warfarin and Hematuria

To determine the probability of visible hematuria with antithrombotic agents and to evaluate association of urologic etiology in antithrombotic-related hematuria.. Preferred Reporting Items in Systematic Reviews and Meta-Analyses guidelines were followed to conduct a systematic review using search engines PUBMED and SCOPUS with the terms "(hematuria) OR (haematuria) OR urinary bleeding)) AND ((anticoagulants) OR anticoagulation) OR noac) OR novel anticoagulants) OR antiplatelet) OR dabigatran) OR rivaroxaban) OR apixaban) OR warfarin) OR aspirin) OR heparin) OR dipyridamole)." Raw data were used to perform a pooled analysis. Chi-square and logistic regression analysis were used for statistical analyses.. Twenty-two studies describing 175,114 patients met inclusion criteria. Odds ratio of hematuria with warfarin to rivoraxaban was 33 and warfarin to dabigatran was 16. The odds ratio of hematuria for oral anticoagulant (26.7%) to prophylactic parenteral anticoagulant (1.1%) agents was 9.6. Antiplatelet agents are 76 times less likely to cause hematuria compared to anticoagulants. Odds of hematuria with aspirin were 6.7 times the odds with clopidogrel and 3.5 times the odds with ticagrelor. Dabigatran was 198 times more likely to cause major hematuria compared to warfarin, whereas clopidogrel is 1.2 times more likely to cause major hematuria compared to aspirin. Urologic pathology was identified in 44% (234/532) of cases, malignancy in 24%.. Warfarin use poses the greatest risk for hematuria but is unlikely to cause major hematuria, whereas novel antithrombotic agents are more commonly associated with major hematuria. This review further characterizes the risk profile of antithrombotic agents and associated hematuria to equip clinicians with knowledge to choose an appropriate antithrombotic agent in patients with high-risk hematuria.

Topics: Age Factors; Anticoagulants; Dabigatran; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Hematuria; Humans; Incidence; Male; Patient Safety; Prognosis; Risk Assessment; Rivaroxaban; Sex Factors; Warfarin

Rifampicin remains one of the first-line drugs used in tuberculosis therapy. This drug's potential to induce the hepatic cytochrome P450 oxidative enzyme system increases the risk of drug-drug interactions. Thus, although the presence of comorbidities typically necessitates the use of multiple drugs, the co-administration of rifampicin and warfarin may lead to adverse drug events. We report a bleeding episode after termination of the co-administration of rifampicin and warfarin and detail the challenges related to international normalized ratio (INR) monitoring.. A 59-year-old Brazilian woman chronically treated with warfarin for atrial fibrillation (therapeutic INR range: 2.0-3.0) was referred to a multidisciplinary anticoagulation clinic at a university hospital. She showed anticoagulation resistance at the beginning of rifampicin therapy, as demonstrated by repeated subtherapeutic INR values. Three months of sequential increases in the warfarin dosage were necessary to reach a therapeutic INR, and frequent visits to the anticoagulation clinic were needed to educate the patient about her pharmacotherapy and to perform the warfarin dosage adjustments. The warfarin dosage also had to be doubled at the beginning of rifampicin therapy. However, four weeks after rifampicin discontinuation, an excessively high INR was observed (7.22), with three-day macroscopic hematuria and the need for an immediate reduction in the warfarin dosage. A therapeutic and stable INR was eventually attained at 50% of the warfarin dosage used by the patient during tuberculosis therapy.. The present case exemplifies the influence of rifampicin therapy on warfarin dosage requirements and the increased risk of bleeding after rifampicin discontinuation. Additionally, this case highlights the need for warfarin weekly monitoring after stopping rifampicin until the maintenance dose of warfarin has decreased to the amount administered before rifampicin use. In particular, patients with cardiovascular diseases and active tuberculosis represent a group with a substantial risk of drug-drug interactions. Learning how to predict and monitor drug-drug interactions may help reduce the incidence of clinically significant adverse drug events.

Topics: Antibiotics, Antitubercular; Anticoagulants; Atrial Fibrillation; Drug Interactions; Female; Hematuria; Humans; Middle Aged; Rifampin; Tuberculosis, Pulmonary; Warfarin

Topics: Adult; Aged; Basophils; Blood Cell Count; Clofibrate; Female; Hematuria; Heparin; Humans; Immunoglobulins; Injections, Intravenous; Lipids; Male; Middle Aged; Migraine Disorders; Warfarin

Warfarin, aspirin, and the combination of these, have all proven to be efficacious in preventing future events after myocardial infarction. The accompanying bleeding tendency is a concern. The aim of the present study was to compare the occurrence of occult bleeding and iron deficiency during these treatment modalities.. The 267 patients who had survived a myocardial infarction were randomly assigned in the Warfarin Aspirin Reinfarction Study to treatment with aspirin 160 mg/day, or warfarin (INR 2.8-4.2), or aspirin 75 mg/day plus warfarin (INR 2.0-2.5). The patients were screened for the occurrence of occult bleeding in faeces and urine after 3 months. Haemoglobin and iron metabolism parameters were measured at baseline, after 3 months, and at the end of the 4 years follow-up.. The number of occult bleeding in faeces was 19 (7.1%) and in urine 29 (10.9%). There were no intergroup differences (p=0.45 and 0.39, respectively). In the occult bleeders, a second test showed 3 (1.1%) positive samples in faeces and 9 (3.4%) in urine. Further investigation revealed 2 cases of malignant disease. Haemoglobin and iron status variables were all within normal limits after 3 months and after 4 years in all treatment groups.. Long-term treatment with aspirin, warfarin, or both, in the present doses and levels of anticoagulation did not lead to anemia or iron deficiency. The occurrence of occult bleeding in faeces and urine was a temporary phenomenon in most patients. Only macroscopic bleedings during these treatment modalities were of clinical importance, and screening for occult bleeding was of limit value.

Topics: Anticoagulants; Aspirin; Drug Therapy, Combination; Female; Fibrinolytic Agents; Follow-Up Studies; Hematuria; Hemorrhage; Humans; Male; Middle Aged; Myocardial Infarction; Occult Blood; Prospective Studies; Risk Factors; Treatment Outcome; Warfarin

The most appropriate treatment for patients with IgA nephropathy is controversial. Treatment with prednisolone, azathioprine, heparin-warfarin, and dipyridamole early in the course of disease may prevent immunologic renal injury in children with severe IgA nephropathy. To determine whether similar results can be obtained with a combination of just heparin-warfarin and dipyridamole, the effects of such treatment were compared to those of treatment with prednisolone, azathioprine, heparin-warfarin, and dipyridamole in 78 children with newly diagnosed IgA nephropathy showing diffuse mesangial proliferation. The patients were randomly assigned to receive either prednisolone, azathioprine, heparin-warfarin, and dipyridamole for 2 yr (group 1) or heparin-warfarin and dipyridamole for 2 yr (group 2). All of the 40 patients in group 1 and 34 of the 38 patients in group 2 completed the trial. The mean urinary protein excretion fell in group 1 patients (P < 0.0001), but remained unchanged in group 2 patients. The mean serum IgA concentration was reduced in group 1 patients (P = 0.0002), but was unchanged in group 2 patients. BP and creatinine clearance were normal at the end of the trial in all but one group 2 patient, who developed chronic renal insufficiency. The percentage of glomeruli showing sclerosis was unchanged in group 1 patients, but increased in group 2 patients (P = 0.006). The intensity of mesangial IgA deposits decreased in group 1 patients (P = 0.02), but remained unchanged in group 2 patients. In conclusion, the present study shows that treatment of children with severe IgA nephropathy with prednisolone, azathioprine, heparin-warfarin, and dipyridamole for 2 yr early in the course of disease reduces immunologic renal injury and prevents increase of sclerosed glomeruli.

