bucolome for 18 days, so the prothrombin times (PT) was found to be excessively prolonged beyond the normal therapeutic range. The oral anticoagulation was stopped and intravenous Vitamin K2 was given, so PT was normalized. Though estimate hemorrhage quantity reached 1,200 ml, we had no blood transfusion. The hematoma was completely diminished 4 months later, no reccurence has been occurred. Bucolome has especially pharmacokinetic positive interaction to Warfarin, so we must check PT-INR frequently.

Topics: Aged; Anticoagulants; Atrial Fibrillation; Barbiturates; Hematoma; Humans; International Normalized Ratio; Male; Prothrombin Time; Thromboembolism; Ureteral Diseases; Warfarin

Acute carpal tunnel syndrome following anticoagulation is uncommon. We describe a case in which the diagnosis was missed on three previous presentations by several clinicians. Although the presentation is typical, lack of awareness of this complication, inability to notice subtle signs and failure to do INR may lead to missing the diagnosis.

Topics: Aged; Anticoagulants; Carpal Tunnel Syndrome; Hematoma; Humans; International Normalized Ratio; Magnetic Resonance Imaging; Warfarin

Topics: Abdominal Muscles; Abdominal Pain; Abdominal Wall; Anticoagulants; Female; Hematoma; Humans; Lifting; Middle Aged; Warfarin

A 51-year-old woman on warfarin thromboprophylaxis for transient ischemic attacks developed sudden onset nausea, vomiting, and decreased mental status, rapidly becoming comatose. Head computed tomography (CT) showed intracerebral hemorrhage, extending into all ventricular chambers, and acute obstructive hematocephalus requiring urgent ventricular drainage. CT angiogram showed no evidence of an aneurysm or vascular malformation.. The pretreatment international normalized ratio (INR) of 4.9 was rapidly corrected with recombinant activated factor VII and an external ventricular drain was placed. Despite accurate positioning, the ventriculostomy thrombosed and became nonfunctional. Recombinant tissue plasminogen activator was given intraventricularly and resulted in partial ventricular decompression within 24 hours, with dramatic improvement in the patient's level of consciousness.. Repeated intraventricular fibrinolysis resulted in further reduction of the intraventricular hematoma within a few days and a good patient outcome. The patient did not require permanent ventricular shunt.. To our knowledge, this is the first reported case of combined systemic enhancement of hemostasis and local fibrinolysis as a life-saving measure in intracranial hemorrhage.

Topics: Anticoagulants; Cerebral Hemorrhage; Factor VIIa; Female; Fibrinolytic Agents; Hematoma; Hemostatic Techniques; Humans; Intracranial Thrombosis; Middle Aged; Recombinant Proteins; Thalamus; Tissue Plasminogen Activator; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

This case is reported to inform physicians of a case of amoxicillin/clavulanate potassium use in a patient taking warfarin and the subsequent alteration (prolongation) in the international normalized ratio (INR) that resulted in the formation of a rectus sheath hematoma (RSH).. A 75-year-old man receiving long-term warfarin therapy developed a lower respiratory tract infection with paroxysmal coughing that was treated with oral amoxicillin 250 mg/clavulanate potassium 125 mg TID for 7 days. In the 3 days after completing antibiotic treatment, he developed increasingly severe lower abdominal pain that was clinically diagnosed as RSH. The patient was admitted to the local hospital for confirmation of the diagnosis and appropriate management. Before this episode, his INR was consistently within therapeutic range (2-3); on admission it had risen to 5.7. His condition was managed conservatively, and he was discharged home 6 days postadmission.. This case is reported to highlight the potential interaction between warfarin and amoxicillin/clavulanate potassium and subsequent RSH formation. The potential mechanism of the interaction between amoxicillin/clavulanate potassium and warfarin may be either pharmacokinetic (via metabolism in the cytochrome P4S0 system and preferential metabolism of clavulanate potassium in the liver) or pharmacodynamic (via interference with the production of vitamin K-dependent clotting factors II, VI, IX, and X).. This case of RSH in an elderly patient receiving long-term stable warfarin anticoagulation is probably associated with amoxicillin/clavulanate potassium use and paroxysmal coughing.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anticoagulants; Drug Interactions; Hematoma; Humans; International Normalized Ratio; Male; Rectal Diseases; Warfarin

The study evaluated all patients undergoing permanent pacemaker and ICD implantation over a 4-year period to determine if anticoagulated patients required normalization of coagulation factors in the periprocedural period. The study included 1,025 (597 men, 428 women, age 24-100 years, mean 72 years) consecutive patients who underwent device implantation using mostly a percutaneous subclavian approach. The procedures were performed without reversal of anticoagulation in 470 patients with INRs >or= 1.5 at the time of the procedure (mean INR 2.6 +/- 1.0, range 1.5-7.5). The complication rate in the anticoagulated group was similar to those in patients with a normal INR. Routine normalization of coagulation factors prior to pacemaker/ICD placement may not be necessary.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Cardiac Catheterization; Defibrillators, Implantable; Female; Follow-Up Studies; Hematoma; Heparin; Humans; International Normalized Ratio; Male; Middle Aged; Pacemaker, Artificial; Postoperative Complications; Prosthesis Implantation; Retrospective Studies; Subclavian Vein; Warfarin

Interruption of appropriate therapeutic warfarin therapy imposes a risk of morbidity and mortality on the patient. Strategies to reduce the risks of interruption impose relatively large costs in terms of prolonged hospital stay, medication and coagulation monitoring. We report a series of 47 consecutive surgical episodes on the hands of 39 patients without interruption of therapeutic warfarin anticoagulation and with an INR of between 1.3 and 2.9. There was no difficulty with intraoperative haemostasis. Two patients had minor bleeding-related complications with no long-term sequelae. The authors conclude that interruption to warfarin therapy is unnecessary if the INR is less than 3.0 and therefore inappropriate for therapeutically anticoagulated patients undergoing hand surgery.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Female; Hand; Heart Valve Prosthesis; Hematoma; Hemostasis; Humans; International Normalized Ratio; Male; Middle Aged; Postoperative Complications; Stroke; Thromboembolism; Tourniquets; Treatment Outcome; Warfarin

In the case presented here, we have succeeded in describing the endoscopic findings of anticoagulant ileus and evaluated the degree of bleeding as well as ischemia through endoscopic observation. We have demonstrated that enteroscopy using the double-balloon method is a useful diagnostic tool in the evaluation of a patient suspected to have anticoagulant ileus.

Topics: Anticoagulants; Catheterization; Endoscopy, Gastrointestinal; Hematoma; Humans; Ileus; Jejunal Diseases; Male; Middle Aged; Warfarin

Topics: Abdominal Pain; Anticoagulants; Female; Hematoma; Humans; Ileal Diseases; Ileocecal Valve; Middle Aged; Warfarin

Warfarin increases mortality of intracerebral hemorrhage (ICH). The authors investigated whether this effect reflects increased baseline ICH volume at presentation or increased ICH expansion.. Subjects were drawn from an ongoing prospective cohort study of ICH outcome. The effect of warfarin on baseline ICH volume was studied in 183 consecutive cases of supratentorial ICH age > or = 18 years admitted to the emergency department over a 5-year period. Baseline ICH volume was determined using computerized volumetric analysis. The effect of warfarin on ICH expansion (increase in volume > or = 33% of baseline) was analyzed in 70 consecutive cases in whom ICH volumes were measured on all subsequent CT scans up to 7 days after admission. Multivariable analysis was used to determine warfarin's influence on baseline ICH, ICH expansion, and whether warfarin's effect on ICH mortality was dependent on baseline volume or subsequent expansion.. There was no effect of warfarin on initial volume. Predictors of larger baseline volume were hyperglycemia (p < 0.0001) and lobar hemorrhage (p < 0.0001). Warfarin patients were at increased risk of death, even when controlling for ICH volume at presentation. Warfarin was the sole predictor of expansion (OR 6.2, 95% CI 1.7 to 22.9) and expansion in warfarin patients was detected later in the hospital course compared with non-warfarin patients (p < 0.001). ICH expansion showed a trend toward increased mortality (OR 3.5, 95% CI 0.7 to 8.9, p = 0.14) and reduced the marginal effect of warfarin on ICH mortality.. Warfarin did not increase ICH volume at presentation but did raise the risk of in-hospital hematoma expansion. This expansion appears to mediate part of warfarin's effect on ICH mortality.

Topics: Adult; Aged; Anticoagulants; Apolipoproteins E; Cerebral Hemorrhage; Cohort Studies; Disease Progression; Female; Genotype; Hematoma; Hospital Mortality; Humans; Hyperglycemia; Hypertension; Life Tables; Male; Middle Aged; Platelet Aggregation Inhibitors; Prospective Studies; Radiography; Risk; Treatment Outcome; Warfarin

The study investigated clinical, radiological findings and treatment methods used in patients who developed intraabdominal hemorrhage due to chronic warfarin use.. Eight patients receiving warfarin for cardiac valve replacement, pulmonary thromboemboli, and atrial fibrillation were admitted to our hospital. The patients had abdominal pain, nausea, and vomiting although there was no hematemesis and melena.. Abdominal ultrasonography and computerized tomography identified the individuals' problems as intraabdominal hemorrhage (n=2), intestinal intramural and intraabdominal hemorrhage (n=2), bleeding into the sheath of the rectus abdominus muscle (n=1), subcapsular splenic hemorrhage (n=1), and bleeding due to ruptured ovarian cyst (n=2).. Clinicians must be alert for intraabdominal bleeding in patients who are prescribed warfarin treatment. Abdominal ultrasonography and computerized tomography should be used to investigate all such cases of suspected hemorrhage. Blood and plasma replacements are first line of supportive treatment and surgery should be avoided if possible.

Topics: Adult; Aged; Anticoagulants; Atrial Fibrillation; Female; Gastrointestinal Hemorrhage; Heart Valve Prosthesis Implantation; Hematoma; Humans; Male; Middle Aged; Pulmonary Embolism; Thromboembolism; Tomography, X-Ray Computed; Turkey; Ultrasonography; Warfarin

Topics: Aged; Anticoagulants; Enoxaparin; Female; Hematoma; Humans; Radiography; Rectus Abdominis; Venous Thrombosis; Warfarin

A 57-year-old man treated with Coumadin for an episode of paroxysmal atrial fibrillation presented to the Emergency Department with progressive dysphagia and odynophagia. Physical examination revealed a large right-sided lateral and posterior pharyngeal wall mass. Laboratory studies were significant for an international normalized ratio (INR) of 5.4 with a white blood cell count of 11,600/muL and a hematocrit of 33.2%. A lateral soft tissue radiograph and computed tomography (CT) scan of the neck demonstrated a retropharyngeal hematoma compromising the airway. Rapid reversal of the coagulopathy was achieved with fresh frozen plasma and vitamin K. Patients with space-occupying retropharyngeal masses present a significant management dilemma. The choice between observation, intubation, or a surgical airway intervention must rely upon knowledge of the natural course and high rate of airway occlusion when faced with a patient who presents with a retropharyngeal hematoma. Once symptoms of airway compromise manifest, the airway must be expeditiously secured before complete obstruction occurs. This diagnosis should be sought when an anticoagulated patient presents with upper airway symptoms.

Topics: Airway Obstruction; Anticoagulants; Atrial Fibrillation; Blood Transfusion; Deglutition Disorders; Disease Progression; Emergency Treatment; Hematocrit; Hematoma; Humans; Laryngoscopy; Leukocyte Count; Male; Middle Aged; Pharyngeal Diseases; Plasma; Risk Factors; Tomography, X-Ray Computed; Vitamin K; Warfarin

Topics: Aged; Anticoagulants; Arteriosclerosis Obliterans; Hematoma; Humans; Lung Diseases; Male; Tomography, X-Ray Computed; Warfarin

Intramural hematoma of the intestine is a rare complication of anticoagulant therapy. We evaluated 7 nontrauma patients with intramural hematoma of the intestine diagnosed at our institution between May 1998 and June 2001. All of the patients were receiving long-term anticoagulant therapy for previous diseases. All 7 patients had abdominal pain, 6 had additional symptoms of nausea and vomiting, and 4 had melanotic stools at admission. Six of the patients had abnormal coagulation parameters. Both abdominal ultrasonography (US) and computerized tomography (CT) showed the exact pathology in all patients. Five of the 7 patients were treated, nonoperatively, and the other patients underwent surgery. All of the patients were followed with abdominal US and CT (mean 12 = months), with complete resolution of their intramural hematomas. Abdominal US and CT evaluation performed together will help the accuracy of diagnosis of intramural hematoma, but nonoperative therapy is the treatment of choice, with surgery indicated if generalized peritonitis or intestinal obstruction develops.

Topics: Abdomen; Abdomen, Acute; Abdominal Pain; Adult; Aged; Anticoagulants; Diagnosis, Differential; Drug Overdose; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Hematoma; Humans; Male; Middle Aged; Radiography, Abdominal; Treatment Outcome; Ultrasonography; Warfarin

Major bleeding is a frequent and hazardous complication associated with thromboprophylaxis using vitamin-K antagonists (VKA). Suggested regimens for control of highly elevated International Normalized Ratio (INR) and hemorrhagic events during VKA treatment include administration of vitamin K, infusion of fresh frozen plasma (FFP) or a prothrombin complex concentrate (PCC). In contrast, this communication present the first report on the efficacious use of recombinant factor VIIa (rFVIIa) as additional therapy in seven patients presenting with central nervous system (CNS) bleeding emergencies. Pre-treatment INRs ranged from 1.7 to 6.6, and 10 min after a single dose of rFVIIa (10-40 microg/kg) all INRs were

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Blood Coagulation; Cerebral Hemorrhage; Computer Systems; Drug Evaluation; Factor VII; Factor VIIa; Female; Hematoma; Hemostatics; Humans; International Normalized Ratio; Male; Middle Aged; Recombinant Proteins; Thrombelastography; Thromboembolism; Treatment Outcome; Vitamin K; Warfarin

Topics: Anesthesia, General; Antibodies, Antiphospholipid; Anticoagulants; Hematoma; Humans; Lipoma; Lupus Coagulation Inhibitor; Male; Middle Aged; Postoperative Complications; Thigh; Thromboembolism; Warfarin

A 27-yr-old woman who had been taking warfarin for 10 yr after mitral valve replacement became pregnant. After knowing her pregnancy, she received heparinization for nine weeks instead of warfarin, and took oral anticoagulant again. At 24 weeks of gestation, fetal ultrasound and MRI showed a left subdural hematoma, and the pregnancy was terminated. Subdural hematoma was demonstrated on autopsy. Fatal bleeding of the fetus is a rare complication of maternal warfarin medication, occurring mostly in the second or third trimester. There is no alternative regimen available, so that regular monitoring by fetal ultrasound and strict control of warfarin dose with regular measurement of prothrombin time are the best way to prevent intrauterine fetal death due to bleeding.

Topics: Adult; Anticoagulants; Ductus Arteriosus, Patent; Female; Fetal Diseases; Heart Valve Diseases; Hematoma; Heparin; Humans; Intracranial Hemorrhages; Maternal Exposure; Pregnancy; Pregnancy Complications, Hematologic; Prothrombin Time; Warfarin

The complications of warfarin therapy have classically been described as bleeding in the genitourinary and gastrointestinal tracts, skin, central nervous system, nose, penis, or retroperitoneum. However, rarely warfarin may cause bleeding that compromises a patient's airway. A sublingual haematoma is an example of such a complication. Only 10 previous cases of sublingual haematomas have been reported.. We describe the case of a 56 year-old woman receiving oral anticoagulation who presented with a sore throat and hoarseness. Examination of her oral cavity revealed a soft, red, submucosal swelling involving the floor of mouth and ventral lingual surface bilaterally. No signs of airway compromise were observed. The patient's PT-INR was 10. Given the potential for rapid airway obstruction, the patient was admitted to a unit with closely monitored beds. Her coagulation disturbance was corrected medically and her haematoma resolved. The patient was discharged to the care of her family physician.. This case makes several important points. First, the case describes a rare, but life-threatening complication of warfarin therapy. Second, the initial signs of a sublingual haematoma are reviewed. Given the vagueness of these signs, diagnosis requires a high index of suspicion on the part of the physician. Finally, the case describes successfully management of this disorder without the use of a surgical airway. For this patient, reversal of her anticoagulation and vigilant monitoring saved her from having a surgical airway placed.

Topics: Airway Obstruction; Female; Hematoma; Humans; Middle Aged; Mouth Diseases; Mouth Floor; Warfarin

Topics: Acute Disease; Aged; Anticoagulants; Colonic Diseases; Female; Hematoma; Humans; Intestinal Obstruction; Tomography, X-Ray Computed; Warfarin

Two women on warfarin anticoagulation experienced urinary retention following urethral collagen bulk injections. Both women developed implant site hematomas, with urinary retention and intravesical hemorrhage. One woman was supratherapeutic and the other was therapeutic on warfarin therapy. Both women required transfusion and prolonged catheterization.

Topics: Aged; Aged, 80 and over; Anticoagulants; Collagen; Female; Hematoma; Humans; Injections; Prostheses and Implants; Urinary Bladder Diseases; Urinary Incontinence, Stress; Urinary Retention; Warfarin

We present a case to illustrate controversies in percutaneous drainage of infected, perinephric haematoma in a tetraplegic patient, who had implantation of baclofen pump in anterior abdominal wall on the same side as perinephric haematoma.. A 56-year-old male with C-4 tetraplegia had undergone implantation of programmable pump in the anterior abdominal wall for intrathecal infusion of baclofen to control spasticity. He developed perinephric haematoma while he was taking warfarin as prophylactic for deep vein thrombosis. Perinephric haematoma became infected with a resistant strain of Pseudomonas aeruginosa, and required percutaneous drainage. Positioning this patient on his abdomen without anaesthesia, for insertion of a catheter from behind, was not a realistic option. Administration of general anaesthesia in this patient in the radiology department would have been hazardous.. Percutaneous drainage was carried out by anterior approach under propofol sedation. The site of entry of percutaneous catheter was close to cephalic end of baclofen pump. By carrying out drainage from anterior approach, and by keeping this catheter for ten weeks, we took a risk of causing infection of the baclofen pump site, and baclofen pump with a resistant strain of Pseudomonas aeruginosa. The alternative method would have been to anaesthetise the patient and position him prone for percutaneous drainage of perinephric collection from behind. This would have ensured that the drainage track was far away from the baclofen pump with minimal risk of infection of baclofen pump, but at the cost of incurring respiratory complications in a tetraplegic subject.

Topics: Abdominal Wall; Anesthetics, Intravenous; Baclofen; Drainage; Hematoma; Humans; Infusion Pumps, Implantable; Male; Middle Aged; Muscle Spasticity; Perinephritis; Propofol; Pseudomonas Infections; Quadriplegia; Venous Thrombosis; Warfarin

Warfarin is frequently used as an anticoagulant. The most common and serious complication is bleeding. We present a 43-year-old warfarinized patient who was admitted with unilateral groin pain and a neurological deficit of the lumbar nerve root L1-4. A CT scan showed a haematoma in and behind the ilio-psoas muscle extending to below the inguinal ligament, due to a warfarin induced coagulation deficit (INR 7.0) which was reversed on admission with vitamin K. There is no conclusive evidence in the literature supporting either conservative or surgical treatment modalities. Our patient was successfully treated conservatively.

Topics: Acute Disease; Adult; Anticoagulants; Femoral Nerve; Hematoma; Humans; Inguinal Canal; Lumbar Vertebrae; Male; Nerve Compression Syndromes; Pain; Pain Management; Peripheral Nervous System Diseases; Psoas Muscles; Radiography; Ultrasonography; Warfarin

Drugs containing paracetamol are widely used as analgesics but may result in increased anticoagulation in patients who take warfarin, the mechanism being unclear. Retroperitoneal haemorrhage is a serious and well described complication in patients who develop increased anticoagulation; this may result in a femoral neuropathy. Both conservative and surgical treatments have been advocated for this complication.

Topics: Acetaminophen; Analgesics, Non-Narcotic; Drug Synergism; Female; Femoral Neuropathy; Hematoma; Humans; International Normalized Ratio; Middle Aged; Retroperitoneal Space; Warfarin

Anticoagulation is routinely employed in cardiac surgery following mechanical valve replacement. Warfarin is the most common agent used for anticoagulation. Bleeding, internal or external, remains the major complication with anticoagulant therapy. The risk is known to be higher with INR levels above 4.5. We report a case of a retropharyngeal hematoma following trivial blunt trauma to a patient whose INR had shot up to 6.8 and also discuss its management.