Topics: Adolescent; Azathioprine; Blood Urea Nitrogen; Child; Dipyridamole; Drug Therapy, Combination; Glomerular Mesangium; Glomerulonephritis, IGA; Hematuria; Heparin; Humans; Immunoglobulin A; Microscopy, Fluorescence; Prednisolone; Proteinuria; Warfarin

The hypothesis that the combination of low-dose aspirin and warfarin therapy is more effective than aspirin alone in secondary prophylaxis after myocardial infarction is to be examined in the Coumadin Aspirin Reinfarction Study. This pilot study addressed the safety and anticoagulation effect of a fixed, low-dose combination in 114 patients (aged 64 +/- 8 years, 85% men) with stable coronary artery disease receiving 3 mg of warfarin plus 80 mg of aspirin daily for 8 weeks. The international normalized ratio (INR) was measured within 72 hours of initial therapy, and weekly. Of the 110 patients with evaluable INRs, 87 patients (79%) maintained the 3 + 80 mg combination, 19 (17%) had the dose reduced to 1 mg warfarin + 80 mg aspirin, and 4 (4%) discontinued therapy because of a confirmed INR of > or = 4.5. At steady state, patients had INRs of 1.48 +/- 0.41 (3 + 80 mg group) and 1.21 +/- 0.23 (1 + 80 mg group), and inter- and intra-patient variability (estimated by the mean of the between- and within-patient SDs at steady state) was 0.49 +/- 0.08 and 0.13 +/- 0.14, respectively. There was no apparent effect of age on INR distribution. Microscopic hematuria was the most frequent (20%) adverse clinical event, but was unrelated to the INR. Three patients required discontinuation of therapy because of bleeding events (persistent hematuria and epistaxis). A fixed low-dose combination of warfarin and aspirin results in a predictable and stable increase in the INR in a large proportion of patients with coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Aged, 80 and over; Anticoagulants; Aspirin; Blood Coagulation; Coronary Disease; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Hematuria; Humans; Male; Middle Aged; Pilot Projects; Proportional Hazards Models; Warfarin

Chronic kidney disease (CKD) is characterized by increased interstitial fibrosis and tubular atrophy (IFTA) in the kidney. Chronic hematuria is a hallmark of several human kidney diseases and often is seen in patients on anticoagulation therapy. We had previously demonstrated that chronic hematuria associated with warfarin increases IFTA in 5/6 nephrectomy (5/6NE) rats, and such treatment increases reactive oxygen species (ROS) in the kidney. The goal of this study was to evaluate the effects of the antioxidant N-acetylcysteine (NAC) on the progression of IFTA in 5/6NE mice. 5/6NE C57BL/6 and 5/6NE 129S1/SvImJ mice were treated with warfarin alone or with warfarin and NAC for 23 weeks. Serum creatinine (SCr), hematuria, blood pressure (BP), and ROSs in the kidney were measured; kidney morphology was evaluated. Warfarin doses were titrated to achieve prothrombin time (PT) increase to the levels seen with therapeutic human doses. Warfarin treatment resulted in an increased SCr, systolic BP, hematuria, expression of TGF-ß and ROS in the kidney in both mouse strains. Tumor necrosis factor alpha (TNF-ɑ) levels in the serum were increased in 5/6NE mice treated with warfarin. IFTA was increased as compared with control 5/6NE mice, and this increase in IFTA was more prominent in 129S1/SvImJ than in C57BL/6 mice. NAC ameliorated the warfarin-associated increase in SCr and BP but not hematuria. IFTA, TGF-ß, and ROS in the kidney as well as TNF-ɑ levels in the serum were reduced in mice treated with NAC and warfarin as compared to mice treated with warfarin alone. NAC mitigates the increase in SCr and IFTA in mice with chronic hematuria by reducing oxidative stress in the kidney. This data open novel possibilities for treatments in CKD patients.

Topics: Acetylcysteine; Animals; Fibrosis; Hematuria; Humans; Kidney; Mice; Mice, Inbred C57BL; Nephrectomy; Rats; Reactive Oxygen Species; Renal Insufficiency, Chronic; Tumor Necrosis Factor-alpha; 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

Although Gross hematuria in patients receiving anticoagulants is not very common, it is one of the most common reasons of consulting with urologists. It is recommended to investigate urinary tract malignancies but simultaneous approach to anticoagulation and hematuria so as the optimum balance could be attained, is not clearly defined in the literature yet. We aim to answer pitfalls of hematuria management in anticoagulant receiving patients in this manuscript.. In a prospective case control study during 2017-2019, we observed and collected the data of patients receiving anticoagulant therapy and suffered from gross hematuria with coagulation parameters in prophylactic or therapeutic range in an academic hospital affiliated to Tehran University of Medical Sciences. SPSS 24th version was used for descriptive analysis of collected data.. Sixty-six patients encountered hematuria while receiving anticoagulant therapy. Although hematuria was more common in male patients, its recurrence was higher in female patients. It started mostly in first 72 h of therapy and was anticoagulant-dose dependent. Degree of hematuria was mostly mild or moderate by visual estimation and controlled easily by holding the anticoagulant therapy for less than 2 days. Anti-platelet therapy, urinary catheterization and patient's activity did not have any effect on re-bleeding rate.. Considering the fact that ruling out the urinary tract malignancy is mandatory in these patients, moderate and severe hematuria can be controlled simply by short term holding the anticoagulant therapy while continuing antiplatelet therapy albeit there is possibility to continue them in mild cases. Removing urinary catheters and decreasing the patient's mobility are not recommended. In order to decrease the recurrence of hematuria, re-establishing anticoagulation with LMWH and non-Vitamin D dependent oral agents rather than continuing Heparin and Warfarin might be helpful.

Topics: Anticoagulants; Case-Control Studies; Female; Hematuria; Heparin, Low-Molecular-Weight; Humans; Iran; Male; Warfarin

A 55-year-old man with Marfan syndrome taking warfarin for anticoagulant therapy after aortic valve replacement developed acute kidney injury (serum creatinine level of 9.01 mg/dL) and gross macrohematuria. Renal biopsy showed red cell casts in the renal tubules, glomerular crescent formation in the glomeruli with immunoglobulin A deposition, and global sclerosis. Based on these findings, the patient was diagnosed with warfarin-related nephropathy with acute kidney injury characterized by immunoglobulin A nephropathy with crescents. The warfarin was withdrawn, and his hematuria and renal function improved without immunosuppressive agents.