Topics: Anticoagulants; Female; Heart Valve Prosthesis Implantation; Hematoma; Humans; International Normalized Ratio; Middle Aged; Postoperative Complications; Warfarin

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

Topics: Aged; Anticoagulants; Hematoma; Humans; Kidney Diseases; Male; Tomography, X-Ray Computed; Venous Thrombosis; Warfarin

Topics: Abdominal Muscles; Aged; Anticoagulants; Female; Hematoma; Humans; Tomography, X-Ray Computed; Warfarin

To study the demographic and clinical characteristics of patients with antiphospholipid syndrome (APS) with serious haemorrhagic complications of anticoagulant treatment in an attempt to establish risk factors for bleeding.. Patients with APS who were attending our lupus unit and who presented with severe bleeding while receiving oral anticoagulation were studied retrospectively. Severe bleeding was defined by the need for admission to hospital. Demographic data, clinical features, concomitant diseases and drugs, warfarin doses, duration of anticoagulation, and International Normalised Ratios (INR) at the time of bleeding were collected.. Fifteen patients were included in the study (12 with systemic lupus erythematosus (SLE) plus APS and 3 with primary APS). The median age was 41.7 (range 27-66) and the median duration of the disease was 12.9 years (range 3-22). Duration of anticoagulation was between 10 days and 17 years. The INR at the time of bleeding was under 3 in 4 patients, between 3 and 4 in 5 patients and above 4 in 6 patients. There were 4 episodes of subdural haematoma, 4 episodes of renal haematoma (two after renal biopsy), 2 episodes of ovarian haemorrhage, 2 episodes of rectal haemorrhage, 1 episode of menorrhagia, 1 episode of haemarthrosis, and 1 episode of spinal haematoma. Concomitant drugs were aspirin in 9 patients, antibiotics in 2 patients, and azathioprine in 3 patients. In 6 patients hypertension was present as a concomitant disease. There were no deaths due to bleeding. Anticoagulant treatment was restarted in all patients and 3 of them had a new episode of bleeding.. No relation was established between age, duration of oral anticoagulant treatment, and bleeding. Concomitant drugs, mainly aspirin, and high blood pressure were present at the time of bleeding in a large number of patients.

Topics: Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Antiphospholipid Syndrome; Aspirin; Female; Hemarthrosis; Hematoma; Hematoma, Subdural; Hemorrhage; Humans; Hypertension; Kidney Diseases; Male; Menorrhagia; Middle Aged; Ovarian Diseases; Recurrence; Risk Factors; Thrombosis; Warfarin

Topics: Accidental Falls; Aged; Aged, 80 and over; Anticoagulants; Arthroplasty, Replacement, Hip; Female; Hematoma; Hip; Humans; International Normalized Ratio; Male; Middle Aged; Pain; Psoas Muscles; Risk Factors; Time Factors; Tomography, X-Ray Computed; Venous Thrombosis; Warfarin

Chronic anticoagulant treatment is administered mostly for cardiological reasons. Cumarin derivatires are used in the majority of cases (Warfarin, Pelentan). It is necessary to monitor this treatment regularly and to control the dose according to the INR value. Different complications can occur; the haemorrhage represents a serious one. The authors discuss several aspects of anticoagulant therapy and possible prevention of the complications. The importance of the problems is demonstrated on the authors' clinical experience--two cases of haemorrhage after Warfarin administration simulating an acute surgical event.

Topics: Abdomen, Acute; Abdominal Muscles; Aged; Aged, 80 and over; Anticoagulants; Ethyl Biscoumacetate; Female; Hematoma; Hemorrhage; Humans; Male; Retroperitoneal Space; Warfarin

Unwanted haemorrhage can be seen due to long-term oral anticoagulant use. Sometimes these may lead obstructions forming intramural haemotomas. We noticed a case of duodenal obstruction due to an intramural hematoma in a patient who is on chronic oral anticoagulant therapy. In Taksim Hospital 1st General Surgery Department in April 2000, we treated a patient who presented anaemia, jaundice, pyloric obstruction conservatively. As a result we implicated to treat such cases nonoperatively.

Topics: Administration, Oral; Anticoagulants; Diagnosis, Differential; Duodenal Obstruction; Emergency Treatment; Hematoma; Humans; Male; Middle Aged; 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; Anticoagulants; Diagnosis, Differential; Genital Diseases, Male; Genital Neoplasms, Male; Hematoma; Humans; Lipoma; Male; Scrotum; Tomography, X-Ray Computed; Ultrasonography; Venous Thrombosis; Warfarin

We report a case of an important and uncommon haemorrhagic complication in a patient receiving warfarin treatment. We reflect on the importance of close monitoring of anticoagulant therapy to prevent haemorrhagic complications and to ensure safety in longterm use.

Topics: Acute Kidney Injury; Aged; Anticoagulants; Hematoma; Humans; Male; Medication Errors; Retroperitoneal Space; Warfarin

Four cases of lower extremity hematoma in patients undergoing anticoagulant therapy after heart valve replacement are herein reported, with special emphasis on the comparative diagnostic value of ultrasonography and computerized tomography. Although conservative management is sufficient for patients with no neurological impairment, needle aspiration after autolysis of the hematoma, which can be confirmed by CT study, is also recommended.

Topics: Acute Disease; Aged; Anticoagulants; Diagnosis, Differential; Female; Heart Valve Prosthesis Implantation; Hematoma; Humans; Leg; Male; Middle Aged; Thrombosis; Warfarin

A 46-year old nurse complaining of multiple hematomas including bleeding into the tongue was referred for hemostasis evaluation. A very low Quick percentage value, i.e. a severely prolonged prothrombin time with severely depressed vitamin K-dependent coagulation factors (FII:C, FVII:C, FX:C) and normal FV:C and fibrinogen level was found. In the absence of cholestasis, malabsorption and broad-spectrum antibiotic therapy, ingestion of vitamin K antagonists was suspected. Three years previously, she had been on oral anticoagulant treatment with phenprocoumon (Marcoumar) for postoperative pulmonary embolism. She denied having voluntarily ingested anticoagulant drugs. A high plasma level of coumarins was found. To exclude accidental ingestion, the patient's son living in the same household was tested as well. Surprisingly, a low level of coumarin was found also in his plasma. We suspect that the patient voluntarily intoxicated herself and gave a low dose of coumarin anticoagulant to her son as well.

Topics: Anticoagulants; Blood Coagulation Tests; Drug Overdose; Female; Hematoma; Hemorrhagic Disorders; Humans; Middle Aged; Phenprocoumon; Tongue Diseases; Warfarin

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

Topics: Abdominal Pain; Adult; Anticoagulants; Hematoma; Humans; Intestine, Small; Male; Tomography, X-Ray Computed; Warfarin

Topics: Administration, Oral; Anticoagulants; Female; Hematoma; Humans; Mesenteric Arteries; Middle Aged; Rupture, Spontaneous; Shock, Hemorrhagic; Warfarin

We report the first case in which a fluid-blood interface was identified at autopsy in a patient with acute intracerebral hematoma on anticoagulant therapy. Anticoagulation may be one of the major factors contributing to the production of an intracerebral blood sedimentation level.

Topics: Aged; Anticoagulants; Blood Sedimentation; Blood-Brain Barrier; Brain; Cerebral Hemorrhage; Fibrin; Heart Valve Prosthesis Implantation; Hematoma; Humans; Male; Mitral Valve Stenosis; Postoperative Complications; Warfarin

Topics: Abdominal Pain; Anticoagulants; Hematoma; Humans; Jejunal Diseases; Male; Middle Aged; Warfarin

Topics: Acute Disease; Aged; Anticoagulants; Epiglottitis; Hematoma; Humans; Laryngeal Diseases; Male; Warfarin

Topics: Aged; Anticoagulants; Antifungal Agents; Drug Interactions; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Ileum; Miconazole; Peritoneal Diseases; Psoas Muscles; Warfarin

Acute carpal tunnel syndrome is well recognized in patients with haemophilia and conservative management with factor replacement and temporary splinting is recommended. There have, however, been very few reported cases of acute carpal tunnel syndrome as a complication of oral anticoagulant therapy. We describe such a case in a patient on long-term warfarin anticoagulation, drawing attention to particular features of the history and clinical findings. In contrast to previous reports, we recommend prompt decompression under local anaesthesia and continuation of the anticoagulant therapy.

Topics: Anticoagulants; Aortic Valve; Carpal Tunnel Syndrome; Decompression, Surgical; Heart Valve Prosthesis; Hematoma; Humans; Male; Middle Aged; Postoperative Complications; Warfarin

We present one patient who was admitted with a peritonsillar haematoma as a complication of acute tonsillitis and concomitant warfarin therapy for prosthetic aortic valves. While tonsillar haemorrhage as a result of acute tonsillitis has been well described, no cases of isolated haematoma formation have been documented, nor has it been recognized previously as a complication of long-term anticoagulant therapy. We discuss establishing the diagnosis, the likely aetiology and implications of this complication.

Topics: Acute Disease; Adult; Anticoagulants; Heart Valve Prosthesis; Hematoma; Humans; Male; Pharyngeal Diseases; Pharynx; Tonsillitis; Warfarin

Many patients who undergo cutaneous surgery take medications that can affect bleeding. The role of these medications in postoperative bleeding complications is unclear. Dermatologists have no clear guidelines regarding the need to discontinue these medications preoperatively.. We designed a prospective study to evaluate the incidence of postoperative bleeding complications in patients taking aspirin, warfarin, or nonsteroidal antiinflammatory agents.. Data were collected from patients undergoing Mohs surgery regarding preoperative medication history, operative bleeding, and postoperative bleeding. Frequency of postoperative bleeding complications was then evaluated.. There was no statistically significant difference in postoperative bleeding complications between patients on aspirin, warfarin, or nonsteroidal antiinflammatory agents, when compared with controls.. It may not be necessary to discontinue aspirin, warfarin, or nonsteroidal antiinflammatory agents in patients undergoing many common dermatologic surgical procedures, such as Mohs surgery.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Bandages; Blood Loss, Surgical; Dermatologic Surgical Procedures; Evaluation Studies as Topic; Hematoma; Humans; Incidence; Medical History Taking; Mohs Surgery; Postoperative Hemorrhage; Practice Guidelines as Topic; Prospective Studies; Skin Transplantation; Surgical Flaps; Warfarin

Topics: Aged; Anticoagulants; Aortic Valve; Arm; Arm Injuries; Compartment Syndromes; Heart Valve Prosthesis; Hematoma; Humans; Long-Term Care; Male; Nerve Compression Syndromes; Nerve Regeneration; Neurologic Examination; Paralysis; Rupture; Tendon Injuries; Warfarin

Abdominal wall haematomas are uncommon, difficult to diagnose clinically and often associated with systemic anti-coagulation. Seven cases together with the imaging results are presented and the characteristic features and potential pitfalls are discussed. Ultrasound is the first line investigation but the results can be misleading and computed tomography (CT) is often required to confirm the diagnosis.

Topics: Abdominal Muscles; Aged; Anticoagulants; Female; Hematoma; Heparin; Humans; Male; Middle Aged; Muscular Diseases; Tomography, X-Ray Computed; Ultrasonography; Warfarin

This case report illustrates an unusual complication of chronic warfarin administration.. The presurgical determination that the destructive process at L1-L2 was not infection or neoplasm involved the recognition that there was instability at this level resulting from chronic stress fractures.. Periosteal or osseous hemorrhagic masses (pseudotumors) have been well described in patients with hemophilia. To the authors' knowledge, this is the first reported case of this well-known phenomenon occurring in the axial skeleton as a consequence of warfarin administration.. Serial radiographic studies of the lumbar spine were available showing a progressive destructive lesion at L1-L2 and coinciding with the initiation of warfarin anticoagulation after aortic valve replacement.. The destructive mass was demonstrated surgically to represent a large partially solidified chronic hematoma.. Patients with stress fractures of the posterior arch and subsequent instability may be subject to development of such a spondyloarthropathy. Recognition of this unusual potential complication of warfarin therapy would prevent an incorrect diagnosis of tumor or infection. Early recognition of its occurrence could lead to early spinal stabilization.

Topics: Aged; Fractures, Stress; Hematoma; Humans; Lumbar Vertebrae; Male; Radiography; Spinal Diseases; Spondylitis, Ankylosing; Warfarin

We present a case of a patient suffering from acute abdomen with a palpable mass on the left lower quadrant of the abdominal wall. The clinical manifestations and plain abdomen gave the misleading diagnosis of a ventral hernia. A review of the patient history revealed the use of anticoagulants for pulmonary embolism, and as a result computed tomography (CT) was performed which provided an accurate diagnosis of rectus sheath hematoma. The probable pathogenesis is discussed.

Topics: Aged; Female; Hematoma; Humans; Pulmonary Embolism; Radiography, Abdominal; Tomography, X-Ray Computed; Warfarin

Venipuncture is a commonly used modality for therapeutic monitoring in patients on anticoagulant therapy. The antecubital fossa provides an easily accessible site with low associated morbidity. A case report of an acute complete radial nerve compression neuropathy that developed after antecubital venipuncture in a patient on anticoagulant therapy is presented.

Topics: Acute Disease; Aged; Anticoagulants; Hematoma; Humans; Male; Nerve Compression Syndromes; Neurologic Examination; Phlebotomy; Radial Nerve; Warfarin

Topics: Aged; Anticoagulants; Cardiac Output, Low; Female; Gastrointestinal Hemorrhage; Hematoma; Hip Prosthesis; Humans; Malpractice; Postoperative Complications; Retroperitoneal Space; Risk Management; Warfarin

Topics: Aged; Airway Obstruction; Anticoagulants; Female; Hematoma; Humans; Laryngeal Diseases; Male; Pharyngeal Diseases; Warfarin

The effect of influenza vaccine on the prothrombin time (PT) among patients taking warfarin is unclear, as previous studies have shown conflicting results and the clinical significance of such a purported effect is uncertain. Moreover, to our knowledge, there are no data confirming the safety of intramuscular injections in patients receiving anticoagulant therapy with regard to possible local hematoma formation. We measured the effect of influenza vaccine on the PT among patients receiving long-term warfarin sodium therapy and evaluated the safety of intramuscular injections among them.. Forty-one adult patients who were receiving anticoagulant therapy were given 0.5 mL of influenza vaccine intramuscularly. Prothrombin time and arm girth were measured at baseline and on days 3, 7, and 14 after immunization. Local pain and tenderness were assessed on a five-point scale. Patients and study nurses were blinded to all prior measurements. Differences between baseline PT and that at each subsequent visit and the maximal change in arm circumference from baseline were calculated for each patient. Mean, range, and 95% confidence intervals were calculated for the entire group.. There was no statistically significant change in PT between baseline and days 3, 7, and 14 after vaccination, and no significant change in arm circumference was noted. There were no clinically detectable local complications after intramuscular injection and no major or minor bleeding episodes after influenza vaccination.. Influenza vaccine has no significant effect on the PT in patients who are being treated with warfarin. Influenza vaccine can be administered intramuscularly to patients who are receiving anticoagulant therapy without the risk of local bleeding complications.

Topics: Aged; Arm; Hematoma; Hemorrhage; Humans; Influenza Vaccines; Injections, Intramuscular; Male; Middle Aged; Prothrombin Time; Time Factors; Warfarin

This paper deals with two patients on warfarin in whom the use of topical methylsalicylate preparations led to clinically significant bleeding problems. The first patient required fresh frozen plasma to tide over the crisis while the second patient recovered spontaneously on stopping the warfarin temporarily. The possible mechanisms by which salicylates potentiate the anticoagulant effect of warfarin are briefly outlined.

Topics: Adult; Anti-Inflammatory Agents; Anticoagulants; Drug Interactions; Female; Gingiva; Hematoma; Hemorrhage; Humans; Leg; Male; Middle Aged; Salicylates; Steroids; Warfarin

We report a patient on warfarin prophylaxis who had major intraperitoneal hemorrhage 17 days following percutaneous liver biopsy (PLBx). Selective hepatic angiography revealed a pseudoaneurysm of a branch of the right hepatic artery, associated with an arterio-portal venous fistula. Ultrasound with Doppler studies showed flow through the pseudoaneurysm. Embolization with platinum micro-coils resulted in cessation of flow through the pseudoaneurysm, and closure of the arterio-portal venous fistula. Anticoagulation was then resumed without recurrent bleeding. Pseudoaneurysms and arteriovenous fistulas may be mechanisms by which delayed bleeding occurs after PLBx. Doppler ultrasonography and hepatic angiography are useful in the evaluation and management of this event.

Topics: Aged; Aneurysm, False; Arteriovenous Fistula; Biopsy, Needle; Embolization, Therapeutic; Hematoma; Hepatic Artery; Humans; Liver Diseases; Male; Portal Vein; Time Factors; Warfarin

Warfarin therapy is associated with a variety of haemorrhagic complications. We report a representative series of six cases of warfarin-induced bleeding in non-cerebral sites admitted to one unit. In all of these cases, there was inadequate control of anticoagulation, resulting in major morbidity and one death. In particular, closer attention must be paid to the indications for and duration of warfarin treatment.

Topics: Aged; Aged, 80 and over; Female; Hematoma; Hemorrhage; Humans; Male; Middle Aged; Retroperitoneal Space; Warfarin

Topics: Heart Valve Prosthesis; Hematoma; Humans; Male; Massage; Middle Aged; Warfarin

The relative safety of epidural catheter placement with subsequent heparinization has been well documented. However, what is the risk of neurologic sequelae in such patients who receive warfarin perioperatively? This study retrospectively evaluates the risk of spinal hematoma in patients receiving postoperative epidural analgesia while receiving low-dose warfarin after total knee replacement. All patients received low-dose warfarin to prolong the prothrombin time (PT) to 15.0-17.3 s (normal 10.9-12.8 s). There were 192 epidural catheters placed in 188 patients. All catheters were advanced through an 18-gauge needle. In 13 instances, blood was noted during needle and/or catheter placement. In addition to warfarin, 36 patients with indwelling catheters received nonsteroidal antiinflammatory drugs (NSAIDs). Epidural catheters were left indwelling 37.5 +/- 15 h (range 13-96 h). The mean PT was not increased beyond the normal range until the third postoperative day and did not reach 15 s until the seventh postoperative day. Cumulative warfarin dose at that time was 20.0 +/- 7.6 mg. Mean PT at the time of epidural catheter removal was 13.4 +/- 2 s. There were no signs of spinal hematoma. Although epidural catheter placement and subsequent anticoagulation with warfarin appears relatively safe, there is a large variability in patient response to warfarin; therefore, coagulation status should be monitored to avoid excessive prolongation of the PT, and the patient should be watched closely for evidence of spinal hematoma.

Topics: Aged; Analgesia, Epidural; Catheters, Indwelling; Female; Hematoma; Humans; Knee Prosthesis; Male; Postoperative Period; Retrospective Studies; Spinal Cord Diseases; Thrombophlebitis; Warfarin

There are no validated guidelines for administering or monitoring oral anticoagulant therapy in pediatric patients. A pediatric thromboembolism program at the Hospital for Sick Children, Toronto, prospectively monitored consecutive children requiring warfarin over an 18 month period. A uniform protocol was followed and dose adjustments based upon international normalized ratios (INRs). One hundred and fifteen consecutive children; 68 males and 47 females, received warfarin. The age distribution was: <1y (19); 1-5 ys (33); 6-10 ys (20); 11-18 ys (43). Warfarin was used for secondary prevention of venous thromboembolism (n = 56) and primary prevention of thromboembolism (n = 59). Underlying disorders included: congenital heart disease (CHD) without mechanical valves (MV) (49); CHD with MV (18); cancer (8); longterm total parenteral nutrition (7); renal disorders (10); other (23). Treatment length was considered as short term (3-6 mths) n = 37 (32%); longterm (> 6 mths) n = 38 (33%); and life-long n = 40 (35%) of children. While receiving warfarin, 95 children received concurrent longterm treatment with other drugs: 1 drug (28); 2 drugs (27); 3 drugs (21); 4 or more drugs (19). The amounts of warfarin/kg required to achieve INRs of 2 to 3 decreased with increasing age. Children <1 year of age required 0.32 +/- 0.05 mg/kg whereas children 11-18 yrs required 0.09 +/- 0.01 mg/kg; P < 0.001. Monitoring warfarin required an average of 4.0 measurements per month and 1.5 dose changes per month. Changes in warfarin doses were primarily precipitated by drugs, intermittent illness, and changes in diet.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Adolescent; Adult; Child; Child, Preschool; Drug Evaluation; Female; Hematoma; Hemorrhage; Humans; Infant; Infant, Newborn; Male; Program Evaluation; Prospective Studies; Prothrombin Time; Recurrence; Thromboembolism; Treatment Outcome; Warfarin

Coumadin is a coumarin anticoagulant that induces a state similar to vitamin K deficiency and is routinely used for chronic oral anticoagulation. Intramural hematoma of the bowel is a rare complication of anticoagulant therapy. In this paper, we describe such a case of an anticoagulated patient who had complaints of abdominal pain and who had inadvertently been taking higher dose of coumadin. Although the diagnosis can usually be made by history and plain abdominal x-ray, we report here some radiographic signs that can be seen on a CT-scan of the abdomen and are relatively specific for this diagnosis. We stress the importance of recognizing the disorder because the management is conservative and surgery is reserved for cases in which no improvement is seen.