Topics: Acute Kidney Injury; Anticoagulants; Aortic Valve Insufficiency; Glomerulonephritis, IGA; Hematuria; Humans; Kidney; Kidney Glomerulus; Kidney Tubules; Male; Marfan Syndrome; Middle Aged; Treatment Outcome; Warfarin

Clinical variables including hypertension could be linked with major bleeding events and death beyond vitamin K antagonist (warfarin) or direct oral anti-coagulants (DOACs) treatment strategy.. Subgroup analysis of major bleeding (primary endpoint) associated with clinical variables, site of bleeding, ongoing antithrombotics, reversal treatment or blood transfusion, outcomes (secondary endpoints) was performed in patients with bleeding events submitted to hard 5:1 propensity-score matching for hypertension.. Enrolled patients were 2,792 (mean age, 65.6 ± 19.9 years) during 2-year survey including 166,000 visits, of 200,000 inhabitants catchment area; 8,239 patients received warfarin and 3,797 DOACs. Hypertension account for 1,077 (39%) patients; major bleeding for 474 (17%); death for 29 (1%), and 72 (3%) on 1-month and 1-year, respectively. Hypertension, age, glucose, cancer, ischemic vascular disease, and CHA2D2VASc score were more likely to link with major bleeding. On multivariate analysis, only age (odds ratio [OR], 1.02; P < 0.001), CHA2DS2VASc score ≥ 2 (OR, 2.14; P = 0.001), and glucose (OR, 1.01; P = 0.005) were predictors of major bleeding. Kaplan-Meier analysis demonstrated patients with hypertension as compared with patients without showed 60% versus 20% death on 1-month (P < 0.001). Warfarin compared with DOACs was more likely to present with major bleeding (0.7% versus 0.2%; OR, 2.8; P = 0.005). Receiver operator characteristics analysis showed high value (0.61) of age and glucose over creatinine and systolic arterial pressure (P = NS).. Four in 10 patients with major bleeding showed hypertension; of these 8 in 10 will die within 1 month. Warfarin compared with DOACs was more likely to present with major bleeding.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Anticoagulants; Blood Glucose; Blood Transfusion; Cardiovascular Diseases; Creatinine; Dabigatran; Emergency Service, Hospital; Epistaxis; Female; Gastrointestinal Hemorrhage; Hematuria; Hemoptysis; Hemorrhage; Humans; Hypertension; Intracranial Hemorrhages; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Prognosis; Propensity Score; Pyrazoles; Pyridines; Pyridones; Rivaroxaban; Severity of Illness Index; Sex Factors; Thiazoles; Warfarin

In March and April 2018, more than 150 patients presented to hospitals in Illinois with coagulopathy and bleeding diathesis. Area physicians and public health organizations identified an association between coagulopathy and synthetic cannabinoid use. Preliminary tests of patient serum samples and drug samples revealed that brodifacoum, an anticoagulant, was the likely adulterant.. We reviewed physician-reported data from patients admitted to Saint Francis Medical Center in Peoria, Illinois, between March 28 and April 21, 2018, and included in a case series adult patients who met the criteria used to diagnose synthetic cannabinoid-associated coagulopathy. A confirmatory anticoagulant poisoning panel was ordered at the discretion of the treating physician.. A total of 34 patients were identified as having synthetic cannabinoid-associated coagulopathy during 45 hospitalizations. Confirmatory anticoagulant testing was performed in 15 of the 34 patients, and superwarfarin poisoning was confirmed in the 15 patients tested. Anticoagulant tests were positive for brodifacoum in 15 patients (100%), difenacoum in 5 (33%), bromadiolone in 2 (13%), and warfarin in 1 (7%). Common symptoms at presentation included gross hematuria in 19 patients (56%) and abdominal pain in 16 (47%). Computed tomography was performed to evaluate abdominal pain and revealed renal abnormalities in 12 patients. Vitamin K. Our data indicate that superwarfarin adulterants of synthetic cannabinoids can lead to clinically significant coagulopathy. In our series, in most of the cases in which the patient presented with bleeding diathesis, symptoms were controlled with the use of vitamin K

Topics: 4-Hydroxycoumarins; Abdominal Pain; Adult; Anticoagulants; Blood Coagulation Disorders; Blood Transfusion; Cannabinoids; Female; Hematuria; Hemorrhage; Humans; Illinois; International Normalized Ratio; Male; Middle Aged; Patient Readmission; Vitamin K; Warfarin

Long-acting anticoagulant rodenticides, also called superwarfarins, are known for their greater potency, longer half-life and delayed onset of symptoms. Cases of superwarfarin poisoning can pose a diagnostic and clinical challenge due to a wide array of presentations and prolonged severe coagulopathy requiring months of high-dose oral vitamin K therapy. The most common presentation of long-acting anticoagulant rodenticide poisoning is mucocutaneous bleeding, with other common presentations including haematuria, gingival bleeding, epistaxis and gastrointestinal bleeding. We discuss a case of deliberate self-poisoning with long-acting anticoagulant rodenticides presenting with haematuria and coagulation values above measurable limits. This case is important as it required immediate and maintenance therapy in order to prevent profound bleeding, as well as the evaluation of the patient's psychosocial factors to ensure medical compliance and to prevent refractory complications or repeated self-harm.

Topics: Abdominal Pain; Anticoagulants; Antifibrinolytic Agents; Anxiety Disorders; Blood Coagulation; Blood Coagulation Disorders; Chronic Pain; Comorbidity; Delayed-Action Preparations; Gastrointestinal Hemorrhage; Hematuria; Humans; Male; Middle Aged; Referral and Consultation; Suicide, Attempted; Treatment Outcome; Vitamin K; Warfarin

Hematuria is a common and important complication in atrial fibrillation (AF) patients on oral anticoagulation therapy (OAT). This study evaluated the clinical significance of hematuria and its relationship with genitourinary disease in AF patients receiving OAT.Methods and Results:Among 20,456 consecutive AF patients who visited a tertiary hospital from January 2005 to April 2015, 5,833 had hematuria. Of these 5,833 patients, 3,798 were on OAT (OAT(+) group) and 2,035 were not (OAT(-) group). A total of 1,785 patients from each group were then matched on propensity score analysis. The prevalence of cancer and other diseases in the genitourinary tract was evaluated. While there was no difference in the prevalence of genitourinary stones or urinary tract infection, genitourinary cancer was significantly more common in the OAT(+) group than in the OAT(-) group (1.6% vs. 0.7%, P=0.011). Bladder cancer was the most common genitourinary malignancy, and it was significantly more common in the OAT(+) group (1.2% vs. 0.5%, P=0.019). Subjects on warfarin were more likely to have bladder cancers of lower pathologic grade (63.6% vs. 33.3%, P=0.124).. OAT was associated with a higher prevalence and early detection of genitourinary cancer in AF patients with hematuria. Meticulous evaluation of the cause of hematuria is necessary in AF patients with hematuria receiving OAT.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Female; Hematuria; Humans; Male; Middle Aged; Urinary Bladder Neoplasms; Urogenital Neoplasms; Urologic Diseases; Warfarin

We report the case of 23-year-old man with mitral valve regurgitation and Glanzmann thrombasthenia, who underwent mechanical mitral valve replacement. Warfarin therapy was devastating, causing bilateral hemothorax, pericardial effusion, gastrointestinal bleeding, and hematuria. Redo mitral valve replacement with a biological prosthesis was required to resolve this critical situation. To our knowledge, this is the first report of mitral valve replacement in Glanzmann thrombasthenia, highlighting the danger of oral anticoagulation in this pathology.

Topics: Administration, Oral; Anticoagulants; Bioprosthesis; Blood Coagulation; Device Removal; Gastrointestinal Hemorrhage; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hematuria; Humans; Male; Mitral Valve; Mitral Valve Insufficiency; Pericardial Effusion; Postoperative Hemorrhage; Prosthesis Design; Reoperation; Risk Factors; Thrombasthenia; Treatment Outcome; Warfarin; Young Adult

Warfarin-related nephropathy (WRN) is a newly recognized entity, which is characterized by the occlusion of renal tubules by red blood cells following glomerular hemorrhage in a patient overexposed to warfarin (international normalized ratio>3).. We report a 70-year-old man with no previous renal condition who developed WRN when his INR was>12. He did not fully recover his previous renal function.. The diagnosis of WRN should be considered whenever INR exceeds 3 in patients exposed to warfarin, particularly in the presence of hematuria. Vitamin K is the only therapeutic option.