Topics: Drug Overdose; Female; Hematoma; Humans; Intestinal Diseases; Intestinal Obstruction; Intestine, Small; Middle Aged; Warfarin

We have described two cases of spontaneous intracerebral hematoma, characterized by sedimentation level seen on unenhanced cerebral CT, in patients receiving anticoagulation therapy. Anticoagulation or coagulopathy may be important in producing sedimentation levels. The "sedimentation level" is a more accurate term than the commonly used "blood-fluid level" or "hematocrit effect."

Topics: Aged; Body Fluids; Cerebral Hemorrhage; Fatal Outcome; Hematocrit; Hematoma; Hemoglobins; Humans; Male; Middle Aged; Rheumatic Heart Disease; Thrombophlebitis; Tomography, X-Ray Computed; Warfarin

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

Topics: Aged; Aged, 80 and over; Cervical Vertebrae; Combined Modality Therapy; Dexamethasone; Hematoma; Hemiplegia; Hemorrhage; Humans; Laminectomy; Male; Plasma; Spinal Cord; Spinal Cord Compression; Spinal Cord Diseases; Vitamin K; Warfarin

The case of a 26-year-old patient who developed acute carpal tunnel syndrome while taking warfarin (Coumadin) is reported. She underwent carpal tunnel release with complete resolution of symptoms. We found reports of two other patients taking Coumadin with acute carpal tunnel syndrome. In all three cases, discontinuation of Coumadin therapy and open surgical release of the carpal tunnel led to a good result.

Topics: Acute Disease; Adult; Carpal Tunnel Syndrome; Female; Hand Injuries; Hematoma; Humans; Warfarin

An unusual case of bilateral femoral nerve compression caused by iliacus hematomas in a patient on anticoagulant therapy is herein reported with special reference to the comparative diagnostic value of ultrasonography, computerized tomorgraphy, and magnetic resonance imaging. The importance of early surgical decompression is also emphasized.

Topics: Adult; Female; Femoral Nerve; Hematoma; Humans; Magnetic Resonance Imaging; Muscular Diseases; Nerve Compression Syndromes; Retroperitoneal Space; Warfarin

Trauma patients are at significant risk for deep venous thrombosis (DVT) and pulmonary embolism (PE). Anticoagulation is standard therapy for DVT/PE, but may cause severe complications. We reviewed the course of 70 trauma ICU patients treated over a 28-month period. Thirty-six patients (51.4 percent) were treated by continuous IV heparin and/or oral warfarin. Of these, 13 patients (36 percent) developed complications requiring termination of anticoagulation. These included recurrent PE (four), subdural hematomas (three), hemothorax (two), heparin-induced thrombocytopenia (one), hemorrhagic pericardial effusion (one), retroperitoneal hematoma (one), and sudden unexplained drop in hemoglobin and shock (one). All patients with subdural hematomas had no prior evidence of head injury on brain computed tomography. All patients with recurrent PE received adequate anticoagulation therapy. Age > 55 was associated with increased risk of complications (8 of 13; p = .02:chi 2). Thirty-four other patients (48.6 percent) received inferior vena caval filters with no related complications or deaths. Anticoagulation for DVT/PE should be used selectively in trauma patients and avoided in elderly patients. Such patients should undergo early caval filter placement.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Hematoma; Hemothorax; Heparin; Humans; Middle Aged; Pulmonary Embolism; Recurrence; Retrospective Studies; Risk Factors; Thrombocytopenia; Thrombophlebitis; Warfarin; Wounds and Injuries

Topics: Acute Kidney Injury; Aged; Female; Hematoma; Hemorrhage; Humans; Metronidazole; Ureteral Diseases; Warfarin

The case is reported of a 35-year-old lady on long-term anticoagulation with warfarin who developed a spontaneous acute compartment syndrome in the forearm. Despite a delay in diagnosis, an extensive decompression resulted in complete recovery.

Topics: Adult; Compartment Syndromes; Fasciotomy; Female; Forearm; Hematoma; Humans; Pressure; Pulmonary Embolism; Time Factors; Warfarin

Topics: Airway Obstruction; Hematoma; Humans; Male; Mediastinal Diseases; Middle Aged; Tracheal Stenosis; Tracheostomy; Warfarin

A case of warfarin-induced intramural hematoma and hemorrhagic infarction of the small intestine is described, and the literature on this adverse effect is reviewed. A 32-year-old white woman who had been receiving warfarin and carbamazepine came to a clinic complaining of lower back and stomach pain. She had a history of iliofemoral deep venous thromboses and seizures. A pelvic sonogram showed a large quantity of fluid present. Her prothrombin time (PT) was 29.2 sec. Her hemoglobin concentration and hematocrit were within the normal ranges. The patient was admitted to the hospital when her back pain increased and she vomited. The warfarin was discontinued. On day 5 the patient was still having abdominal pain and nausea. Her hemoglobin concentration and hematocrit had fallen to 6.6 g/dL and 20%, although her PT had decreased to 12.5 sec. On the same day, the patient underwent an exploratory laparotomy, and an indurated and ischemic area of jejunum was found and resected. The pathology report indicated the presence of hemorrhage and infarction consistent with an anticoagulant-related disorder. About 100 cases of intramural hematoma of the small intestine induced by anticoagulant therapy have been reported. Most patients are white males about 60 years of age. The sites most frequently involved are the duodenum and proximal jejunum. Symptoms include constipation, nausea, vomiting, and abdominal pain. Laboratory test and radiological findings are fairly nonspecific, but when found together in a patient receiving an anticoagulant, the diagnosis can be made with some confidence. Management may be complicated by the bleeding disorder, the intestinal obstruction if present, and the original indication for warfarin therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestine, Small; Warfarin

Two cases of intracerebral hemorrhage in patients with prosthetic heart valves receiving anticoagulant therapy without preceding embolic cerebral infarction are reported. Phytonadione and fresh frozen plasma were immediately given, and the intracerebral hematoma evacuated successfully. In one case, intractable bleeding occurred perioperatively until the thrombotest value reached 40% or more. This patient later developed fatal massive multiple intracerebral hemorrhages.

Topics: Adolescent; Cerebral Hemorrhage; Heart Valve Prosthesis; Hematoma; Humans; Incidence; Male; Middle Aged; Postoperative Complications; Prothrombin Time; Risk Factors; Warfarin

Guidelines for the management of patients receiving chronic anticoagulation therapy who require liver biopsy are not clearly defined. In patients with normal coagulation, liver biopsy is a relatively safe procedure with a morbidity of less than 0.1% and a mortality of less than 0.01%. We report a patient with a prosthetic aortic valve who developed a large subcapsular hematoma 12 days after a percutaneous liver biopsy as a consequence of warfarin toxicity. Based on the experience with this patient, reinstitution of anticoagulant therapy should be avoided for at least 72 h after a percutaneous liver biopsy. Intravenous heparin should be resumed first, and warfarin added if no bleeding has occurred after an additional 48-72 h. The prothrombin time should be maintained at 1.5 times the baseline.

Topics: Biopsy, Needle; Carcinoma, Hepatocellular; Chemical and Drug Induced Liver Injury; Hematoma; Humans; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Prothrombin Time; Time Factors; Warfarin

Topics: Anticoagulants; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestinal Obstruction; Jejunal Diseases; Male; Middle Aged; Warfarin

We examined a series of 200 consecutive patients with spontaneous intracerebral hematoma clinically and by computed tomography, excluding patients with trauma, aneurysm, or tumor. Hematoma volume varied from 1 to 230 (average 35) ml, and overall mortality was 30% (60 patients). Of the 200 patients, 14% (28) were receiving anticoagulants; among these 28 patients hematoma volume averaged 72 ml and mortality 57% (16 patients). The 140 survivors were followed for 2-24 months. Our findings indicate that anticoagulation therapy after previous cerebral infarction or embolism of cardiogenic origin did not predispose to intracerebral hemorrhage. Prognosis was poor when the initial level of consciousness was low and the hematoma volume exceeded 50 ml in combination with dilatation of the contralateral ventricle. An intracerebral hematoma of greater than 80 ml volume was always fatal, regardless of therapy. With volumes of 40-80 ml, early surgical evacuation of the lobar hematoma may improve outcome.

Topics: Adult; Aged; Aged, 80 and over; Cerebral Hemorrhage; Female; Hematoma; Humans; Male; Middle Aged; Prognosis; Tomography, X-Ray Computed; Warfarin

We investigated incidence, age distribution in relation to etiology, and localization of spontaneous intracerebral hematoma in 100 consecutive cases. Incidence in the total population of the Giessen area was estimated to be greater than 11/100,000 inhabitants/yr and increased with age. There was a trend toward higher incidence in males. Overall mortality was 27%, 22% of 58 patients aged less than 70 years and 33% of 42 patients aged greater than or equal to 70 years. Hypertensive putaminal hematoma showed the highest mortality rate (42%, 10 of 24 cases). Chronic alcoholism and anticoagulant medication influenced the mortality rate unfavourably. We found the following localizations and etiologies to have a specific relation with age: 1) lobar hematomas from vascular malformations, group aged less than 40 years; 2) hypertensive putaminal hematomas and hypertensive thalamic hematomas, group aged 40-69 years; and 3) lobar hematomas, group aged greater than or equal to 70 years. Alcoholism was an additional factor in 38% of the 13 middle-aged men with hypertensive putaminal hematomas. Fourteen cases of spontaneous intracerebral hematoma were possibly due to cerebral amyloid angiopathy. Six of these 14 patients had recurrent lobar hematomas, but only three of the six could be histologically investigated. In these three cases, cerebral amyloid angiopathy was proven.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Alcoholism; Cerebral Hemorrhage; Female; Germany; Hematoma; Humans; Hypertension; Incidence; Male; Middle Aged; Sex Characteristics; Warfarin

Topics: Administration, Oral; Aged; Female; Hematoma; Humans; Infarction; Intestine, Small; Peritoneal Diseases; Warfarin

The authors present the case of a 60-year old man with a spontaneous spinal intradural hematoma in the thoracic and lumbar region, which was caused by anticoagulant therapy and led to a severe progressive transverse lesion. After substitution of coagulation factors, a small catheter was inserted into the subarachnoid space via a lumbar puncture. By alternating irrigation and suction removal of the blood clot, restoration of the cerebrospinal fluid passage was possible along with a marked improvement in the neurological deficits. At 8 months' follow-up, the patient had completely recovered from the severe paraparesis and bladder dysfunction.

Topics: Catheterization; Drainage; Hematoma; Humans; Male; Middle Aged; Spinal Cord Diseases; Warfarin

The experiment of a self-injury by permanent intoxication with the coumarin derivative Warfarin is described. Various isolated haemostatic defects as differential-diagnostically demarcated causes for the leading symptom decrease of the value of the thromboplastin time which concern the effect of coumarin are mentioned. It is referred to the coagulation-analytic and chemical-toxic methods of proof of coumarins.

Topics: Adult; Blood Coagulation Tests; Diagnosis, Differential; Female; Gastrointestinal Hemorrhage; Hematoma; Hemorrhage; Humans; Self Mutilation; Urologic Diseases; Warfarin

This is a case report of a 66-year-old female who had been taking coumadin for 4 weeks for deep vein thrombosis. She developed acute carpal tunnel syndrome following minor trauma to her wrist. After conservative therapy failed to relieve her symptoms she underwent release of her carpal tunnel with resolution of her symptoms. While there are many patients taking coumadin, its association with acute carpal tunnel syndrome is quite rare: we were only able to find only one other reported case in the literature. While one is tempted to treat these patients conservatively, operative therapy may be indicated.

Topics: Acute Disease; Aged; Carpal Tunnel Syndrome; Female; Hematoma; Humans; Warfarin

Topics: Aged; Aged, 80 and over; Airway Obstruction; Glottis; Hematoma; Humans; Laryngeal Diseases; Male; Warfarin

Soft tissue bleeding can be manifested clinically by swelling, skin discoloration, pain and tenderness. Early recognition can be difficult in the spinal cord-injured population in whom sensation is impaired. We are presenting a case of occult bleeding into the gluteal region during anticoagulation therapy in a paraplegic patient that presented as migrating pain and tenderness in the hip and pelvic area.

Topics: Adolescent; Buttocks; Contusions; Hematoma; Humans; Male; Spinal Cord Injuries; Thrombosis; Tomography, X-Ray Computed; Warfarin

A 62-year-old patient on anticoagulant therapy presented with hemothorax, pulmonary hemorrhages and a high retroperitoneal hematoma with obstruction-infarction of the right kidney. Following plasma infusion and pleural drainage, the clinical condition stabilized and kidney function improved.

Topics: Hematoma; Hemothorax; Heparin; Humans; Infarction; Kidney; Lung Diseases; Male; Middle Aged; Retroperitoneal Space; Warfarin

Topics: Adult; Compartment Syndromes; Drug Therapy, Combination; Female; Hematoma; Heparin; Humans; Lumbosacral Region; Muscles; Thrombophlebitis; Warfarin

We describe a case of spontaneous infection of a renal hematoma complicating warfarin sodium anticoagulant therapy. The infected hematoma was successfully drained by sonar-guided fine-needle aspiration. All reported cases of renal hematomas complicating anticoagulant therapy are reviewed.

Topics: Aged; Drainage; Escherichia coli Infections; Female; Hematoma; Humans; Kidney Diseases; Warfarin

A patient with severe rheumatoid arthritis (RA) receiving chronic anticoagulation therapy developed acute life threatening airway obstruction. The source of obstruction was a retropharyngeal hematoma compressing the upper airway rather than acute laryngeal dysfunction from the patient's RA. Our case illustrates a new cause of acute stridor and airway obstruction in RA. Publications on upper airway obstruction in RA and airway obstruction secondary to retropharyngeal hematoma are discussed.

Topics: Airway Obstruction; Arthritis, Rheumatoid; Drug Interactions; Female; Hematoma; Humans; Middle Aged; Pharynx; Pressure; Sulindac; Warfarin

Topics: Aged; Hematoma; Humans; Laryngeal Diseases; Male; Mouth Floor; Pulmonary Edema; Warfarin

We treated a patient for warfarin-induced sublingual hematoma causing upper-airway obstruction. This complication of oral anticoagulation therapy is rare; only three other cases have been reported in the English literature. All reported patients developed acute respiratory embarrassment necessitating emergency airway establishment. Sublingual hematomas usually resolve spontaneously, and surgical drainage is rarely necessary.

Topics: Airway Obstruction; Cricoid Cartilage; Hematoma; Humans; Male; Middle Aged; Mouth Floor; Oral Hemorrhage; Thyroid Cartilage; Warfarin

Topics: Diagnosis, Differential; Hematoma; Humans; Leg; Male; Middle Aged; Thrombophlebitis; Warfarin

We present the case of a 28-year-old man on chronic warfarin therapy who sustained a minor muscle tear and developed increasing pain and a flexure contracture of the right hip. Surgical exploration revealed an iliopsoas hematoma and femoral nerve entrapment, resulting in a femoral nerve palsy and partial loss of quadriceps functions. Anticoagulant-induced femoral nerve palsy represents the most common form of warfarin-induced peripheral neuropathy; it is characterized by severe pain in the inguinal region, varying degrees of motor and sensory impairment, and flexure contracture of the involved extremity.

Topics: Adult; Femoral Nerve; Hematoma; Humans; Male; Muscular Diseases; Nerve Compression Syndromes; Paralysis; Thigh; Warfarin

Topics: Aged; Female; Femoral Nerve; Hematoma; Humans; Male; Middle Aged; Nerve Compression Syndromes; 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

Described are the cases of two patients who presented with vocal cord hematomas consequent to poor control of anticoagulation. Both patients presented with hoarseness and cough. One required intubation due to respiratory obstruction. Vocal cord hematomas should be considered in patients who present with upper airway symptoms while anticoagulated.

Topics: Aged; Airway Obstruction; Female; Glycolates; Hematoma; Hoarseness; Humans; Laryngeal Diseases; Male; Middle Aged; Ticrynafen; Vocal Cords; Warfarin

A 41-year-old anticoagulated woman presented with increasing pelvic pain that had begun two days prior during intercourse. An ultrasound and computerized tomographic (CT) scan confirmed the diagnosis of pelvic hematoma. The hematoma resolved spontaneously with normalization of clotting studies. The emergency physician should consider this rare cause of pelvic pain in selected anticoagulated patients. The need for a thorough history in emergency patients is emphasized, as well as the value of ultrasound and CT scan in the diagnosis of this disorder.

Topics: Adult; Coitus; Female; Hematoma; Humans; Pelvis; Warfarin

Scintigraphy with RBCs labeled with technetium Tc 99m sodium pertechnetate effectively located the source of hemorrhage in a patient receiving long-term anticoagulant therapy. (The patient was initially seen with a large hematoma on the flank.) More important, the procedure was used to monitor activity in this otherwise-occult bleeding site. Scintigraphic studies may be useful in the management of these difficult clinical problems.

Topics: Aged; Hematocrit; Hematoma; Hemorrhage; Humans; Male; Prothrombin Time; Sodium Pertechnetate Tc 99m; Technetium; Tomography, Emission-Computed; Warfarin

In a patient taking oral anticoagulants, the complaint of pharyngeal pain, a change in the voice, dysphagia, respiratory difficulty, or a neck mass should prompt a thorough investigation to rule out hemorrhage into the upper airway. This case report describes an anticoagulated patient who experienced precipitous hemorrhagic upper airway obstruction. She was successfully treated with tracheostomy, plasma infusion, and parenteral vitamin K1.

Topics: Airway Obstruction; Emergencies; Female; Hematoma; Hemorrhage; Humans; Middle Aged; Respiratory Tract Diseases; Thrombophlebitis; Tracheotomy; Vitamin K 1; Warfarin

Topics: Adult; Airway Obstruction; Drug Synergism; Hematoma; Humans; Male; Mouth Floor; Phenylbutazone; Warfarin

During a poorly controlled warfarin treatment, a 51-year-old man developed bleeding in various organs. He presented a pulmonary haematoma with the radiologic appearance of a pulmonary nodule. In the literature we found only one report of a pulmonary haematoma with a similar presentation caused by anticoagulant therapy.

Topics: Diagnosis, Differential; Hematoma; Humans; Lung Diseases; Male; Middle Aged; Radiography; Warfarin

Massive subchorionic hematoma (Breus' mole) of the placenta occurred in a stillbirth. The mother was receiving oral warfarin sodium. The extravasated blood was mostly fetal in origin.

Topics: Adult; Chorion; Female; Fetal Blood; Fetal Death; Hematoma; Humans; Placenta Diseases; Pregnancy; Rheumatic Heart Disease; Warfarin

An anterior mediastinal haematoma and left haemothorax developed in a hypertensive diabetic patient on oral anticoagulant therapy. This occurred in spite of well-controlled anticoagulation and the absence of other evidence of systemic bleeding. Angiography and daily chest X-ray follow-up were not only sufficient to confirm the diagnosis, but also avoided hazardous interventional procedures.

Topics: Female; Hematoma; Hemothorax; Humans; Mediastinal Diseases; Middle Aged; Warfarin

A case of femoral neuropathy secondary to psoas muscle hematoma in a patient on warfarin sodium anticoagulation therapy is presented. Computed tomography was used to establish the diagnosis. The literature is reviewed with regard to the pathophysiology, clinical presentation, and therapy of this case. Surgical decompression is suggested to shorten the recovery period and minimize residual neurological deficit.

Topics: Femoral Nerve; Hematoma; Humans; Male; Middle Aged; Muscular Diseases; Nerve Compression Syndromes; Peritoneum; Radiography; Warfarin

Intramural hematomas of the small bowel, an uncommon complication of anticoagulant therapy, usually present with nausea, vomiting, crampy abdominal pain, and often gastrointestinal bleeding of some degree. The diagnosis can be suggested by history and by a plain abdominal x-ray film, but an upper GI series is the most reliable means of confirming the diagnosis. Treatment is nonoperative, with emphasis on correction of clotting abnormalities, and blood loss, continuous nasogastric decompression, parenteral alimentation, and hydration.