Topics: Acute Kidney Injury; Aged; Anticoagulants; Hematuria; Humans; Male; Medication Errors; Renal Dialysis; Warfarin

Vitamin K intake is considered as a controllable contributor to warfarin sensitivity. It is restricted in warfarin-treated patients. However, little study has assessed the vitamin K status in warfarin-treated patients. We directly measured plasma vitamin K in warfarin-treated patients and evaluated its effect on anticoagulation.. A total of 302 plasma vitamin K concentrations were assessed using high-performance liquid chromatography for 203 outpatients with atrial fibrillation under warfarin treatment. Clinical and laboratory information including warfarin dosage, plasma warfarin concentrations, prothrombin time international normalized ratio (PT INR) and CYP2C9/VKORC1 genotypes was reviewed retrospectively. The anticoagulation stability (intra-individual variability, frequency of PT INR tests and complications) was investigated in 163 patients with long-term warfarin therapy. Plasma vitamin K was measured in 40 healthy subjects and in 40 patients before and after initial warfarin treatment.. Vitamin K concentrations were significantly decreased after the initiation of warfarin treatment (before treatment: 1.72 ng/ml; after treatment: 0.59 ng/ml, P<0.05). There was a large inter-individual variability in vitamin K levels (0.2-4.2 ng/ml) in warfarin-treated patients. PT INR was more frequently checked in patients with low plasma vitamin K levels than in those with high vitamin K levels (9.5 times/year vs 7.5 times/year, P=0.029). Two patients with gross hematuria showed very low vitamin K levels (<0.4 ng/ml).. We found high inter- and intra-individual variability in vitamin K concentration in warfarin-treated patients. Low vitamin K concentration in warfarin-treated patients suggested excessive dietary restriction. Plasma vitamin K measurement would be helpful for dietary control and anticoagulation stability.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Diet; Drug Monitoring; Enzyme Inhibitors; Female; Food-Drug Interactions; Hematuria; Humans; International Normalized Ratio; Male; Middle Aged; Nutritional Status; Republic of Korea; Retrospective Studies; Vitamin K; Vitamin K Deficiency; Vitamin K Epoxide Reductases; Warfarin

We present the case of a 34-year-old woman with a history of antiphospholipid syndrome with triple positivity for antiphospholipid antibodies, who had multiple thrombotic events, predominantly pulmonary embolic events, despite treatment with enoxaparin. She is currently on warfarin, with which she has been adequately controlled most of the time, presenting with only one haemorrhagic event consisting of haematuria and prolonged international normalised ratio (INR) without bleeding. This kind of patient represents a challenge for clinicians, particularly due to INR therapeutic targets, which should be higher than recommended in other patients due to the lupus anticoagulant positivity.

Topics: Adult; Anticoagulants; Antiphospholipid Syndrome; Enoxaparin; Female; Hematuria; Hemorrhage; Humans; International Normalized Ratio; Lupus Coagulation Inhibitor; Pulmonary Embolism; Thrombosis; Treatment Outcome; Warfarin

Topics: Acute Kidney Injury; Anticoagulants; Female; Hematuria; Humans; Male; Warfarin

Warfarin is a well-established cause of gross hematuria. However, impaired kidney function does not occur except in the rare instance of severe blood loss or clot formation that obstructs the urinary tract. It has been recently described an entity called warfarin-related nephropathy, in which acute kidney injury is caused by glomerular hemorrhage and renal tubular obstruction by red blood cell casts. We report a patient under warfarin treatment with chronic kidney disease, macroscopic hematuria and acute kidney injury. A renal biopsy showed massive occlusion of renal tubules by red blood cells and casts. The possible relationship of the warfarin therapy, intratubular hemorrhage and acute kidney injury is discussed.

Topics: Acute Kidney Injury; Aged; Anticoagulants; Hematuria; Humans; Kidney Glomerulus; Male; Renal Insufficiency, Chronic; Warfarin

The patient was an 82-year-old female. She had been treated with warfarin for atrial fibrillation that developed after a heart valve replacement operation. She was admitted because of a progressive loss of renal function together with persistent microscopic hematuria and proteinuria. Although the renal biopsy showed only focal mononuclear cell infiltration and mild mesangial expansion in the glomeruli, the occlusive red blood cell casts were remarkable in the tubules and were accompanied by inflammatory and edematous changes in the surrounding interstitial area. After the adjustment of an excessively extended prothrombin time, her renal function gradually improved in parallel with the marked decrease in the microhematuria. It was assumed that an acute kidney injury observed in this case was caused by the occlusive red blood cell casts as a result of abnormal hemorrhage in the glomeruli due to focal glomerulonephritis and a warfarin overdose. The present case, therefore, suggests that a warfarin overdose is a potential risk factor for acute kidney injury in the presence of coexisting glomerular injury.

Topics: Acute Kidney Injury; Aged, 80 and over; Female; Glomerulonephritis, IGA; Hematuria; Humans; Kidney Glomerulus; Warfarin

Warfarin-related nephropathy is reported to occur with an INR >3.0 as a result of glomerular bleeding. There is a lack of prospective studies examining the effect of supratherapeutic warfarin anticoagulation on haematuria and acute kidney injury (AKI). Older patients may be susceptible due to greater warfarin use, prevalence of kidney disease and comorbidities. The objective of this study was to determine the incidence and nature of haematuria and AKI in older patients on warfarin and to determine any association with high INR levels.. This was a prospective, observational study of 150 elderly patients receiving warfarin anticoagulation who were acutely hospitalised in a tertiary hospital. AKI was assessed using RIFLE criteria. Urinalysis was performed to quantify haematuria, characterise erythrocyte morphology and measure the albumin-creatinine ratio. Positive cases received follow-up at 4-6 weeks to determine resolution.. An INR >3.0 was found in 54 % of patients. Pre-admission antibiotic use increased the risk of excessive anticoagulation. The incidence of isolated AKI, isolated haematuria and both was 18.7, 13.3 and 12 %, respectively. Factors associated with a higher risk of haematuria were an INR >4.0, non-urinary infection, catheterisation and albuminuria. Most cases of AKI were mild, and there was no demonstrable correlation between the admission INR and AKI. Admission with heart failure was significantly associated with an increased risk of persistent kidney impairment at follow-up.. Supratherapeutic warfarin anticoagulation was associated with an increased risk of haematuria, but not with AKI. The majority of cases of haematuria were transient.

Topics: Acute Kidney Injury; Aged, 80 and over; Anticoagulants; Female; Hematuria; Hospitalization; Humans; Male; Prospective Studies; 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

Topics: Acute Kidney Injury; Adult; Anti-Bacterial Agents; Anticoagulants; Blood Coagulation Disorders; Cardiomyopathy, Dilated; Drug Interactions; Hematuria; Humans; International Normalized Ratio; Levofloxacin; Male; Ofloxacin; Shock; Urinary Tract Infections; Warfarin