Topics: Aged; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestine, Small; Radiography; Warfarin

Topics: Aged; Anticoagulants; Hematoma; Humans; Lung Diseases; Male; Radiography; Warfarin

Topics: Adult; Cimetidine; Drug Synergism; Guanidines; Hematoma; Humans; Male; Retroperitoneal Space; Warfarin

Topics: Adult; Female; Hematoma; Humans; Mesentery; Peritoneal Diseases; Thrombophlebitis; Tomography, X-Ray Computed; Ultrasonography; Warfarin

Topics: Acenocoumarol; Adult; Anticoagulants; Femoral Nerve; Hematoma; Humans; Ilium; Male; Middle Aged; Muscular Diseases; Nerve Compression Syndromes; Tomography, X-Ray Computed; Warfarin

Topics: Femoral Nerve; Hematoma; Humans; Male; Middle Aged; Peripheral Nervous System Diseases; Retroperitoneal Space; Warfarin

Of 217 patients with clinical diagnosis of acute stroke 23% had nonischemic lesions diagnosed by computed tomography (CT) or lumbar puncture (LP). CT demonstrated all 37 cases of intracerebral hemorrhagic lesions; 9 were detected by LP. CT failed to demonstrate 8 of 17 cases of subarachnoid hemorrhage, but only 1 of these lacked headache or stiff neck. In 7 of 342 patients who were treated with anticoagulants after LP, spinal hematoma followed LP ( 5 with paraparesis). CT evaluation reduced the incidence of fatal cerebral hemorrhage during anticoagulant therapy of acute stroke. However, even if patients were evaluated with both CT and LP, the incidence of fatal cerebral hemorrhage resulting from intravenous anticoagulant therapy was 2.4%.

Topics: Anticoagulants; Cerebrovascular Disorders; Hematoma; Heparin; Humans; Ischemic Attack, Transient; Spinal Cord Diseases; Spinal Puncture; Tomography, X-Ray Computed; Warfarin

Topics: Aged; Anticoagulants; Diagnosis, Differential; Female; Hematoma; Humans; Kidney Diseases; Kidney Neoplasms; Tomography, X-Ray Computed; Warfarin

Topics: Aged; Atrial Fibrillation; Drug Interactions; Female; Hematoma; Humans; Pharyngeal Diseases; Pharynx; Radiography; Sulfamethoxazole; Trimethoprim; Urinary Tract Infections; Warfarin; Whole Blood Coagulation Time

A case of intramural hematoma of the gastric cardia occurring in a young woman with S.L.E. and on warfarin is presented and discussed. This unusual case illustrates the importance of careful evaluation of radiological mass lesions of the cardia.

Topics: Adult; Aged; Cardia; Child; Female; Hematoma; Humans; Lupus Erythematosus, Systemic; Male; Middle Aged; Radiography; Stomach Diseases; Warfarin

Therapeutic doses of oral anticoagulants have been associated with spontaneous hemorrhage and rupture of apparently normal abdominal viscera. To our knowledge, this is the second reported case of such rupture involving the liver. The patient had sudden severe epigastric pain and signs of acute abdomen and shock. Discrete microscopic changes in the liver may precede massive hemorrhage.

Topics: Aged; Autopsy; Female; Hematoma; Hemorrhage; Humans; Liver Diseases; Rupture, Spontaneous; Warfarin

Twenty horses suffering from navicular disease were treated with warfarin given orally. The dosage was to effect, to give a 2 to 4 second prolongation of the one stage prothrombin time (OSPT). Dosage was initially at a rate of 0.018 mg/kg, changing the dose by amounts of 20 per cent until the required dose was achieved. Final dose rates varied from 0.012 mg/kg to 0.75 mg/kg. All the cases treated received warfarin daily throughout the trial. Seventeen of the animals became sound and the remaining 3 showed a marked improvement in their gait. The mean of the ages of the horses was 7.5 years, the mean of the periods of lameness 9 months and the mean of the time taken to recovery one treatment was commenced was 7 weeks.

Topics: Administration, Oral; Animals; Foot Diseases; Forelimb; Hematoma; Horse Diseases; Horses; Osteitis; Warfarin

Of five patients in who sciatic paresis developed as the result of hemorrhage and hematoma following hip surgery, four were receiving prophylactic or therapeutic anticoagulants. The patient who was managed expectantly still had disabling motor and sensory deficity at follow-up. Three patients who had early operative decompression showed more complete return of nerve function. The fifth patient died three weeks after onset with the neuropathy still present. Severe low-back and buttock pain, ecchymosis over these regions, marked swelling in the thigh, sciatic-nerve tenderness, and a distal sciatic neural deficit in the ipsilateral lower limb of a patient who has had hip surgery are evidence of hemorrhage in the vicinity of the sciatic nerve. Early recognition and prompt surgical decompression can prevent irreversible nerve damage.

Topics: Adolescent; Adult; Aged; Arthroplasty; Female; Hematoma; Hemorrhage; Heparin; Hip Joint; Humans; Leg; Male; Middle Aged; Muscles; Muscular Diseases; Nerve Compression Syndromes; Paralysis; Postoperative Care; Sciatic Nerve; Warfarin

A case of intramural oesophageal haematoma complicating anticoagulant therapy is described. Severe chest pain and complete obstruction of the oesophagus resulted. Early fibreoptic endoscopy facilitated the diagnosis. The condition resolved spontaneously with conservative management. A similar case has not been previously reported.

Topics: Aged; Esophageal Diseases; Hematoma; Humans; Male; Warfarin

Topics: Adolescent; Adult; Anticoagulants; Female; Hematoma; Humans; Ovarian Diseases; Ovary; Warfarin

Two hundred sixty cases of intestinal intramural hematoma and subsequent bowel obstruction have been reported in the world literature. These cases have been evaluated and seventeen additional cases are reported. Multiple etiologic factors are presented, with trauma and anticoagulant therapy being the most common. Barium x-ray examination is the single most reliable diagnostic study. The mode of therapy for intramural hematoma depends upon thorough evaluation of the patient. Patients on anticoagulant therapy are best treated by observation and cessation of anticoagulants. Should the patient fail to improve or become worse, then surgery may become necessary. When trauma is a factor, prompt operative intervention is indicated.

Topics: Abdominal Injuries; Adolescent; Adult; Child; Child, Preschool; Gastrointestinal Diseases; Hematoma; Heparin; Humans; Infant; Intestinal Obstruction; Middle Aged; Warfarin

Topics: Anticoagulants; Female; Hematoma; Hematuria; Humans; Kidney Diseases; Kidney Diseases, Cystic; Middle Aged; Warfarin

Topics: Femoral Nerve; Hematoma; Hemorrhagic Disorders; Humans; Iatrogenic Disease; Male; Manipulation, Orthopedic; Middle Aged; Peripheral Nervous System Diseases; Warfarin

I report a patient in whom warfarin sodium induced upper airway obstruction secondary to a spontaneous nontraumatic hemorrhage into the sublingual space. Treatment of this obstructive sublingual space hematoma with conservative medical management is reviewed. I discuss the role of warfarin sodium in coagulation and in the production of this pseudo-Ludwig phenomenon.

Topics: Airway Obstruction; Hematoma; Humans; Male; Middle Aged; Mouth Diseases; Mouth Floor; Warfarin

A twenty-six year old white male on long-term sodium warfarin (Coumadin therapy for recurrent thrombophlebitis had sudden onset of severe groin pain, right iliac hematoma, and a femoral nerve palsy. A review of the twelve previously reported cases of this hemorrhagic complication indicates that immediate surgical decompression may be necessary to prevent residual disability.

Topics: Adult; Electromyography; Femoral Nerve; Hematoma; Humans; Male; Nerve Compression Syndromes; Pulmonary Embolism; Thrombophlebitis; Warfarin

A case is reported in which anticoagulant therapy for thrombophlebitis and pulmonary embolism produced bilateral massive intrarenal hematomas (pseudotumors). The role of radiologic investigation (nephrotomography, renal scan and selective high dose arteriography) was found to identify and localize the intrarenal hematomata and exclude underlying renal pathology. Although an abnormal kidney is more likely to bleed, this case presentation demonstrates that even carefully monitored anticoagulation within the therapeutic range can induce massive intrarenal hemorrhage in previously normal kidneys. The renal architecture returned to normal on late follow-up examination on simple conservative management.

Topics: Female; Hematoma; Humans; Kidney; Kidney Diseases; Middle Aged; Pulmonary Embolism; Radiography; Thrombophlebitis; Warfarin

Topics: Cecum; Colon; Diagnosis, Differential; Embolism; Gastrointestinal Hemorrhage; Hematoma; Humans; Ileum; Intestinal Mucosa; Intestinal Obstruction; Intestine, Small; Male; Mesentery; Middle Aged; Warfarin

A syndrome of retroperitoneal hemorrhage during anticoagulant therapy associated with nerve involvement in femoral nerve or lumbar plexus is described. Twenty-one cases were collected from the English-language literature, and five new cases were added for review and analysis. In these 26 cases spontaneous hemorrhage occurred under iliopsoas fascia in the retroperitoneal space. The clinical picture, involved nerves, laboratory findings of coagulation studies, anemia, and the outcome of these cases are summarized and discussed. Retroperitoneal space may contain a large quantity of internal hemorrhage. Irreversible damage of lumbar plexus or femoral nerve may result from entrapment of nerves in the hematoma. Laboratory coagulation studies may guide effective administration of anticoagulant therapy and minimize hemorrhagic complication, but they will not eliminate the risk of hemorrhage completely.

Topics: Adult; Aged; Anticoagulants; Female; Femoral Nerve; Hematoma; Hemorrhage; Heparin; Humans; Lumbosacral Plexus; Male; Middle Aged; Nerve Compression Syndromes; Retroperitoneal Space; Warfarin

From March 1971 through April 1975, one hundred twenty patients underwent mitral valve replacement with a Hancock "stabilized glutaraldehyde process" porcine aortic xenograft. A simultaneous canine experimental series was also carried out. In the clinical series, the early mortality was 8.3%. Actuarial analyses of all patients predicts survival at two years of 81.0% and at four years of 70.0%. The predicted survival for patients without coronary disease or prior prosthetic valve replacement is 87.5% at two years and 77.5% at four years. There were four thromboembolic episodes, a rate of 2.4% per patient-year. None were fatal. No valve failure were noted. Histologic examination and shrink temperature analysis of recovered valves show excellent tissue preservation at 40 months. The data indicate that the Hancock valve is durable, enjoys a low incidence of thromboembolism, and may be the valve of choice for mitral valve replacement.

Topics: Adult; Aged; Aldehydes; Animals; Aortic Valve; Brain Diseases; Cardiac Surgical Procedures; Coronary Disease; Dogs; Endocarditis, Bacterial; Evaluation Studies as Topic; Female; Gastrointestinal Hemorrhage; Glutaral; Hematoma; Humans; Male; Methods; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Stenosis; Postoperative Complications; Swine; Thromboembolism; Thrombophlebitis; Transplantation, Heterologous; Warfarin

Topics: Aged; Female; Gastrointestinal Hemorrhage; Heart Valve Prosthesis; Hematoma; Humans; Intestinal Obstruction; Postoperative Complications; Thrombosis; Warfarin

Topics: Gastrointestinal Hemorrhage; Hematoma; Humans; Jejunum; Male; Middle Aged; Warfarin

In the prevention of thromboembolic complications following elective total hip operations, warfarin is a safe and effective agent which causes minimal bleeding complications, if the drug is first administered on the first postoperative day and thereafter continued in various dosages to maintain a prothrombin time between one and one and one-half and two times that of the control. Dextran also is effective in preventing thromboembolic complications but causes more bleeding problems, especially when administered intraoperatively.