To assess the impact of oral anticoagulation (OA) on morbidity of transurethral resection of the prostate (TURP). OA included warfarin and platelet aggregation inhibitors (PAI).. Multicenter analysis of patients operated for symptomatic benign prostatic hyperplasia (BPH) by TURP. Patients under OA were compared to those with no OA.. Out of 612 patients included in the analysis, 206 (33%) were on OA prior surgery (55 warfarin, 142 PAI, and 9 warfarin and PAI). No patient continued warfarin and clopidogrel during the operating period. Patients under OA were significantly older (75 vs. 71 yo, P < 0.001), had larger prostate volume (56 vs. 49 ml, P = 0.05), and had higher rate of bladder catheter prior surgery (26 vs. 17%, P = 0.02). At 3 months follow-up, patients in the OA group had a higher weight of resected tissue (24 vs. 21.7 g, P < 0.001), a longer duration of hospitalization (6.4 vs. 4.7 days P < 0.001), a higher rate of bladder clots (13 vs. 4.7%, P < 0.001), red cell transfusion (1.9 vs. 1.0%, P = 0.026), late hematuria (15.0 vs. 8.4%, P = 0.004), and thromboembolic events (2.4 vs. 0.7, P = 0.02). In multivariable analysis, OA status was the sole independent parameter associated with bladder clots (P = 0.004) and with late hematuria (P = 0.03).. OA had a significant and independent impact on TURP outcome in terms of bleeding complications. This data could be used for treatment decision and for patient's information prior BPH surgery.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anticoagulants; Erythrocyte Transfusion; Hematuria; Humans; Length of Stay; Male; Middle Aged; Morbidity; Platelet Aggregation Inhibitors; Thromboembolism; Transurethral Resection of Prostate; 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

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

Patients with certain CYP2C9 genetic variants have increased sensitivity to warfarin and are at increased risk of over-coagulation with standard warfarin dose. We report over-anticoagulation and hematuria manifest as a slow increase in the international normalized ratio (INR) due to warfarin treatment in a patient with the CYP2C9*3/*3 allele.. A 58-y-old man with paroxysmal atrial fibrillation received a standard warfarin dose of 2.0mg/day. Because INR was 2.00 one week after treatment initiation, he was discharged from the hospital. One month later, hematuria was present and INR had increased to 7.26. Although in normal cases (R)-warfarin plasma concentrations are higher than (S)-warfarin, this patient had the opposite warfarin enantiomer plasma concentration profile.. Increased anticoagulation was due to an increased concentration of (S)-warfarin, the more active warfarin enantiomer. INR response to warfarin in this CYP2C9*3/*3 patient was slow. The later INR response appears to be strongly affected by CYP2C9 variants. He also had the VKORC1 -1639G>A AA genotype, requiring a lower warfarin dose. In this case, increased risk of bleeding could have been identified by prospective genotyping of CYP2C9 and VKORC1 prior to initiating warfarin therapy.

Topics: Anticoagulants; Aryl Hydrocarbon Hydroxylases; Atrial Fibrillation; Cytochrome P-450 CYP2C9; Genotype; Hematuria; Humans; Male; Middle Aged; Warfarin

Topics: Aged; Anticoagulants; Atherosclerosis; Cystitis; Diagnosis, Differential; Embolism, Cholesterol; Female; Foreign-Body Reaction; Gastrointestinal Hemorrhage; Granuloma; Hematuria; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypertension; Ischemic Attack, Transient; Risk Factors; Syndrome; Tuberculosis, Urogenital; Urinary Bladder Neoplasms; Warfarin

Acute kidney injury (AKI) during warfarin therapy usually is hemodynamic secondary to massive blood loss. Here, we report pathological findings in kidney biopsy specimens from 9 patients with warfarin overdose, hematuria, and AKI. Kidney biopsy specimens from patients on warfarin therapy with AKI were identified in our database within a 5-year period. Each kidney biopsy specimen was evaluated by using semiquantitative morphometric techniques, and medical history was reviewed for conditions explaining AKI. Biopsy specimens with morphological findings of active glomerulonephritis and active inflammatory lesions were excluded from the study. Biopsy specimens from 9 patients were selected. At presentation with AKI, each patient had an abnormal international normalized ratio (mean 4.4 +/- 0.7 IU) and increased serum creatinine level (mean, 4.3 +/- 0.8 mg/dL). Morphologically, each biopsy specimen showed evidence of acute tubular injury and glomerular hemorrhage: red blood cells (RBCs) in Bowman space and numerous occlusive RBC casts in tubules. Each biopsy specimen showed chronic kidney injury. Six of 9 patients did not recover from AKI. These data suggest that warfarin therapy can result in AKI by causing glomerular hemorrhage and renal tubular obstruction by RBC casts. Our experience suggests that this may be a potentially serious complication of warfarin therapy, especially in older patients with underlying chronic kidney injury.

Topics: Acute Kidney Injury; Adult; Aged; Aged, 80 and over; Anticoagulants; Biopsy; Erythrocytes; Female; Hematuria; Hemorrhage; Humans; Kidney; Kidney Tubules, Proximal; Male; Middle Aged; Thrombosis; Warfarin

Superwarfarin poisoning is considered a significant public health problem in the US. In 2004, there were 16,054 cases of poisoning; most were accidental ingestions of rat bait by children but 4576 patients required hospital treatment, 23 patients had major adverse outcomes and 1 patient died. Similar information is unavailable for the UK. The National Poisons Information Service is presently auditing cases. The case of a farmer who presented with haematuria, 9 days after spilling a rodenticide containing a superwarfarin over himself is reported here. He was physically well except for mild abdominal tenderness. He had grossly deranged clotting studies (prothrombin time (PT) >200 s, activated partial thromboplastin time (APTT) 56 s) that were rapidly corrected with fresh frozen plasma and vitamin K. He was sent home after 5 days without follow up. Unfortunately, he presented again 2 days later, again with haematuria and an international normalised ratio (INR) >10. He required inpatient treatment with high-dose vitamin K for 1 week. Upon discharge, he required daily vitamin K and INR monitoring for a further month. The original inpatient team had not identified the specific poison (chlorophacinone). They were unaware that superwarfarins are more potent and longer acting than warfarin, with toxic effects for weeks or even months, and that large doses of vitamin K are often required.

Topics: Hematuria; Humans; International Normalized Ratio; Male; Middle Aged; Poisoning; Prothrombin Time; Recurrence; Rodenticides; Vitamin K; Warfarin

An 87-year-old African-American man came to the internal medicine clinic for a routine anticoagulation management visit. He had no complaints. His medical history was significant for stage IV-A follicular non-Hodgkin's lymphoma, atrial fibrillation, and hypertension. His long-term drug therapy consisted of warfarin, felodopine, lisinopril-hydrochlorothiazide, controlled-release diltiazem, potassium chloride, and oxycodone. He reported adherence with his prescribed drugs and denied taking any over-the-counter or herbal products. Overall, the patient's drug therapy had been consistent during the preceding 3 months, no significant changes had occurred in his clinical status, and no significant changes had been noted in his diet; his international normalized ratio (INR) had ranged from 1.9-2.4 (therapeutic range 2-3). He denied tobacco use, alcohol consumption, and recent travel. Four weeks later, the patient came to the emergency department with hematuria. He denied dysuria, taking more than the prescribed amount of warfarin, any changes in his diet, taking any over-the-counter or herbal products, and any other bleeding. On admission to the hospital, his INR was 6.88, which increased to 7.29 during his hospital stay. On further investigation, the patient admitted that he had started taking an herbal supplement, royal jelly, 1 week earlier. When asked specifically about the ingredients in the supplement, he stated that royal jelly was the only component. Relative to the patient's denial of any other changes in his condition or drug regimen, the most probable explanation for his elevated INR and subsequent bleeding is a possible interaction between royal jelly and warfarin. To our knowledge, no case reports concerning royal jelly and warfarin taken concomitantly have been reported. Clinicians should be proactive and repeatedly provide education regarding the potential dangers of dietary supplements taken with conventional drugs.

Topics: Aged, 80 and over; Anticoagulants; Fatty Acids; Hematuria; Herb-Drug Interactions; Humans; Insect Hormones; Male; Warfarin

To determine the relation between warfarin use and the frequency of bleeding complications after biopsy of the prostate guided by transrectal ultrasound (TRUS).. Overall, 1022 consecutive patients with suspected prostatic disease were followed after biopsy. Warfarin and aspirin use was determined on the day of the procedure. A TRUS-guided biopsy was performed and patients were offered a questionnaire to complete 10 days after the procedure, to determine any immediate or delayed bleeding complications. Follow-up telephone calls were made to those who had not replied within the stipulated period.. Of the 1000 patients who replied, 49 were receiving warfarin, 220 were receiving aspirin and 731 were not receiving any anticoagulant drugs. Of the 49 subjects reporting current use of warfarin, 18 (36.7%) experienced haematuria, compared with 440 (60.2%) of the patients receiving no anti-coagulant drugs who reported haematuria. This was statistically significant (p = 0.001). Of the group receiving warfarin, 4 (8.2%) experienced haematospermia whereas 153 (21%) of the group receiving no anticoagulant medication reported haematospermia. This difference also was statistically significant (p = 0.030). Rectal bleeding was experienced by 7 (14.3%) of the group receiving warfarin compared with 95 (13%) in the group without anticoagulant medication, but this was not statistically significant (p = 0.80). We also demonstrated that there was no statistically significant association between the severity of the bleeding complications and medication with warfarin.. None of the group receiving warfarin experienced clinically important bleeding complications. Our results suggest that the frequency and severity of bleeding complications were no worse in the warfarin group than in the control group and that discontinuing anticoagulation medication before prostate biopsy may be unnecessary.

Topics: Aged; Aged, 80 and over; Anticoagulants; Aspirin; Biopsy; Blood; Fibrinolytic Agents; Follow-Up Studies; Gastrointestinal Hemorrhage; Hematuria; Humans; Male; Middle Aged; Postoperative Hemorrhage; Prostate; Prostatic Neoplasms; Rectum; Semen; Severity of Illness Index; Ultrasonography, Interventional; Warfarin

Topics: Anticoagulants; Arthritis, Juvenile; Child; Diagnosis, Differential; Epistaxis; Female; Hematuria; Humans; Infant; Kidney; Low Back Pain; Male; Prognosis; Urinalysis; Vitamin K Deficiency; Warfarin

Causes of gross hematuria in a patient with end-stage renal disease are limited compared with those in patients with normal renal function. Given the increased likelihood of patients with end-stage renal disease developing renal cell carcinoma, the workup focuses on a careful evaluation of the collecting system. The workup for gross hematuria in a renal transplant recipient is similar; however, the focus shifts toward a more thorough evaluation of the transplanted kidney and bladder because immunosuppression increases the overall risk for malignancy. An immunosuppressed patient also is at risk for infectious processes in the transplanted kidney manifesting as gross hematuria. Concerns for chronic rejection also should be investigated, although microscopic hematuria is more common in this scenario. If this is unrevealing, then close scrutiny of the native kidneys for possible sources of bleeding is warranted. We present an interesting and unusual cause of painless gross hematuria in a patient with end-stage renal disease and transplant nephrectomy 3 months before the onset of bleeding.

Topics: BK Virus; Diagnosis, Differential; Embolization, Therapeutic; Fistula; Graft Rejection; Hematuria; Hepatitis C, Chronic; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Nephrectomy; Nephritis; Polyomavirus Infections; Postoperative Complications; Renal Artery; Renal Dialysis; Suture Techniques; Thrombosis; Tumor Virus Infections; Urinary Fistula; Urologic Neoplasms; Valsalva Maneuver; Vascular Diseases; Warfarin; Weight Lifting

Topics: Acute Kidney Injury; Adult; Anticoagulants; Biopsy; Female; Glomerulosclerosis, Focal Segmental; Hematuria; Humans; Hypertension, Pulmonary; International Normalized Ratio; Lupus Erythematosus, Systemic; Lupus Nephritis; Pneumonia; Pulmonary Embolism; Warfarin

Miconazole oral gel is frequently prescribed for the treatment of oral Candidal infections. Its ability to be systemically absorbed and interact with other drugs has previously been recorded but is not universally known. As a reminder, a further case of derangement of anticoagulation following concomitant use of warfarin and miconazole is reported. Other potential drug interactions of miconazole and fluconazole are highlighted.

Topics: Administration, Topical; Anticoagulants; Antifungal Agents; Drug Interactions; Gels; Hematuria; Humans; Male; Miconazole; Middle Aged; Warfarin

Topics: Acetaminophen; Aged; Analgesics, Non-Narcotic; Anticoagulants; Drug Interactions; Female; Gingival Hemorrhage; Hematuria; Humans; International Normalized Ratio; Phytotherapy; Warfarin; Zingiber officinale

A 63-year-old Caucasian man had a painless episode of dark-colored urine while taking warfarin 62.5 mg/week for lone atrial fibrillation in the presence of documented stable anticoagulation. Urinalysis revealed microscopic hematuria. Three weeks later, he had an episode of gross, painless hematuria. Thorough evaluation of the upper and lower urinary tract with renal ultrasound, intravenous pyelography, and cystoscopy revealed poorly differentiated, early-stage, transitional cell carcinoma of the bladder. The patient was not aware of any exposure to carcinogens known to predispose to bladder cancer, nor was he a tobacco user. Early identification of the malignancy allowed for aggressive surgical intervention. Although this patient was considered low risk for the development of bladder cancer and was taking anticoagulants, the presence of hematuria was indicative of underlying pathology. Timely and thorough evaluation of hematuria in patients taking anticoagulants is necessary to identify and treat clinically important pathology.

Topics: Anticoagulants; Carcinoma, Transitional Cell; Hematuria; Humans; Male; Middle Aged; Urinary Bladder Neoplasms; Warfarin

Topics: Blood Coagulation Disorders; Drug-Related Side Effects and Adverse Reactions; Hematuria; Humans; Intracranial Hemorrhages; Male; Middle Aged; Rodenticides; Warfarin

To report a case of warfarin-amoxicillin/clavulanate potassium (AM/CL) interaction resulting in an elevated international normalized ratio (INR) and hematuria.. A 58-year-old Hawaiian/Asian/European woman developed an elevated INR and microscopic hematuria as a result of a drug-drug interaction between warfarin and AM/CL.. Our report of an increased INR with bleeding complications as a result of an interaction between warfarin and AM/CL is consistent with those in the literature. Although the mechanism for this interaction is not fully known, it is suspected that a decrease in vitamin K-producing gut flora with resulting vitamin K deficiency would be the most likely contributing factor. An objective causality assessment revealed that this adverse drug event as a result of the warfarin and AM/CL interaction was possible.. An increased INR secondary to warfarin interactions with various antibacterial agents is a known phenomenon. An increased awareness of warfarin-AM/CL interaction and appropriate monitoring are essential to control the INR levels and prevent bleeding complications.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anticoagulants; Antifibrinolytic Agents; Blood Transfusion; Drug Interactions; Drug Therapy, Combination; Female; Hematuria; Humans; International Normalized Ratio; Middle Aged; Vitamin K; Warfarin

Topics: Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Arthritis, Rheumatoid; Drug Synergism; Hematuria; Humans; International Normalized Ratio; Isoxazoles; Leflunomide; Male; Middle Aged; Warfarin

Topics: Anticoagulants; Diagnosis, Differential; Female; Hematuria; Hemorrhage; Humans; Kidney Diseases; Kidney Neoplasms; Kidney Pelvis; Middle Aged; Mucous Membrane; Radiography; Warfarin