Topics: Aged; Anticoagulants; Dextrans; Female; Hematoma; Hemorrhage; Hip Joint; Humans; Joint Prosthesis; Male; Middle Aged; Osteoarthritis; Postoperative Complications; Pulmonary Embolism; Rheumatic Diseases; Surgical Wound Infection; Thromboembolism; Thrombophlebitis; Warfarin

In a patient receiving warfarin and heparin in the treatment of pulmonary embolism, a hematoma developed in the iliacus muscle, compressing the overlying femoral nerve. Femoral nerve paralysis ensued, causing inability to walk, pain and loss of sensation in the sensory distribution of the nerve. Surgical intervention and removal of the hematoma relieved the nerve compression and the condition gradually improved.

Topics: Adult; Female; Femoral Nerve; Hematoma; Heparin; Humans; Muscles; Nerve Compression Syndromes; Pulmonary Embolism; Thigh; Warfarin

The retropharyngeal space is a rare site of spontaneous hemorrhage and the formation of a hematoma in this location is a rarer complication of therapy with anticoagulants. Nineteen cases of retropharyngeal hematoma have been reported in the literature, only two of which have been associated with anticoagulation therapy. In the case reported here, a retropharyngeal hematoma developed in a 61-year-old man who had been receiving anticoagulants. The complication was associated with a violent tussive episode. Airway obstruction necessitated a tracheostomy, and the persistent hematoma required external drainage.

Topics: Airway Obstruction; Drainage; Hematoma; Humans; Male; Middle Aged; Pharyngeal Diseases; Vitamin K 1; Warfarin

Topics: Abdominal Muscles; Aged; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestinal Obstruction; Male; Middle Aged; Myocardial Infarction; Radiography; Retroperitoneal Space; Warfarin

Topics: Exercise Therapy; Female; Hematoma; Hematuria; Hip; Hip Joint; Humans; Male; Melena; Postoperative Care; Postoperative Complications; Prothrombin Time; Pulmonary Embolism; Thrombophlebitis; Warfarin

Topics: Adult; Aged; Angiography; Brain Edema; Cerebral Hemorrhage; Cerebral Ventriculography; Corpus Striatum; Diagnosis, Computer-Assisted; Female; Hematoma; Humans; Hypertension; Infant, Newborn; Infant, Newborn, Diseases; Intracranial Arteriovenous Malformations; Male; Phlebitis; Thalamus; Tomography, X-Ray; Warfarin

Topics: Adult; Aged; Arthritis, Rheumatoid; Cloxacillin; Female; Hematoma; Hip; Hip Dislocation; Hip Joint; Humans; Joint Prosthesis; Male; Middle Aged; Ossification, Heterotopic; Osteoarthritis; Postoperative Complications; Pulmonary Embolism; Staphylococcal Infections; Streptomycin; Surgical Wound Infection; Thromboembolism; Warfarin

Topics: Adolescent; Adult; Aged; Anticoagulants; Arthritis, Rheumatoid; Female; Femoral Fractures; Follow-Up Studies; Gastrointestinal Hormones; Hematoma; Hip; Hip Dislocation; Hip Joint; Humans; Iatrogenic Disease; Joint Prosthesis; Male; Middle Aged; Ossification, Heterotopic; Osteoarthritis; Postoperative Complications; Thromboembolism; Warfarin

Topics: Acute Disease; Adult; Aged; Emergencies; Gastrointestinal Hemorrhage; Hematoma; Humans; Hypoprothrombinemias; Intestinal Obstruction; Male; Middle Aged; Phenindione; Radiography; Warfarin

Topics: Anti-Bacterial Agents; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestine, Small; Middle Aged; Shock, Septic; Warfarin

Topics: Adult; Aortic Valve; Female; Head; Heart Valve Prosthesis; Hematoma; Heparin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Mitral Valve; Pregnancy; Warfarin

Topics: Adult; Angiography; Arterial Occlusive Diseases; Carotid Artery Diseases; Carotid Artery Injuries; Carotid Artery, Internal; Electroencephalography; Hematoma; Humans; Male; Mental Disorders; Physical Therapy Modalities; Rupture; Ultrasonography; Vasa Vasorum; Warfarin

Topics: Adult; Esophageal Diseases; Hematoma; Hemodialysis, Home; Heparin; Humans; Male; Radiography; Warfarin

Topics: Adult; Anticoagulants; Autopsy; Cardiac Catheterization; Digoxin; Female; Hematoma; Hemorrhage; Humans; Lung Diseases; Pulmonary Artery; Quinidine; Rupture; Warfarin

Topics: Adult; Amides; Anticoagulants; Fibrinogen; Hematoma; Hemorrhage; Heparin; Hip Joint; Humans; Iodine Radioisotopes; Joint Prosthesis; Leg; Phlebography; Physical Examination; Postoperative Complications; Radionuclide Imaging; Thiazines; Thiazoles; Thrombophlebitis; Ultrasonography; Warfarin

Topics: Arthritis, Juvenile; Arthritis, Rheumatoid; Arthroplasty; Female; Follow-Up Studies; Hematoma; Heparin; Hip; Hip Joint; Humans; Joint Prosthesis; Male; New York City; Osteoarthritis; Paralysis; Peroneal Nerve; Postoperative Care; Postoperative Complications; Pulmonary Embolism; Splints; Surgical Wound Infection; Thromboembolism; Warfarin; Wound Healing

Topics: Abdominal Muscles; Aged; Cysts; Diagnosis, Differential; Female; Hematoma; Hemorrhage; Heparin; Hernia; Humans; Intestinal Diseases; Male; Middle Aged; Neoplasms; Radiography; Rest; Warfarin

Topics: Aged; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestinal Obstruction; Intestine, Small; Laparotomy; Male; Necrosis; Postoperative Complications; Warfarin

Topics: Acute Kidney Injury; Aged; Anticoagulants; Hematoma; Hematuria; Hemoperitoneum; Heparin; Humans; Male; Retroperitoneal Space; Warfarin

Topics: Aorta, Abdominal; Dextrans; Endarterectomy; Female; Femoral Artery; Follow-Up Studies; Hematoma; Hemorrhage; Humans; Intermittent Claudication; Ischemia; Leg; Male; Popliteal Artery; Postoperative Complications; Pulmonary Embolism; Saphenous Vein; Surgical Wound Infection; Thrombosis; Vascular Surgical Procedures; Warfarin

Topics: Atrial Fibrillation; Esophageal Diseases; Esophagoscopy; Female; Hematoma; Humans; Middle Aged; Mitral Valve Stenosis; Warfarin

Topics: Aged; Duodenal Obstruction; Hematoma; Hematuria; Hemoperitoneum; Humans; Laparotomy; Male; Prothrombin Time; Vitamin K 1; Warfarin

Topics: Anticoagulants; Blood Coagulation Tests; Cerebrospinal Fluid; Chiropractic; Female; Hematoma; Humans; Laminectomy; Meninges; Middle Aged; Neurologic Manifestations; Prothrombin Time; Spinal Diseases; Subarachnoid Hemorrhage; Warfarin

Topics: Adenocarcinoma, Papillary; Blood Coagulation Tests; Blood Platelet Disorders; Blood Transfusion; Chromium Isotopes; Colectomy; Colonic Neoplasms; Gastrointestinal Hemorrhage; Hematoma; Humans; Male; Middle Aged; Postoperative Complications; Staphylococcus; Thrombocytopenia; Thrombophlebitis; Warfarin

Topics: Adult; Aged; Female; Hematoma; Humans; Male; Middle Aged; Phenindione; Prothrombin Time; Warfarin

Topics: Dextrans; Female; Hematoma; Hematuria; Heparin; Humans; Maternal-Fetal Exchange; Pregnancy; Pregnancy Complications, Cardiovascular; Thrombophlebitis; Uterine Hemorrhage; Vagina; Warfarin

Topics: Anticoagulants; Corpus Luteum; Female; Hematoma; Humans; Mitral Valve Stenosis; Postoperative Care; Warfarin

Topics: Diagnosis, Differential; Female; Hematoma; Hematuria; Hemorrhage; Humans; Kidney Diseases; Kidney Neoplasms; Male; Middle Aged; Urography; Warfarin

Topics: Abdominal Muscles; Aged; Female; Hematoma; Heparin; Humans; Middle Aged; Warfarin

Topics: Abdominal Muscles; Aged; Hematoma; Heparin; Humans; Male; Muscular Diseases; Warfarin

Topics: Abdomen, Acute; Abdominal Muscles; Diagnosis, Differential; Female; Hematoma; Humans; Middle Aged; Warfarin

Topics: Cerebral Angiography; Cerebral Hemorrhage; Hematoma; Hematoma, Subdural; Humans; Intracranial Hemorrhages; Neurosurgery; Neurosurgical Procedures; Toxicology; Warfarin

Topics: Anticoagulants; Cerebral Angiography; Cerebrovascular Disorders; Heart Diseases; Hematoma; Hematuria; Hemorrhage; Humans; Pulmonary Embolism; Retroperitoneal Space; Toxicology; Warfarin

Topics: Diagnosis; Dicumarol; Geriatrics; Hematoma; Humans; Intestinal Diseases; Intestine, Small; Intestines; Radiography; Toxicology; Warfarin

Topics: Anticoagulants; Geriatrics; Hematoma; Humans; Intestinal Diseases; Intestinal Obstruction; Intestine, Small; Myocardial Infarction; Surgical Procedures, Operative; Toxicology; Warfarin

Topics: Aged; Anticoagulants; Coronary Disease; Drug Therapy; Hematoma; Hematoma, Subdural; Humans; Phenindione; Toxicology; Warfarin

Topics: Adolescent; Adult; Animals; Anticoagulants; Blood Coagulation Disorders; Bone Development; Child; Child, Preschool; Female; Fibrin; Fractures, Bone; Fractures, Ununited; Hematoma; Hemophilia A; Heparin; Humans; Infant; Male; Periosteum; Pseudarthrosis; Rabbits; Radiography; Radius Fractures; Warfarin; Wound Healing

Topics: Coagulants; Gastrointestinal Hemorrhage; Hematoma; Hemorrhage; Humans; Jejunum; Warfarin