To investigate the results of evaluations in patients presenting with gross hematuria while receiving anticoagulant or aspirin treatment and to compare the source of bleeding in these respective groups.. We retrospectively studied all patients admitted because of gross hematuria while receiving warfarin or aspirin treatment between 1990 and 1998. The degree of anticoagulation was evaluated in patients taking anticoagulation medication. Almost all patients were evaluated by cystoscopy and either excretory urography or ultrasound.. Patients taking warfarin had a normal evaluation almost twice as often as those taking aspirin: 38% versus 22%, respectively. The leading pathologic findings in both groups were a bleeding benign prostate and a tumor in the urinary tract, in similar proportions. Overall, a tumor was diagnosed in one quarter of patients, and other treatable pathologic findings were diagnosed about half the time. In the 11 patients receiving excessive anticoagulation medication, two tumors were found (18%). Hemorrhagic cystitis was diagnosed in 12 patients. All 12 were taking aspirin.. A normal evaluation was more prevalent in the warfarin group. A tumor was diagnosed in about one quarter of the patients. The prevalence of hemorrhagic cystitis in patients taking aspirin may point to a specific bleeding diathesis in the urothelium of these patients. In light of these findings, a full evaluation is warranted in patients receiving aspirin or warfarin therapy, and the presence of excessive anticoagulation should not impede a full evaluation.

Topics: Aged; Anticoagulants; Aspirin; Female; Hematuria; Humans; Male; Retrospective Studies; Warfarin

Because of the emergence of warfarin resistance in rodents, second-generation anticoagulants named "superwarfarins" were developed and marketed in over-the-counter rodenticide products. The availability of these compounds has resulted in accidental or intentional human ingestions, which cause severe bleeding. The methods for diagnosis and treatment of patients using superwarfarins are different from those for patients taking the regular warfarins. We report a case of intentional superwarfarin ingestion that caused petechiae and hematuria. Although the patient denied taking anticoagulant, the persistence of vitamin K-dependent factor deficiency led us to investigate the serum for anticoagulant rodenticides. We found high levels of brodifacoum, a superwarfarin compound. This case emphasizes the need for suspicion of superwarfarin poisoning in patients who show unexplained bleeding due to deficiency of vitamin K-dependent factors and resistance to treatment.

Topics: 4-Hydroxycoumarins; Adult; Blood Coagulation Tests; Hematuria; Humans; Male; Poisoning; Rodenticides; Vitamin K Deficiency; Warfarin

Topics: Aged; Amiodarone; Anti-Arrhythmia Agents; Anticoagulants; Blood Coagulation Disorders; Drug Interactions; Hematuria; Humans; Male; Prothrombin Time; Warfarin

Warfarin is one of the most commonly used oral anticoagulants. Many medications have been shown to influence the prothrombin time in patients treated with warfarin by various mechanisms. We observed a major bleeding episode that resulted from a probable interaction between levamisole (Ergamisol), 5-fluorouracil, and warfarin. It is conceivable that many patients who are predisposed to thromboembolism because of cancer and surgery will be taking this combination of medications.

Topics: Adjuvants, Immunologic; Anticoagulants; Drug Synergism; Female; Hematuria; Hospitalization; Humans; Levamisole; Middle Aged; Warfarin

Topics: Blood Coagulation Disorders; Child; Hematuria; Humans; Male; Rodenticides; Warfarin

Topics: Allopurinol; Blood Platelets; Drug Interactions; Hematuria; Humans; Indomethacin; Warfarin

A 57-year-old man developed spontaneous skin bruising and haematuria during combined therapy with warfarin and indomethacin. Due to the potential effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on the anticoagulant action of warfarin and platelet function, patients receiving both warfarin and NSAIDs should have their prothrombin time monitored very closely. Also, the risk of gastrointestinal haemorrhage with any NSAIDs must always be remembered.

Topics: Drug Interactions; Gout; Hematuria; Humans; Indomethacin; Male; Middle Aged; Risk Factors; Thrombophlebitis; Warfarin

Topics: Aged; Drug Interactions; Female; Hematuria; Humans; Ofloxacin; Prothrombin Time; Warfarin

To achieve clinical remission, intensive therapy in active IgA nephropathy was conducted on a trial basis. Forty-five patients with active IgAN in which cellular crescents were present were divided into two groups. The patients in one group (Group A, N = 19) were treated with a combined regimen of steroid pulse, cyclophosphamide (4 months), dipyridamole (36 months) and warfarin. The patients in the other group (Group B, N = 26) were treated with tonsillectomy in addition to the same regimen as Group A. Three years after the initiation of treatment, proteinuria and hematuria had significantly decreased in both groups, and the renal function in Group B was significantly improved. Remission of proteinuria and hematuria was achieved in five patients (26.3%) and eight patients (42.1%), respectively, in Group A, and 14 patients (53.8%) and 20 patients (76.9%), respectively, in Group B. These results indicate that early intensive therapy combined with tonsillectomy in active IgAN is potentially of great benefit from both the medical and socioeconomic points of view.

Topics: Adolescent; Adult; Cyclophosphamide; Dipyridamole; Drug Therapy, Combination; Female; Follow-Up Studies; Glomerulonephritis, IGA; Hematuria; Humans; Male; Middle Aged; Proteinuria; Remission Induction; Tonsillectomy; Warfarin

Topics: Aged; Drug Interactions; Female; Hematuria; Humans; Moricizine; Warfarin

An unusual case of Munchausen's syndrome is described in which a former microbiology technician was suspected of inoculating himself with contaminated material to produce sepsis and ingesting warfarin in the form of rat poison to cause hematuria. This combination of factitious disorders has rarely been reported. Other unusual features included a nonemergent presentation through the hospital emergency room and a clinical profile not typical of previously published cases.

Topics: Adult; Diagnosis, Differential; Hematuria; Humans; Male; Munchausen Syndrome; Shock, Septic; Sick Role; Warfarin

Two patients who developed hypoprothrombinemia and bleeding due to lovastatin-warfarin drug interaction are described. Because of the wider use of lovastatin and warfarin, heightened clinical awareness of this potentially serious interaction must be publicized. Therefore, prothrombin time should be monitored diligently when warfarin is prescribed to patients receiving lovastatin.

Topics: Atrial Fibrillation; Drug Interactions; Epistaxis; Gastrointestinal Hemorrhage; Hematuria; Humans; Hypercholesterolemia; Hypoprothrombinemias; Intracranial Embolism and Thrombosis; Lovastatin; Male; Middle Aged; Warfarin

Topics: Adult; Back Pain; Diagnostic Errors; Drug Hypersensitivity; Female; Hematuria; Humans; Munchausen Syndrome; Warfarin

We evaluated 29 consecutive patients in whom gross or microscopic hematuria developed while they were on heparin or warfarin anticoagulant therapy. Patients who had bleeding as a result of anticoagulant overdosage and/or from an additional organ system(s) other than the urinary tract were excluded from this review. Significant pathological findings consisting of carcinoma, calculi, renal infarction, infection, benign prostatic hyperplasia and/or adult polycystic renal disease were identified in 17 patients. Insignificant or incidental pathological findings classified as posterior urethritis, simple renal cyst or renal scarring were noted in 6 patients. No pathological condition was found in the remaining 6 patients. We conclude that a thorough and appropriate evaluation of the urinary tract should be conducted in patients on anticoagulant therapy who have gross or microscopic hematuria, since a pathological lesion of variable clinical significance often is discovered.

Topics: Adult; Aged; Aged, 80 and over; Female; Hematuria; Heparin; Humans; Kidney Diseases; Male; Middle Aged; Urinary Calculi; Urologic Neoplasms; Warfarin

Topics: Calcium Oxalate; Hematuria; Humans; Kidney Calculi; Warfarin

Topics: Aged; Epistaxis; Female; Hematuria; Humans; Influenza Vaccines; Nursing Homes; Theophylline; Warfarin

A case report of overt bleeding in a young woman on warfarin given the anabolic steroid danazol for menorrhagia is reported. This interaction appears to be poorly recognised and we suggest that when commencing such a treatment the dose of anticoagulant should initially be halved and thereafter tailored to the thrombotest.

Topics: Administration, Oral; Adult; Anticoagulants; Blood Coagulation Tests; Danazol; Drug Interactions; Female; Hematuria; Humans; Menorrhagia; Pregnadienes; Pulmonary Embolism; Warfarin

Topics: Aged; Female; Hematuria; Humans; Male; Middle Aged; Urologic Neoplasms; Warfarin

Eight acute spinal injury patients with deep vein thrombosis and/or pulmonary emboli are presented witn an in-depth analysis and management of anticoagulation therapy. Special considerations for acute spinal cord injury patients with regards to prophylactic and therapeutic anticoagulation by heparin and coumadin are discussed. There was a wide variation in the requirement of heparin and/or coumadin to maintain effective coagulability which could only be elicited by frequent laboratory monitoring. Inadequate dose and shorter duration of administration of anticoagulant resulted in recurrence of thromboembolism in three out of eight patients in the present series. Haemorrhagic complications were minor and easily manageable. Co-trimoxazole potentiation of coumadin action occurred in two of our patients and it requires special mention as the drug is used increasingly in the treatment of urinary tract infections.

Topics: Administration, Oral; Adult; Anticoagulants; Drug Combinations; Drug Interactions; Hematuria; Heparin; Humans; Injections, Subcutaneous; Male; Middle Aged; Pulmonary Embolism; Spinal Cord Injuries; Sulfamethoxazole; Thrombophlebitis; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Warfarin

Potentiation of warfarin by trimethoprim-sulfamethoxazole (TMP-SMX) has been reported occasionally but not in the urologic literature. Three cases are presented in which significant bleeding developed when TMP-SMX was added for the patient already on warfarin anticoagulants. The mechanism of this interaction is uncertain but probably involves competitive protein binding by the two drugs.

Topics: Aged; Drug Synergism; Epistaxis; Female; Hematuria; Humans; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Warfarin

Topics: Adult; Hematuria; Humans; Male; Substance-Related Disorders; Warfarin

In 66 months, a general hospital's outpatient Anticoagulation Service (ACS) monitored 263 patients who received 280 courses of warfarin sodium totalling 254 patient treatment years. Major hemorrhagic morbidity was 4% of courses and there was no mortality attributable to warfarin therapy. Major hemorrhage occurred in patients with increased anatomic risk of bleeding (diverticulosis, hemorrhoids, cystitis), and was not a function of patient age, sex, anticoagulation control, or medications administered concurrently with warfarin. Control of anticoagulation was not correlated with age or other medications, but was worsened significantly by the presence of congestive heart failure. We attribute a favorable experience with outpatient ACS to careful patient selection, patient education and monitoring, attention to duration of anticoagulation, and continuing communication with primary physicians who retained responsibility for medical care. An ACS offers safety, consistency, efficiency, and a unified approach to outpatient anticoagulation in the general hospital setting.

Topics: Aged; Blood Coagulation Disorders; Female; Gastrointestinal Hemorrhage; Health Education; Heart Failure; Hematuria; Humans; Male; Maryland; Middle Aged; Outpatient Clinics, Hospital; Prothrombin Time; Thromboembolism; Time Factors; Warfarin

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

The unpredictability of hemorrhagic complications during anticoagulant therapy is well known. An unusual case of massive intraperitoneal hemorrhage from a ruptured corpus luteum during such therapy is presented. That this complication is uncommon may be because relatively few premenopausal women are placed on anticoagulant therapy. In addition, the most likely condition for which premenopausal women are given anticoagulants is thrombophlebitis associated with pregnancy and childbirth when ovulation is inhibited.

Topics: Corpus Luteum; Female; Hematuria; Hemoperitoneum; Heparin; Humans; Middle Aged; Ovarian Diseases; Rupture, Spontaneous; Thrombophlebitis; Warfarin

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

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

Topics: Acetaminophen; Aged; Animals; Dextropropoxyphene; Drug Interactions; Female; Hematuria; Humans; Male; Middle Aged; Rats; Warfarin

Topics: Acetaminophen; Adult; Dextropropoxyphene; Drug Combinations; Drug Interactions; Female; Hematuria; Humans; Warfarin

Clinical features have been correlated with renal function, histology and selective renal angiography in 19 patients with recurrent painless haematuria, recurrent loin pain, or both haematuria and loin pain in whom urinary infection, calculi and anatomical abnormalities of the urinary tract had been excluded. No deterioration in renal function was observed in any patient over periods of up to nine years. Although all patients showed similar glomerular changes histologically, consisting of focal and segmental mesangial thickening and proliferation and periglomerular fibrosis, mild tubular damage was more common in those with loin pain. All patients with loin pain whether or not they had haematuria, had abnormal renal angiograms consisting of focal or generalized vascular lesions sometimes associated with cortical infarcts. The possible aetiological factors are discussed with particular reference to oestrogen-containing compounds.

Topics: Adolescent; Adult; Biopsy; Blood Vessels; Estrogens; Female; Hematuria; Humans; Infarction; Kidney; Kidney Cortex; Kidney Diseases; Male; Pain; Radiography; Recurrence; Renal Artery; Warfarin

Topics: Administration, Oral; Adult; Anticoagulants; Coumarins; Dicumarol; Hematuria; Humans; Kidney Pelvis; Male; Middle Aged; Radiography; Ureter; Warfarin

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

Topics: Aged; Diagnosis, Differential; Female; Hematuria; Hemorrhage; Humans; Kidney; Kidney Neoplasms; Nephrectomy; Thrombophlebitis; Urography; Warfarin

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

Topics: Adolescent; Adult; Contusions; Dipyridamole; Drug Interactions; Epistaxis; Female; Glomerulonephritis; Hematuria; Humans; Male; Middle Aged; Phenindione; Prothrombin Time; Warfarin

Topics: Accidents, Traffic; Adult; Blood Coagulation; Cystoscopy; Hematuria; Humans; Male; Radiography; Thrombophlebitis; Ureteral Obstruction; Urination Disorders; Warfarin

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

Topics: Drug Interactions; Female; Hematuria; Humans; Middle Aged; Phenformin; Warfarin

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

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

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

Topics: Aortic Valve Stenosis; Blood Coagulation; Drug Synergism; Hematuria; Humans; Male; Middle Aged; Prothrombin Time; Quinidine; Warfarin

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

Topics: Dicumarol; Duodenal Diseases; Gastrointestinal Hemorrhage; Geriatrics; Hematuria; Hemorrhage; Hypoprothrombinemias; Ileum; Intestinal Obstruction; Intestine, Small; Jejunum; Pathology; Radiography; Surgical Procedures, Operative; Toxicology; Warfarin

Topics: Anticoagulants; Blood Coagulation Tests; Hematuria; Hemostatics; Prothrombin; Toxicology; Warfarin

Topics: Anticoagulants; Blood Chemical Analysis; Chemical Phenomena; Chemistry; Coronary Disease; Gout; Hematuria; Humans; Oxyphenbutazone; Phenylbutazone; Pyrazoles; Toxicology; Uric Acid; Warfarin

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